Postoperative management

The postoperative management of dissection differs little from that of any postoperative cardiac surgical patient. In the majority of cases surgery is palliative; the intimal tear is repaired but the false channel remains. There is potential for further dissection and blood pressure control is particularly important (as in medical management). Maintenance of an adequate circulation can be difficult to achieve in patients with coexistent or consequent cardiac dysfunction. Traditionally, it has been taught that dissection is an absolute contraindication to the use of intra-aortic balloon pumps; however, there are case reports of their having been used in extremis to salvage patients who have had technically successful operations but who cannot maintain an adequate circulation postoperatively.

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