title: Modified total arch replacement using a four-branched arch graft for acute type A aortic dissection with minimal brain and spinal cord ischemic time.
abstract: OBJECTIVE
  This study aimed to evaluate the results of modified surgical strategies of total arch replacement using a four-branched arch graft, stented elephant trunk, and innovative organ protection method for acute type A aortic dissection.
  
  
  METHODS
  Between August 2011 and December 2011, 21 patients with acute type A aortic dissection underwent modified total arch replacement using the four-branched arch graft technique. All 21 patients had emergency surgery. Five patients had undergone previous aortic or cardiac surgery. The operations were stented elephant trunk implantation in 17 patients, ascending aorta replacement in 21 patients, coronary artery bypass grafting in four patients, Bentall operation in two patients, and aortic valve replacement in one patient. Twenty-one operations were performed under deep hypothermic extracorporeal circulation, modified selective cerebral perfusion, and end-organ and spinal cord protection for arch reconstruction.
  
  
  RESULTS
  There was two in-hospital deaths (9.5%). No persisting neurologic deficits or paraplegia occurred in 21 patients. Cardiopulmonary bypass time was 177.9±37.8 minutes. Myocardial ischemic time was 110.3±29.3 minutes. ICU time was 8.8±6.9 days and in-hospital duration was 28.7±13.7 days. Ventilation time varied from 9 hours to 21 days. A tracheotomy was necessary in four patients. Mean follow-up was 7.3±1.7 months and all patients are still alive.
  
  
  CONCLUSIONS
  Modified total arch replacement using a four-branched arch graft with stented elephant trunk and innovative organ protection is a useful and safe alternative technique for the treatment of acute type A aortic dissection and the results are encouraging.
authors.affiliation: Shanghai Institute of Cardiovascular Disease, Zhongshan Hospital, Fudan University, Shanghai, China - gordonsd@126.com.
authors.forename: S
authors.initials: S
authors.lastname: Lu
authors.forename: X
authors.initials: X
authors.lastname: Sun
authors.forename: T
authors.initials: T
authors.lastname: Hong
authors.forename: S
authors.initials: S
authors.lastname: Yang
authors.forename: K
authors.initials: K
authors.lastname: Song
authors.forename: H
authors.initials: H
authors.lastname: Lai
authors.forename: C
authors.initials: C
authors.lastname: Wang
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000784:Aortic Dissection / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D002545:Brain Ischemia / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control*; D002560:Cerebrovascular Circulation; D050792:Circulatory Arrest, Deep Hypothermia Induced; D004630:Emergencies; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D010477:Perfusion / Q000009:adverse effects / Q000379:methods*; D011474:Prosthesis Design; D012189:Retrospective Studies; D020760:Spinal Cord Ischemia / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control*; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult