title: Open aortic arch surgery in chronic dissection with visceral arteries originating from different lumens.
abstract: OBJECTIVE
  Surgical management of chronic aortic dissection is controversial, especially when the dissection extends into the abdominal aorta in which the visceral arteries originate from different lumens and is combined with aortic arch pathology necessitating surgery. The aim of the study was to evaluate the results of open surgery in this complex aortic pathology.
  
  
  METHODS
  Between June 2002 and 2015, a total of 17 patients (median age 57, range 32-76 years) necessitating complete arch replacement presented complex chronic dissection of the thoraco-abdominal aorta with the visceral arteries originating from different lumens. Fourteen patients (82%) had had previous cardiac surgery, which was performed on the proximal aorta in all but one because of acute type A dissection. Nine patients without considerable dilatation of the descending aorta received aortic arch replacement with distal resection of the dissection membrane, and 8 patients with progressive dilatation of the thoracic aorta underwent aortic arch and descending aorta replacement via clamshell approach.
  
  
  RESULTS
  No early (defined as 30-day, 90-day and in-hospital period) deaths, strokes or spinal cord injuries occurred. Only 1 patient (6%) presented temporary neurological dysfunctions (delirium, agitation), which resolved completely before discharge, and an injury of the recurrent laryngeal nerve was documented in 2 patients (12%). Temporary dialysis was necessary in 1 case. The follow-up was complete for all patients. All but one patient, who died due to leukaemia 23 months after surgery, were alive at the last follow-up (median duration 33 months, range 2-118 months). No patient needed a reoperation or an intervention on the thoracic and/or abdominal aorta. Moreover, no noticeable progression of the chronic dissection in the downstream aorta was documented in any patient.
  
  
  CONCLUSIONS
  The results after conventional aortic arch repair with distal resection of the dissection membrane and, if necessary, with replacement of the progressively dilated chronic dissected thoracic aorta can offer excellent results in experienced hands and, therefore, this technique may be considered as a preferable option for surgical treatment of chronic aortic dissection with involvement of the aortic arch and the visceral arteries originating from different lumens.
authors.affiliation: Cardiovascular Clinic Bad Neustadt, Bad Neustadt, Germany p.urbanski@kardiochirurg.de.
authors.forename: Paul P
authors.initials: PP
authors.lastname: Urbanski
authors.affiliation: Cardiovascular Clinic Bad Neustadt, Bad Neustadt, Germany.
authors.forename: Petros
authors.initials: P
authors.lastname: Bougioukakis
authors.affiliation: Cardiovascular Clinic, Medical University of Silesia, Katowice, Poland.
authors.forename: Marek A
authors.initials: MA
authors.lastname: Deja
authors.affiliation: Cardiovascular Clinic Bad Neustadt, Bad Neustadt, Germany.
authors.forename: Anno
authors.initials: A
authors.lastname: Diegeler
authors.affiliation: Cardiovascular Clinic Bad Neustadt, Bad Neustadt, Germany.
authors.forename: Vadim
authors.initials: V
authors.lastname: Irimie
authors.affiliation: Cardiovascular Clinic Bad Neustadt, Bad Neustadt, Germany.
authors.forename: Aristidis
authors.initials: A
authors.lastname: Lenos
authors.affiliation: Department of Cardiovascular Surgery and Transplantology, Silesian Center for Heart Diseases, Zabrze, Poland.
authors.forename: Michal O
authors.initials: MO
authors.lastname: Zembala
mesh_terms: D000328:Adult; D000368:Aged; D000784:Aortic Dissection / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D001013:Aorta, Thoracic / Q000503:physiopathology / Q000601:surgery*; D001014:Aortic Aneurysm / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies
keywords: Aortic arch; Aortic surgery; Chronic aortic dissection; Descending aorta; Endovascular aortic repair; Malperfusion