title: Surgery for acute type A dissection using total arch replacement combined with stented elephant trunk implantation: Preservation of autologous brachiocephalic vessels.
abstract: OBJECTIVE
  Various techniques have been introduced to treat acute type A dissection during aortic arch reconstruction. We retrospectively reviewed our experience of total arch replacement, with implantation of a stented elephant trunk, using preservation of autologous brachiocephalic vessels in patients with acute type A dissection.
  
  
  METHODS
  Between August 2011 and April 2013, 20 patients (16 men, 4 women; mean age, 45 ± 10 years, range, 24-62 years) with acute type A dissection underwent total arch replacement combined with stented elephant trunk implantation, using preservation of autologous brachiocephalic vessels under hypothermic cardiopulmonary bypass with selective antegrade cerebral perfusion.
  
  
  RESULTS
  No in-hospital deaths occurred. A transient neurologic deficit occurred in 1 patient, who ultimately required tracheotomy. Reoperation was indicated in 1 patient for bleeding. All patients survived and were discharged. During the mean follow-up period of 26 ± 7 months, 1 patient underwent thoracoabdominal aortic replacement, and 1 patient was lost to follow up. The patency of the anastomotic site between the left subclavian artery and the left common carotid artery was confirmed on computed tomography scanning.
  
  
  CONCLUSIONS
  This technique simplified hemostasis and anastomosis, reduced the size of the residual aortic wall, and preserved the autologous brachiocephalic vessels, yielding satisfactory surgical results. This technique is an alternative approach for suitable patients with acute type A dissection. However, outcomes are preliminary, and long-term follow up is required.
authors: Beijing Aortic Disease Center, Beijing Institute of Heart, Lung and Blood Vessel Diseases & Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
authors: Jun-Ming
authors: JM
authors: Zhu
authors: Beijing Aortic Disease Center, Beijing Institute of Heart, Lung and Blood Vessel Diseases & Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
authors: Rui-Dong
authors: RD
authors: Qi
authors: Beijing Aortic Disease Center, Beijing Institute of Heart, Lung and Blood Vessel Diseases & Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
authors: Lei
authors: L
authors: Chen
authors: Beijing Aortic Disease Center, Beijing Institute of Heart, Lung and Blood Vessel Diseases & Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
authors: Wei
authors: W
authors: Liu
authors: Beijing Aortic Disease Center, Beijing Institute of Heart, Lung and Blood Vessel Diseases & Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
authors: Cheng-Nan
authors: CN
authors: Li
authors: Department of Radiology, Beijing Institute of Heart, Lung and Blood Vessel Diseases & Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
authors: Zhan-Ming
authors: ZM
authors: Fan
authors: Beijing Aortic Disease Center, Beijing Institute of Heart, Lung and Blood Vessel Diseases & Beijing Anzhen Hospital, Capital Medical University, Beijing, China. Electronic address: lizhongsun@outlook.com.
authors: Li-Zhong
authors: LZ
authors: Sun
mesh_terms: D000208:Acute Disease; D000328:Adult; D001013:Aorta, Thoracic / Q000601:surgery*; D001018:Aortic Diseases / Q000145:classification / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods*; D016122:Brachiocephalic Trunk; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D059351:Organ Sparing Treatments; D012189:Retrospective Studies; D015607:Stents; D014656:Vascular Surgical Procedures / Q000379:methods; D055815:Young Adult
keywords: Total arch replacement; acute type A dissection; brachiocephalic vessels