title: Acute type I aortic dissection: traditional versus hybrid repair with antegrade stent delivery to the descending thoracic aorta.
abstract: OBJECTIVE
  We compared the short-term outcomes between patients who had undergone classic repair for type I aortic dissection and those who had undergone concomitant antegrade stenting in the descending thoracic aorta.
  
  
  METHODS
  From January 2005 to December 2012, 112 patients were treated for acute type I aortic dissection. Eighty-seven patients (group A) underwent traditional operations on the ascending and proximal arch (n = 79, 90.8%), total arch (n = 7, 8.1%), or ascending aorta (n = 1, 1.2%). Twenty-five patients (group B) underwent ascending and proximal arch repair and antegrade stent grafting in the descending thoracic aorta. Various concomitant procedures were performed in both groups. The circulatory arrest times were similar between the 2 groups.
  
  
  RESULTS
  The 30-day mortality was 13.8% (n = 12) in group A and 12% (n = 3) in group B. Nine patients in group A (10.3%) and 3 in group B (12%) experienced a postoperative stroke. In group A, 1 patients (1.5%) developed transient spinal cord ischemia, and in group B, 2 patients had transient paraparesis (8.0%). Preoperatively, 24 group A patients and 19 group B patients had malperfusion; this condition resolved postoperatively in 13 group A patients (54.2%) and 16 group B patients (84.2%; P < .037). Eight group A patients (10.8%) and 1 group B patient (4.5%) underwent additional postoperative procedures on the thoracoabdominal aorta a median of 776.5 days (range, 168.5-1102.0) and 54 days postoperatively, respectively.
  
  
  CONCLUSIONS
  Antegrade endovascular grafting of the descending thoracic aorta during repair of acute type I aortic dissection is technically safe, does not increase the circulatory arrest time, and could help patients with preoperative malperfusion. Long-term follow-up data are needed.
authors.affiliation: Department of Cardiovascular Surgery, Texas Heart Institute, Houston, Tex; Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex. Electronic address: opsmile01@aol.com.
authors.forename: Ourania
authors.initials: O
authors.lastname: Preventza
authors.affiliation: Department of Cardiovascular Surgery, Texas Heart Institute, Houston, Tex; Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex.
authors.forename: Roberto
authors.initials: R
authors.lastname: Cervera
authors.affiliation: Department of Cardiovascular Surgery, Texas Heart Institute, Houston, Tex.
authors.forename: Denton A
authors.initials: DA
authors.lastname: Cooley
authors.affiliation: Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex; Michael E. DeBakey Veterans Affairs Medical Center, Houston, Tex.
authors.forename: Faisal G
authors.initials: FG
authors.lastname: Bakaeen
authors.affiliation: Department of Cardiovascular Surgery, Texas Heart Institute, Houston, Tex.
authors.forename: Ahmed S
authors.initials: AS
authors.lastname: Mohamed
authors.affiliation: Department of Radiology, Texas Heart Institute, Houston, Tex.
authors.forename: Benjamin Y C
authors.initials: BY
authors.lastname: Cheong
authors.affiliation: Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex; Michael E. DeBakey Veterans Affairs Medical Center, Houston, Tex.
authors.forename: Lorraine
authors.initials: L
authors.lastname: Cornwell
authors.affiliation: Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex.
authors.forename: Katherine H
authors.initials: KH
authors.lastname: Simpson
authors.affiliation: Department of Cardiovascular Surgery, Texas Heart Institute, Houston, Tex; Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex.
authors.forename: Joseph S
authors.initials: JS
authors.lastname: Coselli
mesh_terms: D000208:Acute Disease; D000368:Aged; D000784:Aortic Dissection / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D017544:Aortic Aneurysm, Abdominal / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D057510:Endovascular Procedures / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D005260:Female; D006324:Heart Arrest, Induced; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality / Q000601:surgery; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome