[Classification and etiology of acute aortic syndromes]

Abstract

Acute aortic syndrome are significantly involved in "sudden death" and in-hospital mortality remains high close to 30%, survivors are lifelong at risk for remaining aorta complication such as thoraco-abdominal aneurysm or new aorta dissection or aortic rupture. Classifications are useful tools to determine perioperative strategy. The Stanford system is determined by whether the ascending aorta is involved or not. In the Stanford Type A, the ascending aorta is involved, the treatment is surgical and urgent: type B, the ascending aorta is not involved, the treatment is a medical treatment: "anti-impulse therapy" based on the association of vasodilatator such as sodium nitroprusside and beta-blockers such as atenolol. Endovascular therapy is the first-line therapy in case of visceral malperfusion. The De Backey system subdivides the dissection in three types, type 1: the intimal tear is in the ascending aorta and the dissection involves the entire aorta, type 2: the dissection is strictly limited to the ascending aorta, type 3: the dissection spares the ascending aorta and the arch. Principles for treatment are the same for type A and type 1 and 2, and for type B and type 3. High-risk patients (Marfan, bicuspid aortic valve, type IV Ehlers-Danlos, history of dissection in family relatives) have to be closely followed by repeated radiologic and echocardiographic examination. Patient over 65 years old suffering from hypertension are mainly at risk and need a close control of their blood pressure. Whether conventional surgery and endovascular therapy have significantly improved, postoperative mortality remains high. Close medical follow up and prophylactic surgery may improve survival in high-risk population.