Open repair of complicated acute type B aortic dissection

INTRODUCTION: Acute aortic dissection remains the most common aortic emergency. Complicated acute type B aortic dissection (cAT-BAD) carries increased morbidity and mortality when compared with uncomplicated acute type B aortic dissection (uATBAD), and often requires urgent intervention with either thoracic endovascular aortic repair (TEVAR) or open surgical repair. With improvements in endovascular technology, TEVAR has become the intervention of choice, when appropriate. In this review, we aimed to define when open repair is indicated. EVIDENCE ACQUISITION: A PubMed search of the literature was performed to obtain relevant articles in relation to management and outcomes of uATBAD. We also review our institution's experience with open surgical repair of cATBAD. EVIDENCE SYNTHESIS: This article is designed to provide a review of current indications for open surgical repair in the setting of cATBAD, and to review the operative technique used to perform open repair. CONCLUSIONS: cATBAD carries a high morbidity and mortality rate. The management of cATBAD has evolved in recent years, with TEVAR now being the preferred treatment modality in the majority of cases. Indications remain for open repair for cATBAD, and include patients not anatomically suited for TEVAR and those with connective tissue disorders including, but not limited to, Marfan syndrome, Loeys-Dietz syndrome, Vascular Ehlers-Danlos syndrome and Familial thoracic aortic aneurysm and dissection (FTAAD) syndrome. When indicated, open repair for cATBAD can be performed with acceptable mortality when performed at centers of excellence.