Aortic Arch Management During Repair of Acute Type A Dissection: Don’t Lose Sight of the Big Picture

Abstract

In an original article by Patel and colleagues1 in this issue of The Annals of Thoracic Surgery, 634 patients who presented to a single institution with acute type A aortic dissection (ATAAD) are retrospectively reviewed. Recognizing the limitations of this retrospective study and specifically the inherent bias in controlling for treatment effect, the findings of this study suggest that patients presenting with shock or heart failure are frequently triaged down a more conservative operative pathway to minimize ischemic time and the need for systemic hypothermia.