The 83rd Annual Scientific Meeting of the Japanese Circulation Society

Plenary session
A Role of Aorta Team in Treatments for Acute Aortic Syndrome: Cooperation Between Cardiologists and Cardiac Surgeons

ENGLISH

Chairperson: Hideaki Yoshino(Department of Internal Medicine, Kyorin University)
Hitoshi Ogino(Department of Cardiovascular Surgery, Tokyo Medical University)
The treatment strategies for acute aortic syndrome (AAS) consisting of acute aortic dissection (AAD) and rupture of penetrating atherosclerotic ulcer and of non-dissecting aneurysm, which are sometimes associated with lethal sequelae, have remains controversial. They are also considerably different depending on the anatomical AAD classifications or on aneurysmal rupture status between surgical and medical approaches. In addition, the recent surgical treatment tactics have been shifted towards the less-invasive endovascular therapies. In type A AAD, most should be emergency open surgical candidates, except of some cases with the false lumen thrombosed including intramural hematoma, who are fitted for best medical treatment. Difficult decision making of the treatment strategies for cases with critical malperfusion of coronary (myocardial infarction), carotid (cerebral infarction), superior mesenteric (bowel necrosis) arteries are also considerable. To rescue the patients, percutaneous catheter interventions without delay by cardiologist should be performed after as well as before central aortic repairs by cardiac surgeons, if possible, at hybrid operating rooms. On the other hand, in cases with type B AAD, the optimal medical treatment with beta-blockers is indicated for the majority of patients. However, for complicated types such as rupture/impending rupture and organ malperfusion, the recent guidelines recommended endovascular treatments as the first line therapy. Moreover, a randomized controlled trial demonstrated the favorable late outcome of preemptive endovascular treatments, even for uncomplicated type B AAD.
As described above, some of the recent AAS treatment strategies have been changed from open surgical repairs to endovascular repairs in conjunction with precise diagnoses and best medical treatments by cardiologists. In this plenary session, a role of Aorta Team consisting of both cardiologist and cardiac surgeons in treatment of AAS would be discussed, including their roles in the Aorta Team itself.

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