Does an Open Distal Anastomosis Confer Prognostic Benefit in Acute Dissection Surgery

Acute type A aortic dissection should in the present era be treated surgically with reconstruction of the ascending aorta in order to prevent rupture, tamponade and dissection of the coronary ostia and aortic valve. How to handle the rest of the aorta in general, and the distal aortic anastomosis in particular, is at the present time more diffuse and controversial. A mainstay of surgical technique has for years been to construct this anastomosis in an open fashion to promote a secure anchoring of the graft in the friable aortic tissue and to enable an inspection of the inner side of the aorta with a subsequently more extensive resection should the tear go beyond the planned anastomosis level. However, a careful review of published results cannot demonstrate a survival benefit, or theoretically possible adverse effect, from this technical solution. Such a critical evaluation of surgical results reveals that the methodological difficulties we face when assessing surgical techniques are substantial for life threatening and relatively rare diseases like acute aortic dissections.