The Difficult Problem that is Aortic Dissection.

There is no other cardiothoracic procedure that is as challenging as the management of a patient with type A aortic dissection.
Untreated, the immediate mortality rate is 1% per hour.   The surgery to repair a type A dissection is extremely challenging, patients are very sick, and coagulopathic and the dissected vascular tissues are incredibly friable and difficult to work with. To make matters worse, the average on call surgeon dealing the majority of these cases will only operate on a very small number of aortovascular cases per year.  The operative mortality in most countries of the world for this procedure is around 25-30%.
I have come across this excellent video presented recently by the American Society of Thoracic Surgeons on some of the very difficult issues surrounding the operative management of these patients.
It is worth a share!