Acute type A aortic dissection: is endovascular repair ready?

Dr Mafalda Massara interviews Prof. Stephan Haulon about the emerging role of endovascular repair for acute type A aortic dissection, exploring which patients may benefit from this approach and the technical challenges that still limit its wider adoption.

The discussion begins by examining the profile of patients considered unfit for conventional open surgery. While surgical repair remains the gold standard for most patients, endovascular treatment may offer an alternative for a carefully selected subgroup, including elderly patients and those with severe comorbidities or malperfusion syndromes that increase surgical risk.

Prof. Haulon then explains the differences between the EndoWheat and EndoBentall concepts. Developed specifically for acute type A dissection with an entry tear distal to the sinotubular junction, EndoWheat avoids coronary artery reconstruction. By contrast, EndoBentall is intended for patients with aortic root aneurysms and requires reconnection of the coronary arteries, making coronary anatomy a major determinant of feasibility.

The interview also addresses key technical considerations, including device profile, vascular access strategies and the importance of a multidisciplinary Heart Team in selecting patients and planning these highly complex procedures.

Watch the interview to gain expert perspectives on patient selection, procedural planning and the future of endovascular solutions for acute type A aortic dissection.