Definitions and classification systemsĪD is now defined as part of clinical spectrum of acute aortic syndromes (AAS). In this review, we mainly focus on articles on epidemiology, classification, risk factors, clinical presentation, diagnostic imaging, treatment, complications, and long-term follow-up of ATAAD in the past 20 years. The aim of this review was to report actual preoperative management, type and extent of surgery, and outcomes of surgical treatment for aortic disease in NHIM, Malaysia.Īn analysis performed on 413 patients presented with ATAAD to NHIM between January 1997 and July 2022. In 2018, the Registry of Aortic Surgery (RAS) was established at National Heart Institute of Malaysia (NHIM), Malaysia, in accordance with the model of the IRAD. The International Registry of Aortic Dissection (IRAD) established in 1996 has published several studies that reported a significant impact on the diagnosis and treatment of aortic dissection worldwide. Many countries and regions have established multicenter registration studies. The patients usually die from complications which, includes rupture of the aorta, pericardial tamponade, acute aortic regurgitation or acute heart failure, and malperfusion syndrome (MPS). The AD involving the ascending aorta is commonly referred to as acute type A aortic dissection (ATAAD) carries a grave prognosis without immediate surgical repair. It is a life-threatening condition of the aorta, and associated with significant morbidity and mortality. True aortic dissection (AD) is defined as separation of the medial layer of the aortic wall leading to formation of a true lumen (TL) and false lumen (FL) with or without communication. Complex techniques such as total arch replacement (TAR) with frozen elephant trunk and valve sparing root surgery may provide long-term benefit in selected patients, but require significant surgical expertise and experience. Different surgical techniques and perfusion strategies have been described to save patients. High index of suspicion and urgent treatment is required to tackle this dynamic disease which include the variation in presentation and clinical course. The diagnosis is often delayed leading to variable outcomes. It covers different aspects of ATAAD and concentrates on the outcome of surgical repair. This review is based on the current literature and includes the results from the Aortic Registry of National Heart Institute of Malaysia (NHIM) database. Despite the continuous improvement in diagnosis and management strategies for ATAAD, clinical outcomes remain poor and the optimal therapy is still debatable especially those with malperfusion syndrome (MPS). Acute type A aortic dissection (ATAAD) still poses significant challenges and management dilemmas for cardiovascular surgeons worldwide.
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