title: Total arch repair with open triple-branched stent graft placement for acute type A aortic dissection: experience with 122 patients.
abstract: OBJECTIVE
  To summarize the clinical experiences and midterm follow-up results of total arch repair with open triple-branched stent graft placement for acute type A aortic dissection.
  
  
  METHODS
  From June 2008 to March 2013, 122 patients (95 men and 27 women; mean age, 50.9 ± 10.4 years) with acute type A aortic dissection underwent total arch repair with open placement of a triple-branched stent graft under hypothermic cardiopulmonary bypass and selective cerebral perfusion. During the follow-up period, enhanced computed tomography and echocardiography were performed at 3 months postoperatively and annually thereafter.
  
  
  RESULTS
  Placement of the triple-branched stent graft into the true lumen of the descending aorta, arch, and 3 arch vessels was technically successful in 121 patients. The cardiopulmonary bypass time was 186.50 ± 38.23 minutes, and the selective antegrade cerebral perfusion time was 31.97 ± 10.08 minutes. The in-hospital mortality was 4.93%. No permanent neurologic dysfunction or paraplegia was observed. Three patients were lost to follow-up. The mean follow-up period was 30.24 ± 12.35 months. After hospital discharge, 3 patients died. On the 3-month postoperative scans, complete thrombus formation around the triple-branched stent graft was observed in 89.38% of the patients. Endoleaks were detected in 12 patients; 8 patients refused any management for the endoleaks, but they maintained a good quality of life. The other 4 patients were successfully treated by additional surgery.
  
  
  CONCLUSIONS
  Total arch repair with open triple-branched stent graft placement is an effective technique with satisfactory early and midterm results. This technique could be an attractive alternative to conventional total arch replacement.
authors.affiliation: Department of Cardiac Surgery, Union Hospital, Fujian Medical University, Fuzhou, Fujian, China. Electronic address: chenliangwan@tom.com.
authors.forename: Liang-Wan
authors.initials: LW
authors.lastname: Chen
authors.affiliation: Department of Cardiac Surgery, Union Hospital, Fujian Medical University, Fuzhou, Fujian, China.
authors.forename: Lin
authors.initials: L
authors.lastname: Lu
authors.affiliation: Department of Cardiac Surgery, Union Hospital, Fujian Medical University, Fuzhou, Fujian, China.
authors.forename: Xiao-Fu
authors.initials: XF
authors.lastname: Dai
authors.affiliation: Department of Cardiac Surgery, Union Hospital, Fujian Medical University, Fuzhou, Fujian, China.
authors.forename: Xi-Jie
authors.initials: XJ
authors.lastname: Wu
authors.affiliation: Department of Cardiac Surgery, Union Hospital, Fujian Medical University, Fuzhou, Fujian, China.
authors.forename: Gui-Can
authors.initials: GC
authors.lastname: Zhang
authors.affiliation: Department of Cardiac Surgery, Union Hospital, Fujian Medical University, Fuzhou, Fujian, China.
authors.forename: Guo-Feng
authors.initials: GF
authors.lastname: Yang
authors.affiliation: Department of Cardiac Surgery, Union Hospital, Fujian Medical University, Fuzhou, Fujian, China.
authors.forename: Yi
authors.initials: Y
authors.lastname: Dong
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000784:Aortic Dissection / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D001013:Aorta, Thoracic / Q000000981:diagnostic imaging / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D001027:Aortography / Q000379:methods; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D002315:Cardiopulmonary Bypass; D057867:Endoleak / Q000209:etiology / Q000601:surgery; D057510:Endovascular Procedures / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D010477:Perfusion / Q000379:methods; D011474:Prosthesis Design; D012086:Reoperation; D015607:Stents; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014463:Ultrasonography; D055815:Young Adult