Stanford type A encompasses all aortic dissections involving the ascending aorta, irrespective of where the intimal tear originates. It is one of the most time-critical cardiovascular emergencies: acute ascending aortic dissection carries an early mortality of approximately 1% to 2% per hour after symptom onset in untreated symptomatic patients.
Initial management — anti-impulse therapy with invasive blood pressure monitoring in an ICU, using intravenous beta-blockers and, where needed, additional intravenous agents for rate or pressure control — aimed for a systolic blood pressure below 120 mm Hg and a heart rate of 60 to 80 bpm.
When these hemodynamic goals are not achieved, or when the anatomy of an ascending aortic dissection itself demands definitive intervention regardless of hemodynamic response, escalation beyond medical therapy is required.
For acute type A aortic dissection, emergency surgical intervention is recommended given the high risk of life-threatening complications. The approach centres on open surgical repair of the ascending aorta; the precise operative strategy is guided by specific anatomical findings at the aortic root and arch. The complete structured protocol — including the decision algorithm and full operative considerations — is available via the link below.
DOI: 10.1161/CIR.0000000000001106
Type A: All dissections involving the ascending aorta, irrespective of the site of the intimal tear.
Acute aortic dissection of the ascending aorta is highly lethal in symptomatic patients left untreated, with an early mortality of 1% to 2% per hour after symptom onset.
In patients presenting with suspected or confirmed acute type A aortic dissection, emergency surgical consultation and evaluation and immediate surgical intervention is recommended because of the high risk of associated life-threatening complications.
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