title: Aortic arch replacement with prophylactic aortic arch debranching during type A acute aortic dissection repair: initial experience with 23 patients.
abstract: OBJECTIVE
  To improve the long-term results of acute type A dissection repair, we developed a technique that combines radical surgical resection, and, at the same time, creates a safe and long landing zone for subsequent endovascular procedure on the descending aorta.
  
  
  METHODS
  Since November 2006, 23 patients (62 ± 13 years) underwent aortic arch replacement concomitant with prophylactic debranching of the supra-aortic vessels, with a specially designed arch graft. The technique consists of replacing the ascending aorta and the aortic arch, and, at the same time, relocating the origin of the supra-aortic vessels just above the sinotubular junction creating a long and safe proximal landing zone for subsequent stent-graft deployment. Perfusion was antegrade through the ascending aorta during cooling and through the vascular prosthesis during rewarming. Distal arch anastomosis was performed under moderate hypothermic circulatory arrest for 25 ± 7 min and antegrade selective cerebral perfusion (46 ± 14 min). Cardiopulmonary bypass and aortic cross-clamp time were 138 ± 46 and 63 ± 22 min.
  
  
  RESULTS
  Hospital mortality was 4.3% (1/23). Postoperative morbidity includes five acute renal failures and four lung failures. No major neurological complications were observed. At follow-up (22±10 months), survival was 100% and two patients required an endovascular thoracic aorta repair for aneurysmal enlargement. In both cases, the stent grafts were successfully released in the landing zone created at the time of primary repair.
  
  
  CONCLUSIONS
  Our technique extends the suitability of endovascular therapies during type A acute dissection repair, creating a long and stable landing zone that allows safe performance of a second endovascular step if needed, both in the short- and long term.
authors.affiliation: Department of Adult Cardiac Surgery, G. Pasquinucci Heart Hospital, Monasterio Fondation-CNR, Via Aurelia Sud 54100, Massa, Italy.
authors.forename: Mattia
authors.initials: M
authors.lastname: Glauber
authors.forename: Michele
authors.initials: M
authors.lastname: Murzi
authors.forename: Pierandrea
authors.initials: P
authors.lastname: Farneti
authors.forename: Stefano
authors.initials: S
authors.lastname: Bevilacqua
authors.forename: Massimiliano
authors.initials: M
authors.lastname: Mariani
authors.forename: Andrea
authors.initials: A
authors.lastname: Tognarelli
authors.forename: Tommaso
authors.initials: T
authors.lastname: Gasbarri
authors.forename: Sergio
authors.initials: S
authors.lastname: Berti
mesh_terms: D000208:Acute Disease; D058186:Acute Kidney Injury / Q000209:etiology; D000328:Adult; D000368:Aged; D000784:Aortic Dissection / Q000601:surgery*; D001013:Aorta, Thoracic / Q000000981:diagnostic imaging / Q000601:surgery*; D001014:Aortic Aneurysm / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000601:surgery; D001027:Aortography / Q000379:methods; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D012008:Recurrence; D012086:Reoperation / Q000379:methods; D015607:Stents; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome