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July 1970

Acute Aortic Dissection Due to Cystic Necrosis: Four Cases of Emergency Replacement of the Ascending Aorta With Survival

Author Affiliations

Boston; Rochester, NY
From the departments of surgery of Peter Bent Brighan Hospital and Harvard Medical School, Boston (Dr. J. Matloff), and Strong Memorial Hospital, Rochester Medical Center, Rochester, NY (Dr. D. Matloff).; Dr. J. Matloff is now director of thoracic and cardiovascular surgery at Cedars-Sinai Medical Center, Los Angeles, and Dr. D. Matloff is now clinical professor of surgery at the University of Rochester School of Medicine, Rochester, NY, and is also staff surgeon at Geneva General Hospital, Geneva, NY.

Arch Surg. 1970;101(1):8-13. doi:10.1001/archsurg.1970.01340250010003

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.