title: Total arch repair for acute type A aortic dissection with 2 modified techniques: open single-branched stent graft placement and reinforcement of the dissected arch vessel stump with stent graft.
abstract: BACKGROUND
  In total arch replacement for patients with acute type A aortic dissection, anastomoses of the graft to the left subclavian artery and descending aorta are often difficult, and the arch vessel anastomosis is frequently performed at the site of dissection. To make this procedure easier and safer, we developed 2 modified techniques: open single-branched stent graft placement into the left subclavian artery and the descending aorta and reinforcement of the dissected arch vessel stump with a stent graft neointima. The feasibility and initial clinical results of these 2 new techniques are reported.
  
  
  RESULTS
  Total arch repair with the 2 new techniques was performed in 26 patients with acute Stanford type A aortic dissection. Most patients had an uneventful postoperative course, and there were no surgical deaths. All implanted stent grafts were fully opened and not kinked, and there was no space or blood flow surrounding any of the stent grafts. The false lumen of the descending thoracic aorta closed with thrombus formation in 22 of 26 patients. Disappearance of the false lumen and recovery of the true lumen was observed in all of the dissected arch vessels.
  
  
  CONCLUSIONS
  Open single-branched stent graft placement into the left subclavian artery and the descending aorta and reinforcement of the dissected arch vessel stump with a stent graft neointima are 2 simple and effective techniques that should make total arch repair an easier and safer procedure for acute type A aortic dissection.
authors.affiliation: Department of Cardiac Surgery, Union Hospital, Fujian Medical University, Fuzhou, Fujian, 350001, China. chenliangwan@tom.com
authors.forename: Liang-Wan
authors.initials: LW
authors.lastname: Chen
authors.forename: Xi-Jie
authors.initials: XJ
authors.lastname: Wu
authors.forename: Lin
authors.initials: L
authors.lastname: Lu
authors.forename: Gui-Can
authors.initials: GC
authors.lastname: Zhang
authors.forename: Guo-Feng
authors.initials: GF
authors.lastname: Yang
authors.forename: Zhao-Wei
authors.initials: ZW
authors.lastname: Yang
authors.forename: Yi
authors.initials: Y
authors.lastname: Dong
authors.forename: Hua
authors.initials: H
authors.lastname: Cao
authors.forename: Qiang
authors.initials: Q
authors.lastname: Chen
mesh_terms: D000208:Acute Disease; D000328:Adult; D000784:Aortic Dissection / Q000145:classification* / Q000473:pathology / Q000601:surgery*; D001011:Aorta / Q000473:pathology / Q000601:surgery; D001013:Aorta, Thoracic / Q000473:pathology / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D015607:Stents; D013348:Subclavian Artery / Q000473:pathology / Q000601:surgery