Our outcomes from aortic dissection repairs are excellent and far better than the national average. We repair over 20 to 30 dissections annually, which is a high volume for an aortic center. We also use innovative stent graph technologies to repair a dissection without open surgery, but when the tear is near the heart, stents are used only in the minority of cases.
Open surgery for a dissection of the aorta nearest to the heart (Type A dissection) involves exposing the breast bone to gain control of the heart and the ascending aorta. We use the heart-lung machine, which protects the brain and the heart as we remove the portion of the aorta that has the tear. We then replace the damaged portion of the aorta with a tube graft, and then reinstate normal blood flow from the heart to the rest of the body.
Many patients now are candidates for stent grafts that cover the site of the original dissection tear. This is particularly suitable for people with descending aortic dissections (Type B dissections). During this surgery, surgeons place the stent graft using a wire that has been entered through a small puncture in the groin. We do have an evolving program for treating descending dissections that do not involve the heart (Type B dissections) with stent grafts which is offering significant promise. Ask your surgeon which is the best option for you.
While some patients may be too ill for a procedure, most are in good enough shape to have the surgery done. When surgery is not an option, we have even been successful in treating patients medically with aggressive blood pressure control.