A Perfect Storm

Acute type A aortic dissection (AAD) is a lethal disease. The overall mortality rate—even when diagnosed and treated in a timely fashion with emergent surgical intervention—exceeds 20%.1 This fact alone serves as a constant reminder that this disease represents a formidable challenge to all cardiovascular professionals who encounter AAD. Cardiovascular surgeons maintain great respect for operations to deal with AAD, because achieving a successful outcome is based on executing a perfect technical operation and solving a myriad of management decisions during the procedure.Article see p 1602In this issue of Circulation , Stanger and colleagues2 report on the infrequent, but extraordinarily complex situation of AAD occurring after nonaortic surgery. The incidence of AAD during or following nonaortic surgery in the present report is 0.15%, which is consistent with other reports, although the true incidence …