Four cases of successful emergency resection and prosthetic graft replacement of the ascending aorta for acute dissections are presented. Hypotensive medical therapy was either not applicable or was ineffectual in these patients. Although such therapy has been demonstrated to have a salutary effect in some cases, surgical evaluation should be a continuing process. The indications for surgery are failure to control progression of the dissection, continuing blood loss, instability of cardiac function, and continuing compromise of major aortic tributaries. In view of the dramatic results in these four critically ill patients and the poor results reported with simple repair, it is suggested that further consideration be given to resection and prosthetic graft replacement in patients with acute dissection of the ascending aorta.
Matloff JM, Matloff DB. Acute Aortic Dissection Due to Cystic NecrosisFour Cases of Emergency Replacement of the Ascending Aorta With Survival. Arch Surg. 1970;101(1):8-13. doi:10.1001/archsurg.1970.01340250010003