[Total arch replacement combined with stented elephant trunk implantation for Stanford type A aortic dissection].
OBJECTIVE
To improve the long term outcomes of the surgery for Stanford type A aortic dissection, we performed ascending aorta and total aortic arch replacement combined with transaortic stented graft implantation into the descending aorta for acute and chronic type A aortic dissection.


METHODS
From April 2003 to March 2004, 40 consecutive patients with acute or chronic Stanford type A aortic dissection underwent this procedure. Right axillary artery cannulation was routinely used for cardiopulmonary bypass and selected cerebral perfusion. The stented elephant trunk was implanted through the aortic arch under hypothermic circulatory arrest. The stented elephant trunk was a 10 cm long self expandable graft. Enhanced electric beam computed tomography (EBCT) was performed in each patient before discharge, three month after surgery, and once each year after discharge to evaluate the postoperative time course of the residual false lumen.


RESULTS
Cardiopulmonary bypass time was (166 +/- 38) min, average cross clamp time was (107 +/- 28) min, and average selective cerebral perfusion and lower body arrest time was (30 +/- 15) min. The in-hospital mortality was 5% (2/40). One patient died of multi-organ failure postoperatively and another died of cerebral infarction 2 month after surgery. One suffered from spinal cord injury perioperatively. There was no late death during follow up.


CONCLUSIONS
Ascending aorta and total aortic arch replacement combined with transaortic stented graft implantation into the descending aorta is an effective way in closing the residual false lumen of the descending aorta and might contribute to the better long term outcomes of type A aortic dissection. Our half mortality of 2 patients suffering acute renal failure suggests that this group may be candidates for medical or delayed surgical intervention. Conversely, our 5% mortality rate for those renal intact patients warrant aggressive and expeditious surgical treatment.
Sun
Li-zhong
LZ
Department of Cardiovascular Surgery, Cardiovascular Institute and Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Unine Medical College, Beijing 100037, China.
Liu
Zhi-gang
ZG
Chang
Qian
Q
Zhu
Jun-ming
JM
Dong
Chao
C
Yu
Chun-tao
CT
Xiong
Hui
H
Liu
Jin-ping
JP
Wang
Gu-yan
GY
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; D002315:Cardiopulmonary Bypass; D001026:Coronary Artery Bypass; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015607:Stents; D016896:Treatment Outcome