Type A Aortic Dissection — FRCA Final MCQ

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ModerateCardiothoracic AnaesthesiaType A Aortic DissectionFRCA Final

A 75-year-old man is admitted with sudden severe chest pain radiating to his back. CT aortography confirms an acute Stanford type A aortic dissection involving the aortic root. He is hypotensive at 85/55 mmHg, and echocardiography demonstrates moderate aortic regurgitation. What is the definitive management?

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Correct answer: E — Emergency open repair of the ascending aorta

The correct answer is E. Acute Stanford type A dissection involves the ascending aorta and requires emergency open surgical repair, usually replacing the affected ascending aorta and addressing the root and aortic valve when required. Hypotension and aortic regurgitation indicate a complicated, haemodynamically unstable presentation and increase the urgency. Analgesia and anti-impulse therapy are temporising measures rather than definitive treatment; blood pressure must not be lowered further in this hypotensive patient. TEVAR is principally used for complicated descending, Stanford type B disease and is not standard definitive treatment for an ascending dissection. TAVI may treat isolated aortic valve disease but does not repair the dissected aorta. Thrombolysis can precipitate catastrophic bleeding, rupture or tamponade and is contraindicated.

Reference: Goodacre S, Lechene V, Cooper G, Wilson S, Zhong J. Acute aortic syndrome—How is it managed? BMJ 2024;386:e080870. https://pubmed.ncbi.nlm.nih.gov/39288946/