title: Surgical treatment for retrograde type A aortic dissection after endovascular stent graft placement for type B dissection.
abstract: Retrograde type A aortic dissection (RTAD) is a life-threatening and underestimated complication of endovascular stent graft placement for type B dissection. Here, we retrospectively investigated our experience of surgical treatment for RTAD after endovascular stent graft placement for type B dissection. Between June 2006 and September 2011, nine patients with RTAD were transferred to our department for surgery. Total arch replacement was performed in six patients and three patients underwent subtotal arch replacement. Associated procedures consisted of ascending aorta replacement in nine patients, coronary artery bypass grafting in one patient and aortic valve plasty in two patients. All operations were performed under deep hypothermic circulatory arrest and selective antegrade cerebral perfusion. Cardiopulmonary bypass time was 158.33 ± 29.18 min. The myocardial ischaemic time was 78.11 ± 28.30 min. The antegrade cerebral perfusion time was 38.67 ± 12.34 min. The mean ventilation time was 45.63 ± 24.74 h. A tracheotomy was necessary in one patient. The ICU time was 7.00 ± 6.80 days and the in-hospital duration was 25.33 ± 11.95 days. There was no in-hospital mortality. The mean follow-up was 34.79 ± 19.37 months and eight patients are still alive. One patient was lost to follow-up. Surgical treatment for RTAD is a safe alternative and the results are encouraging.
authors.affiliation: Shanghai Institute of Cardiovascular Disease, Zhongshan Hospital,  Fudan University, Shanghai,  China.
authors.forename: Shuyang
authors.initials: S
authors.lastname: Lu
authors.forename: Hao
authors.initials: H
authors.lastname: Lai
authors.forename: Chunsheng
authors.initials: C
authors.lastname: Wang
authors.forename: Xiaoning
authors.initials: X
authors.lastname: Sun
authors.forename: Tao
authors.initials: T
authors.lastname: Hong
authors.forename: Kai
authors.initials: K
authors.lastname: Song
authors.forename: Zhenkai
authors.initials: Z
authors.lastname: Yuan
authors.forename: Xueling
authors.initials: X
authors.lastname: Liu
mesh_terms: D000328:Adult; D000368:Aged; D000784:Aortic Dissection / Q000000981:diagnostic imaging / Q000601:surgery*; D001013:Aorta, Thoracic / Q000000981:diagnostic imaging / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000000981:diagnostic imaging / Q000601:surgery*; D001027:Aortography / Q000379:methods; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects* / Q000295:instrumentation; D002681:China; D050792:Circulatory Arrest, Deep Hypothermia Induced; D057510:Endovascular Procedures / Q000009:adverse effects* / Q000295:instrumentation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010477:Perfusion; D012008:Recurrence; D012086:Reoperation; D012189:Retrospective Studies; D015607:Stents; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome