title: Extended total arch replacement for acute type a aortic dissection: experience with seventy patients.
abstract: OBJECTIVE
  We sought to report the clinical experience with extended total arch replacement for acute type A aortic dissection and to determine the factors that influence early mortality, late survival, and late reoperation.
  
  
  METHODS
  Between December 1988 and August 1998, 70 patients underwent emergency graft replacement of both the ascending aorta and the total aortic arch for acute type A aortic dissection. All operations were performed with hypothermic extracorporeal circulation, selective cerebral perfusion for cerebral protection during aortic arch repair, and open distal anastomosis. Concomitant procedures included aortic valve resuspension in 18 patients, composite graft replacement in 10 patients, and coronary artery bypass grafting in 5 patients.
  
  
  RESULTS
  The early mortality rate was 16% (11 of 70 patients). Multivariable analysis showed that renal-mesenteric ischemia and coronary artery bypass grafting were independent determinants for early death. Survival rates at 3 and 5 years postoperatively, including the early deaths, were 75% +/- 5% and 73% +/- 6%, respectively. Multivariable analysis showed that renal-mesenteric ischemia and en bloc repair were independent determinants for late death. Freedom from reoperation was 91% +/- 4% and 77% +/- 8% at 3 and 5 years, respectively. Multivariable analysis showed that anastomotic leakage was the only significant determinant for late reoperation.
  
  
  CONCLUSIONS
  Extended total arch replacement for acute type A aortic dissection could be justified in properly selected patients.
authors.affiliation: First Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, and the Second Department of Surgery, Sapporo Medical University, Sapporo, Japan. surg1ss@hama-med.ac.jp
authors.forename: T
authors.initials: T
authors.lastname: Kazui
authors.forename: N
authors.initials: N
authors.lastname: Washiyama
authors.forename: B A
authors.initials: BA
authors.lastname: Muhammad
authors.forename: H
authors.initials: H
authors.lastname: Terada
authors.forename: K
authors.initials: K
authors.lastname: Yamashita
authors.forename: M
authors.initials: M
authors.lastname: Takinami
authors.forename: Y
authors.initials: Y
authors.lastname: Tamiya
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000784:Aortic Dissection / Q000145:classification / Q000401:mortality / Q000601:surgery*; D001013:Aorta, Thoracic / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000145:classification / Q000401:mortality / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D012086:Reoperation; D015996:Survival Rate; D013997:Time Factors