title: When and how to include arch repair in patients with acute dissections involving the ascending aorta.
abstract: The arch should be included in the repair in patients with acute aortic dissection involving the ascending aorta when (1) the intimal tear is in the arch, (2) rupture of the arch has occurred, (3) the outer wall of the false channel in the arch is tenuous, and (4) the inner wall of the false channel is fragmented. A technique has evolved for patients with acute aortic dissection involving the arch that seems to minimize the difficulties and risks of including the arch, when indicated. Its place will best be determined by additional, prospective, and preferably multi-institutional testing.
authors.affiliation: Department of Surgery, University of Alabama, Birmingham Medical Center 35294.
authors.forename: J W
authors.initials: JW
authors.lastname: Kirklin
authors.forename: N T
authors.initials: NT
authors.lastname: Kouchoukos
mesh_terms: D000208:Acute Disease; D000784:Aortic Dissection / Q000601:surgery*; D001011:Aorta / Q000601:surgery; D001013:Aorta, Thoracic / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000601:surgery*; D001021:Aortic Valve / Q000601:surgery; D001807:Blood Vessel Prosthesis; D002315:Cardiopulmonary Bypass; D006350:Heart Valve Prosthesis; D006801:Humans; D007430:Intraoperative Care / Q000379:methods