Aortic Dissection

The most important treatment of aortic dissection is to reduce the blood pressure to prevent further extension of the dissection. The location of the tear in the aortic wall (or type of aortic dissection) and risk of aortic rupture will determine whether doctors will treat aortic dissection with surgery or medications.

Emergency surgery is required when the tear occurs in the ascending aorta or the portion of the aorta closest to the heart (type A aortic dissection), as arteries to the heart and brain are usually involved. Surgery is required only if there is persistent pain or worsening dissection. 

The risk of death increases by one per cent for each hour that passes after the aorta has torn and has not been treated. Within 48 hours, 50 per cent of the patients will die. The goal of surgery is to prevent death from exsanguination from the rupture of the aorta, stroke, heart attack and severely leaking heart valve.

In open heart surgery, surgeons will replace the damaged portion of the aorta with a synthetic tube graft. The adjacent structures of the heart may also need to be treated if the condition affected the:

The former can be preserved by repair or replaced with prosthetic valves, whilst the latter can be preserved by reimplanting them onto the graft or through additional coronary bypass surgery.

Endovascular stent grafting, a minimally invasive surgery, may be recommended for suitable patients.

Usually, oral or intravenous medications will be recommended instead of surgery, in case of tears involving the descending aorta (type B aortic dissection). The goal is to aggressively reduce and control high blood pressure.

Dissection of other parts of the aorta are usually stabilised medically first. Medications for aortic dissection may be through oral medications, or intravenous medications, if the initial blood pressure is high or not controlled with oral medications. 

Even after surgery, aortic dissection patients will need to continue taking oral medications to control their heart rate and reduce their high blood pressure.