Acute aortic dissection remains the most common of all aortic catastrophes and is associated with significant morbidity and mortality. Urgent surgical intervention should be considered in all patients with acute type A aortic dissection. Immediate repair is performed for those who are hypotensive due to rupture and tamponade and who exhibit malperfusion of the coronary, cerebrovascular, visceral, or peripheral arterial systems. Selective delayed management with eventual repair may be assumed in patients with type A intramural hematoma and in those with coma (potential neurologic devastation), assuming that neurologic status improves. Urgent repair should not be precluded in patients presenting with active stroke, older age, and previous cardiac surgery. Ultimately, each patient should be individualized and the decision to intervene left to the surgeon.
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