Acute type A aortic dissection is one of the most hazardous acute vascular pathology.

To investigate trends in the management of acute type A aortic dissections on the last 15 years.

All consecutive patients who were operated on for an acute type A aortic dissection at the CHU of Toulouse, France, between 2005 and 2019 were retrospectively included. We compared demographics, diagnostic methods and surgical techniques between 3 periods: 2005–2009, 2010–2014 and 2015–2019 (Table 1).

A total of 507 patients were included, mean age was 63±12 years, 354 (70%) were male and 299 (59%) had hypertension. Demographics were similar across periods. About clinical presentation, the proportion of patients admitted to the operating room with cardiac arrest has increased between the 3 periods (12% vs 5% vs7%; P<0.01). Regarding diagnostic, CT was the cornerstone (90%) and the use of TEE has increased (26% vs 10% vs 10%, P<0.01). Regarding surgical management, we observed a decrease of the use of mechanical prosthesis (6% vs 17% vs 12%; P<0.01), an increase of the use of hybrid prosthesis (10% vs 2% vs 0%; P<0.01), of valve sparing (6% vs 0% vs 0%; P<0.01) and of Bentall (29% vs 25% vs 13%; P<0.01) (Figure 1).

Over a 15-years period, the demographics of patients operated on for type A aortic dissection has not significantly changed. However, there is a trend towards the management of patients in a more life-threatening condition. Most of the shifts relate to surgical techniques, with a more proactive approach to the treatment of associated aortic regurgitation.