title: Local transverse arch repair for type A aortic dissection.
abstract: BACKGROUND
  The management of retrograde dissections originating from the transverse arch is controversial. Although replacing the ascending aorta is clearly beneficial, the appropriate approach to the management of the arch tear is not as apparent and ranges from no intervention to total arch replacement.
  
  
  METHODS
  Three patients presented with acute (n = 2) or subacute (n = 1) aortic dissection, with tears involving the transverse arch. All underwent local transaortic pledgeted suture repair of the arch tears during hypothermic circulatory arrest, as well as graft replacement of the ascending aorta.
  
  
  RESULTS
  Circulatory arrest times ranged from 12 to 15 minutes (transaortic arch repairs alone) to 48 minutes (transaortic arch repair and open distal graft anastomosis). Postoperatively all patients awoke within 12 hours and subsequently did well neurologically.
  
  
  CONCLUSIONS
  In the face of a type A dissection with an entry in the transverse arch, local transaortic repair with concomitant ascending aortic replacement represents a viable middle ground between no arch intervention and lengthy arch replacement. Huge entry tears or aneurysmal arch enlargement would preclude such an approach.
authors.affiliation: Harbor-UCLA Medical Center, Torrance 90509, USA.
authors.forename: F J
authors.initials: FJ
authors.lastname: Baumgartner
authors.forename: B O
authors.initials: BO
authors.lastname: Omari
authors.forename: A
authors.initials: A
authors.lastname: Pandya
authors.forename: A
authors.initials: A
authors.lastname: Pandya
authors.forename: D M
authors.initials: DM
authors.lastname: Bethencourt
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000784:Aortic Dissection / Q000601:surgery*; D001013:Aorta, Thoracic / Q000601:surgery; D017545:Aortic Aneurysm, Thoracic / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged