title: Frozen elephant trunk technique and partial remodeling for acute type A aortic dissection.
abstract: OBJECTIVE
  The aimed to describe the frozen elephant trunk (FET) technique and partial remodeling (PR) for acute type A aortic dissection (ATAAD), considering the long-term prognosis on the basis of our 13 years of experience.
  
  
  METHODS
  There were 80 consecutive patients (mean age: 66.4 years) with an FET and PR technique for ATAAD between September 1997 and February 2010. We indicated a PR for all 80 patients without dilatation of the sinuses and a FET for 20 patients with a distal entry in the descending aorta, 14 patients with a dilatation more than 4cm on the distal arch and 46 patients with a narrow true lumen younger than 70 years with a narrow true lumen. During moderate hypothermic circulation with selective cerebral perfusion and distal perfusion from the femoral artery, a stent graft (mean diameter: 27.7mm, mean length: 9.9mm, mean distal depth: thoracic vertebra (Th) 6.0th) was inserted through the transected proximal aortic arch. The plication of the sinotubular junction (N=42) or partial remodeling for right and/or non-coronary cusp (N=38) was performed after total arch replacement with a four-branched prosthesis.
  
  
  RESULTS
  Four patients died in hospital. Early morbidity included two (2.5%) strokes but no spinal cord injury. In long-term follow-up (mean 94.6 months), five patients died of non-aortic events and two re-operations (Bentall and stent grafting to the descending aorta) were required. No patients had patent false lumen on the stent graft and residual aortic regurgitation, according to late follow-up computed tomography (CT) and echogram. The 10-year survival was 75% and the overall 10-year re-operation free rate on the thoracic aorta was 95%.
  
  
  CONCLUSIONS
  FET and modified PR techniques could be effective for improving the long-term outcome on the distal and proximal aorta in an ATAAD.
authors.affiliation: Division of Cardiovascular Surgery, Hiroshima City Asa General Hospital, Hiroshima, Japan. uchidacvs@yahoo.co.jp
authors.forename: Naomichi
authors.initials: N
authors.lastname: Uchida
authors.forename: Akira
authors.initials: A
authors.lastname: Katayama
authors.forename: Kentaro
authors.initials: K
authors.lastname: Tamura
authors.forename: Miwa
authors.initials: M
authors.lastname: Sutoh
authors.forename: Masatsugu
authors.initials: M
authors.lastname: Kuraoka
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Ishihara
mesh_terms: D000208:Acute Disease; D000368:Aged; D000784:Aortic Dissection / Q000601:surgery*; D001014:Aortic Aneurysm / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012086:Reoperation; D012189:Retrospective Studies; D015607:Stents; D016896:Treatment Outcome