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J Thorac Cardiovasc Surg 2002;124:891-893
© 2002 The American Association for Thoracic Surgery

Editorials

Letter to Hans Georg Borst

Axel Haverich, MD

From Medizinische Hochschule Hannover, Klinik fur Thorax-, Herz- und Gefasschirur, Hannover, Germany.

Received for publication April 4, 2002. Accepted for publication July 18, 2002. Address for reprints: Axel Haverich, MD, Medizinische Hochschule Hannover, Klinik fur Thorax-, Herz- und Gefasschirur, Hannover D-30623, Germany (E-mail: haverich@thg.mh-hannover.de).

The first 300 words of the full text of this article appear below.


   Introduction
 


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  		Dr Haverich

 
Dear Hans, Now that it has been six years since you left your office (and the operating room) at the medical school here in Hannover and as you approach your 75th birthday, we know you have become more selective in your reading of medical articles. But I would like to draw your attention to one article, for various reasons. First, this article addresses the (hitherto thought) never-ending controversy about medical versus surgical therapy for acute type B aortic dissections, a question in which you were always extremely interested. Second, it (again) originates from the Stanford group, whose members have been philosophically determined to answer this question for some decades. Third, a (even for surgeons easily understandable) statistical tool called "propensity score analysis" is now used to "upgrade" a retrospective analysis into a prospective study, something you always dreamed of during your active career. Finally, you will be surprised to know that the ultimate answer to the question how to treat aortic type B dissections has been found. However, new technology renders the question partly outdated (of course), posing new questions to keep the gray substance of the next generation of surgeon philosophers active. As both your former resident and current successor, I would desperately like to hear your opinion regarding the paper of Craig Miller's group.Go 1

During the first months of my training, you taught me the differences between acute versus chronic and type A versus type B aortic dissections. You always preferred the Stanford classification system for two reasons: (1) its indicative value for the type of surgical approach; (2) its inherent prognostic information. Our policy then and for the next 20 years was the one exercised by most surgical groups, including Stanford: medical treatment for uncomplicated acute type B dissections and surgery for all type A . . . [Full Text of this Article]


Related Article

Is medical therapy still the optimal treatment strategy for patients with acute type B aortic dissections?
Juan P. Umaña, David T. Lai, R. Scott Mitchell, Kathleen A. Moore, Filiberto Rodriguez, Robert C. Robbins, Phillip E. Oyer, Michael D. Dake, Norman E. Shumway, Bruce A. Reitz, and D. Craig Miller
J. Thorac. Cardiovasc. Surg. 2002 124: 896-910. [Abstract] [Full Text] [PDF]



This article has been cited by other articles:


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H.-Y. Yu, Y.-S. Chen, S.-C. Huang, S.-S. Wang, and F.-Y. Lin
Late outcome of patients with aortic dissection: study of a national database
Eur. J. Cardiothorac. Surg., May 1, 2004; 25(5): 683 - 690.
[Abstract] [Full Text] [PDF]


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