title: Total arch replacement with stented elephant trunk technique for acute type B aortic dissection involving the aortic arch.
abstract: BACKGROUND
  Optimal management of patients with acute type aortic dissection is not clear. The clinical experience with total arch replacement combined with stented elephant trunk technique in the treatment of acute type B aortic dissection involving the aortic arch was analyzed.
  
  
  METHODS
  From January 2006 to April 2011, 24 consecutive patients with acute type B aortic dissection involving the aortic arch underwent total aortic arch replacement with stented elephant trunk implantation. Concomitant procedures included the Bentall procedure in 3 patients, David procedure in 1 patient, and ascending aortic replacement in 7 patients.
  
  
  RESULTS
  The times of cardiopulmonary bypass and selective cerebral perfusion averaged 168±41 and 21±4 minutes, respectively. One patient died of multiorgan failure 3 days after surgery. Complications occurred in 3 patients (3 of 24; 12.5%), including hoarseness and mediastinal bleeding requiring reoperation, each in 1 patient. One patient experienced transient consciousness dysfunction. The in-hospital mortality was 4.1% (1 of 24). No paraplegia occurred postoperatively. Follow-up was available in 22 patients (22 of 23; 95.7%). During the follow-up, 1 patient died of massive gastrointestinal bleeding 2 months after surgery. Type II endoleak occurred in 1 patient. One patient underwent thoracoabdominal aortic replacement 14 months after surgery. The complete thrombosis ratio of the false lumen was 86.4% (19 of 22) 6 months after surgery. The 5-year survival was 91.7%.
  
  
  CONCLUSIONS
  Total arch replacement combined with stented elephant trunk technique was safe and feasible for acute type B aortic dissection involving the aortic arch. A low rate of morbidity and mortality and a satisfactory 5-year survival rate were achieved, as well as improved thrombosis of the false lumen.
authors.affiliation: Beijing Aortic Disease Center, Beijing Institute of Heart, Lung and Blood Vessel Diseases, and Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
authors.forename: Hai-Peng
authors.initials: HP
authors.lastname: Zhao
authors.forename: Jun-Ming
authors.initials: JM
authors.lastname: Zhu
authors.forename: Wei-Guo
authors.initials: WG
authors.lastname: Ma
authors.forename: Jun
authors.initials: J
authors.lastname: Zheng
authors.forename: Yong-Min
authors.initials: YM
authors.lastname: Liu
authors.forename: Li-Zhong
authors.initials: LZ
authors.lastname: Sun
mesh_terms: D000208:Acute Disease; D000328:Adult; D000784:Aortic Dissection / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D001013:Aorta, Thoracic / Q000000981:diagnostic imaging / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D001027:Aortography / Q000379:methods; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods* / Q000401:mortality; D002315:Cardiopulmonary Bypass / Q000379:methods; D015331:Cohort Studies; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality / Q000639:trends*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality / Q000503:physiopathology; D011474:Prosthesis Design; D012189:Retrospective Studies; D018570:Risk Assessment; D015607:Stents; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome