title: Is emergency total arch replacement with a modified elephant trunk technique justified for acute type A aortic dissection?
abstract: BACKGROUND
  We assess the outcome of emergency total arch replacement with a modified elephant trunk technique for acute type A aortic dissection to clarify whether our aggressive approach is justified in certain patients.
  
  
  METHODS
  Between 2000 and 2006, 54 patients (55.1% of all) underwent emergency total arch replacement for acute type A aortic dissection. The surgery was performed using open distal anastomosis with selective antegrade cerebral perfusion under hypothermia. Total arch replacement with individual arch-vessel reconstruction was applied in the following settings: the intimal tear in the transverse arch or the proximal descending aorta, massive arch dissection, Marfan syndrome, arch aneurysm, and atheromatous arch. At the distal anastomosis, a modified elephant trunk procedure was added for secure anastomosis and early thrombosed closure of the false channel in the descending aorta.
  
  
  RESULTS
  Only 2 patients (3.7%) died of low cardiac output, in whom cardiac arrest had developed preoperatively owing to rupture of the arch or to left coronary artery malperfusion. There were 4 late deaths from nonaortic events. On the follow-up computed tomographic scanning, a high incidence of early thrombosed closure of the false channel in the dissected descending aorta was found. Only 2 patients, whose tear had not been resected in the first surgery, required reoperation of the descending aorta.
  
  
  CONCLUSIONS
  Total arch replacement with an elephant trunk procedure, which permits immediate survival and provides early thrombosed closure of the distal false channel, is justified in certain patients with acute type A dissection.
authors.affiliation: Department of Cardiovascular Surgery, National Cardiovascular Center, Osaka, Japan.
authors.forename: Hirotaka
authors.initials: H
authors.lastname: Watanuki
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Ogino
authors.forename: Kenji
authors.initials: K
authors.lastname: Minatoya
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Matsuda
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Sasaki
authors.forename: Motomi
authors.initials: M
authors.lastname: Ando
authors.forename: Soichiro
authors.initials: S
authors.lastname: Kitamura
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000784:Aortic Dissection / Q000601:surgery*; D001013:Aorta, Thoracic / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000601:surgery*; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D002560:Cerebrovascular Circulation; D005260:Female; D006324:Heart Arrest, Induced; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D012086:Reoperation; D012189:Retrospective Studies