title: Early and midterm outcomes of hemiarch replacement combined with stented elephant trunk in the management of acute DeBakey type I aortic dissection: comparison with total arch replacement.
abstract: OBJECTIVE
  For patients with acute DeBakey type I aortic dissection without an intimal tear in the arch, the early and midterm outcomes of hemiarch replacement with stented elephant trunk were compared with those of total arch replacement.
  
  
  METHODS
  From January 2006 to December 2011, 197 patients with acute type I aortic dissection were identified without an intimal tear in the arch. Of the 197 patients, 71 underwent hemiarch replacement with stented elephant trunk implantation (hemiarch group) and 84 underwent ascending aorta and total arch replacement with stented elephant trunk implantation (total arch group).
  
  
  RESULTS
  The incidence of postoperative transient neurologic dysfunction, low cardiac output syndrome, and prolonged ventilation was lower in the hemiarch group (P<.05 for all). The hospital mortality was 4.2% and 5.9% for the hemiarch and total arch groups, respectively (P=.91). No difference was detected in survival between the 2 groups (P=.56). Complete thrombosis in the false lumen of the residual arch was found in 92.1% of those undergoing hemiarch replacement. The rate of complete thrombosis in the false lumen of the distal aorta was similar between the 2 groups (P>.05). The risk of an aortic event was similar for both groups (P=.62).
  
  
  CONCLUSIONS
  For patients with acute DeBakey type I dissection without an intimal tear in the arch, hemiarch replacement with stented elephant trunk implantation was easily performed, with satisfactory early and midterm outcomes. For these selective patients, total arch replacement with the stented elephant trunk technique did not improve the late surgical results further.
authors.affiliation: Department of Cardiac Surgery, First Affiliated Hospital, China Medical University, Shenyang, China.
authors.forename: Enyi
authors.initials: E
authors.lastname: Shi
authors.affiliation: Department of Cardiac Surgery, First Affiliated Hospital, China Medical University, Shenyang, China. Electronic address: cmugtx@sina.com.
authors.forename: Tianxiang
authors.initials: T
authors.lastname: Gu
authors.affiliation: Department of Cardiac Surgery, First Affiliated Hospital, China Medical University, Shenyang, China.
authors.forename: Yang
authors.initials: Y
authors.lastname: Yu
authors.affiliation: Department of Cardiac Surgery, First Affiliated Hospital, China Medical University, Shenyang, China.
authors.forename: Lei
authors.initials: L
authors.lastname: Yu
authors.affiliation: Department of Cardiac Surgery, First Affiliated Hospital, China Medical University, Shenyang, China.
authors.forename: Chun
authors.initials: C
authors.lastname: Wang
authors.affiliation: Department of Cardiac Surgery, First Affiliated Hospital, China Medical University, Shenyang, China.
authors.forename: Qin
authors.initials: Q
authors.lastname: Fang
authors.affiliation: Department of Cardiac Surgery, First Affiliated Hospital, China Medical University, Shenyang, China.
authors.forename: Yuhai
authors.initials: Y
authors.lastname: Zhang
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000784:Aortic Dissection / 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 / Q000379:methods* / Q000401:mortality; D057510:Endovascular Procedures / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods* / Q000401:mortality; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011183:Postoperative Complications / Q000401:mortality; D012189:Retrospective Studies; D012307:Risk Factors; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome