title: Repair of Acute Type A Aortic Dissection With Ascending Aorta Replacement Combined With Open Fenestrated Stent Graft Placement.
abstract: BACKGROUND
  In the conventional ascending replacement for acute type A aortic dissection, the distal aortic anastomosis is frequently performed at the dissected site, and postoperative residual dissection in the arch and downstream aorta still occurs in most patients. We used open placement of a fenestrated stent graft during this operation.
  
  
  METHODS
  During the conventional ascending replacement in 41 patients with acute type A aortic dissection, a fenestrated stent graft was inserted into the arch and the proximal descending aorta through the distal ascending transection. The distal ascending transection incorporating the proximal end of the fenestrated stent graft was directly anastomosed to the Dacron (DuPont, Wilmington, DE) tube graft. Survivors were examined by computed tomography angiography.
  
  
  RESULTS
  The cardiopulmonary bypass time was 134.46 ± 19.03 minutes, aortic cross-clamp time was 46.38 ± 8.57 minutes, and selective cerebral perfusion and lower body arrest time was 12.50 ± 2.19 minutes. There was 1 in-hospital death but no difficult bleeding from the distal aortic anastomosis. On postoperative computed tomography, the false lumen closed, with complete thrombus formation around the inserted fenestrated stent graft found in all survivors (100%), at the diaphragmatic level in 28 patients (70%), and at the superior mesenteric arterial level in 3 (8%).
  
  
  CONCLUSIONS
  An open fenestrated stent graft placement provided extensive primary repair of the thoracic aorta and a strong distal aortic stump during the conventional ascending aorta replacement for acute type A aortic dissection but did not increase the risk or technical difficulty of the operation.
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: Xi-Jie
authors.initials: XJ
authors.lastname: Wu
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: Dong-Shan
authors.initials: DS
authors.lastname: Liao
authors.affiliation: Department of Cardiac Surgery, Union Hospital, Fujian Medical University, Fuzhou, Fujian, China.
authors.forename: Yun-nan
authors.initials: YN
authors.lastname: Hu
authors.affiliation: Department of Cardiac Surgery, Union Hospital, Fujian Medical University, Fuzhou, Fujian, China.
authors.forename: Hui
authors.initials: H
authors.lastname: Zhang
authors.affiliation: Department of Cardiac Surgery, Union Hospital, Fujian Medical University, Fuzhou, Fujian, China.
authors.forename: Yi
authors.initials: Y
authors.lastname: Dong
authors.affiliation: Department of Cardiac Surgery, Union Hospital, Fujian Medical University, Fuzhou, Fujian, China.
authors.forename: Qi-Min
authors.initials: QM
authors.lastname: Wang
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000784:Aortic Dissection / Q000601:surgery*; D001011:Aorta / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000601:surgery*; D006348:Cardiac Surgical Procedures / Q000379:methods; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019919:Prosthesis Implantation / Q000379:methods; D015607:Stents