Modified trifurcated graft in acute type A aortic dissection with the least brain ischemic time.
Cerebral ischemia, bleeding, and inadequate myocardial protection are the major concerns in doing aortic arch operation. The trifurcated graft technique as described by Spielvogel and associates was a useful technique in reducing the risk of postoperative neurologic complications. However, the cerebral ischemic time may be still too long in inexperienced hands. We recently encountered 3 patients of acute type A aortic dissection who needed aortic arch replacement. By modifying the procedure of the trifurcated graft technique and using a reversed sleeve graft technique, we greatly reduced the duration of cerebral and myocardial ischemia and made bleeding a minor problem.
Chen
Chien-Chang
CC
Division of Cardiovascular Surgery, Chi-Mei Hospital, Yungkang City, Taiwan. eadwine_chen@yahoo.com.tw
Hsieh
Shih-Rong
SR
D000784:Aortic Dissection / Q000000981:diagnostic imaging / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000000981:diagnostic imaging / Q000601:surgery*; D016063:Blood Loss, Surgical / Q000517:prevention & control; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000379:methods; D002545:Brain Ischemia / Q000517:prevention & control*; D002315:Cardiopulmonary Bypass / Q000379:methods; D005260:Female; D006801:Humans; D007036:Hypothermia, Induced; D007431:Intraoperative Complications / Q000517:prevention & control*; D008297:Male; D011474:Prosthesis Design; D011859:Radiography; D018570:Risk Assessment; D012494:Sampling Studies; D013997:Time Factors; D016896:Treatment Outcome