title: Aortic Arch Replacement in Patients With Chronic Dissection: Special Considerations.
abstract: The progressive expansion of residual, chronic DeBakey type I dissection often necessitates repair of the aortic arch and the distal aorta (ie, descending thoracic and thoracoabdominal aorta). The vast majority of patients with chronic aortic dissection facing aortic arch surgery are survivors of emergent proximal aortic repair for acute dissection, and thus, these patients now face a reoperative procedure necessitating a redo median sternotomy. One approach for repairing the chronic type I aortic dissection incorporates total transverse aortic arch replacement with and without an elephant trunk extension; an elephant trunk extension is a useful strategy, because the proximal descending thoracic aorta is commonly ectatic or aneurysmal at the time of aortic arch repair-using an elephant trunk approach facilitates subsequent repair in the distal aorta. Patients with chronic DeBakey type I dissection should participate in an imaging surveillance protocol.
authors.affiliation: Baylor College of Medicine, Houston, TX, USA kimdlc@bcm.edu.|Texas Heart Institute, Houston, TX, USA.|Baylor St. Luke's Medical Center, CHI St. Luke's Health System, Houston, TX, USA.
authors.forename: Kim I
authors.initials: KI
authors.lastname: de la Cruz
authors.affiliation: Baylor College of Medicine, Houston, TX, USA.
authors.forename: Susan Y
authors.initials: SY
authors.lastname: Green
authors.affiliation: Baylor College of Medicine, Houston, TX, USA.|Texas Heart Institute, Houston, TX, USA.|Baylor St. Luke's Medical Center, CHI St. Luke's Health System, Houston, TX, USA.
authors.forename: Ourania A
authors.initials: OA
authors.lastname: Preventza
authors.affiliation: Baylor College of Medicine, Houston, TX, USA.|Texas Heart Institute, Houston, TX, USA.|Baylor St. Luke's Medical Center, CHI St. Luke's Health System, Houston, TX, USA.
authors.forename: Joseph S
authors.initials: JS
authors.lastname: Coselli
mesh_terms: D000784:Aortic Dissection / Q000601:surgery*; D001013:Aorta, Thoracic / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000601:surgery*; D002908:Chronic Disease; D006801:Humans; D011300:Preoperative Care; D014656:Vascular Surgical Procedures / Q000379:methods*
keywords: DeBakey type I aortic dissection; aortic arch repair; chronic aortic dissection; open surgery; reoperation