Type B Aortic Dissection

Type B Aortic Dissection

Traditionally, type B dissections (Dissections beyond the left subclavian artery) are treated conservatively unless one of the following situations is present.

• Aneurysm of pseudolumen.
• Tear or leak of the psudolumen.
• Visceral branch or limb branch involvement causing decrease in perfusion of an organ.

However, persisting pain not responding to conservative treatment is a relative indication for intervention nowadays. Various methods of interventional procedures are attempted to control the primary tear in the intima.

One common interventional method is to stent across the proximal intimal tear. This prevents the blood from entering the pseudo-lumen and eventually blood in the pseudo-lumen gets thrombosed.

Whenever decision is made to treat the type B Dissection conservatively, a close follow up is mandatory. CT Aortogram/MR Aortogram should be performed at 3 months and one year.

How is OPCAB done?

It is clear that OPCAB would be technically more difficult to perform than conventional bypass for the plain fact that the fine surgical work needs to be done while the surface is still moving. There are certain devices which make the process a bit easier for the surgeon. Most important of them is called a tissue stabilizer.

Tissue Stabilizer

This, when applied over the heart stabilizes a small portion of the heart wall and reduces the movement in that region. This makes surgical procedure a lot easier to perform. There are other devices which add to the safety like shunts which prevent blood loss and blowers which help to clear operating field.