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Aortic Dissection Treatment

While aortic dissections are a serious and sometimes fatal condition, more patients than ever are living long and healthy lives after undergoing a repair or using medication to manage the problem. 

At the MedStar Heart & Vascular Institute, our surgeons have the experience and skill to perform the challenging surgeries needed to repair aortic dissections. They specialize in complex cases, with other doctors often referring patients to them. And they have specialized expertise in a minimally invasive approach called endovascular repair. 

Learn more about aortic dissections or the team at our Complex Aortic Center

Complex Dissection Cases

We specialize in complex dissection repairs, thanks to the combined skills and partnership of our vascular and cardiac surgeons. Other doctors often refer challenging cases to us — sometimes from more than a hundred miles away. 

Complex dissections often require repair and are frequently marked by:

  • Patients who are especially ill
  • Multiple tears, and several new blood passageways (lumens)
  • Particular challenges in using equipment for repair
  • Skill needed to determine when the dissection is properly repaired and the surgery or procedure is finished
  • An even greater need for precision and accuracy 

Aortic Dissections and Medications

Medications are important for treating dissections, to lower blood pressure and relieve strain on the damaged aorta. We prescribe medication to all our dissection patients, and also recommend repair for many of them. Learn more about the types of aortic dissections

We start most patients with a beta-blocker such as metoprolol or labetalol, which:

  • Blocks adrenaline
  • Widens arteries
  • Decreases the force of the heart’s contraction 

We may also use:

  • Nitroprusside (to relax blood vessels)
  • ACE inhibitors
  • Calcium channel blockers 

Aortic Dissection Surgery

Surgery is the standard treatment for Type A dissections (ascending aorta), though some patients are too sick to undergo an operation and may rely on medication. Patients with Type B dissections (descending aorta) may also need surgery if:

  • The dissection is interfering with the major arteries branching off the aorta, with problems in the limbs or organs
  • The aorta has expanded too much or is at risk of rupturing
  • Medication cannot relieve the pain
  • Internal bleeding is causing problems
  • A large aneurysm has formed (learn more about aortic aneurysms

Learn more about the types of aortic dissections

Dissection Surgery: Steps

Surgically repairing an aortic dissection involves a number of steps:

  1. Patients with Type A dissections are placed on a heart-lung machine (cardiopulmonary bypass). This allows the surgical team to slow the heart and clear the aorta of blood, while still providing blood and oxygen to the brain and body. The brain and body are also cooled so they consume less oxygen.
  2. After a team member administers general anesthesia, and the patient has been placed on the heart lung machine, surgeons make an incision into the aorta to inspect the extent of the tear. They also determine if other vessels or body parts also require repair.
  3. The damaged aorta is replaced with a long-lasting synthetic graft and reconnected.
  4. A Type A dissection may also damage the aortic root. In most cases, this damage can be repaired, but at other times the aortic root may need to be replaced. This involves removing the aortic tissue and replacing it with a long-lasting synthetic graft, reattaching the coronary arteries and either repairing or replacing the aortic valve. Learn more about our heart valve surgery.
  5. The body is re-warmed, bypass is ended and the incision is closed.
  6. Hospital recovery typically takes 7 to 10 days. 

Learn more about the types of aortic dissections.

Endovascular Dissection Repair

While surgery remains an important tool for treating ascending aortic dissections (Type A), our team is among those advancing minimally invasive repair for patients with descending aortic dissections (Type B). 

Called endovascular repair, these procedures involve threading catheters through the femoral artery to your aorta. A stent-graft is sent through one of the catheters, then positioned to reinforce your aorta. An endovascular approach requires a high degree of expertise but offers several advantages:

  • Minimally invasive
  • Faster recovery
  • Fewer complications — less chance of rupturing, better blood flow to organs and less pain 

Learn more about the types of aortic dissections.

Aortic Dissection Follow-Up Care

Many patients follow a post-treatment plan, particularly if they are managing their dissection with medication. Your doctor may ask you to maintain a certain weight or limit yourself to light or moderate exercise.

For information or appointments,
please call 855-463-3320.