What is the preferred treatment for an acute aortic dissection?

• A. Surgical repair
• B. Medical management with observation
• C. Endovascular stent graft as first-line therapy in all cases
• D. No intervention unless rupture occurs

Answer: (A)

Acute dissection involving the ascending aorta is a surgical emergency. The tear in the aortic wall can rapidly compromise the aortic valve, coronary arteries, and can rupture into the pericardial space causing tamponade. While initial medical therapy aims to reduce heart rate and blood pressure to limit shear forces, it does not fix the torn wall or halt progression. Therefore the definitive, best option is emergent surgical repair to remove the damaged segment, reconstruct the aorta with a graft, and address the aortic valve or coronary involvement if needed. Endovascular stent grafts have a role in selected scenarios (especially certain descending or complicated cases), but they are not the universal first-line therapy for all acute dissections, and they are not always feasible in the ascending aorta. Observation without intervention is unsafe in acute ascending dissection. So, urgent surgical repair offers the best chance of survival in acute dissections involving the ascending aorta.