title: Open aortic arch reconstruction for acute type a aortic dissection: a single-center experience with 267 consecutive patients.
abstract: BACKGROUND
  This study aimed to analyze the mortality and morbidity of patients undergoing open aortic arch reconstruction for acute type A aortic dissection.
  
  
  METHODS
  Between September 2005 and January 2012, 267 consecutive patients underwent open aortic arch reconstruction for acute type A aortic dissection at our center. The mean age was 51.2 ± 10.0 years, and 200 patients were male. Sixty-three and 184 patients underwent hemiarch replacement and total arch replacement, respectively, whereas the remaining 20 patients underwent single- or triple-branched stent graft implantation. Long-term mortality was estimated by Kaplan-Meier method.
  
  
  RESULTS
  The in-hospital and operative mortality rates within 30 days were 11.2 % and 8.2 %, respectively. The cardiopulmonary bypass, myocardial ischemic, and antegrade cerebral perfusion times were 150.2 ± 43.3, 71.9 ± 33.2, and 33.6 ± 14.4 min, respectively. The overall in-hospital and intensive care unit durations and mean ventilation time were 23.9 ± 18.4 and 9.5 ± 12.7 days and 122.7 ± 183.4 h, respectively. We observed new postoperative permanent neurological dysfunction in 29 patients and temporary neurological dysfunction in 17 patients. The mean follow-up duration was 52.4 ± 27.9 months; 76.4 % of patients completed follow-up and 143 remained alive. Overall long-term survival was 82.2 % at 5 years.
  
  
  CONCLUSIONS
  The open aortic arch reconstruction technique for acute type A dissection carries a relatively high in-hospital mortality risk, although the late results are encouraging. Patients with an advanced age or impaired renal function may opt for endovascular or modified single- or triple-branched stent graft implantation therapy.
authors.affiliation: Shanghai Institute of Cardiovascular Disease, Zhongshan Hospital, Fudan University, Shanghai, China.|Department of Cardiovascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China.
authors.forename: Shuyang
authors.initials: S
authors.lastname: Lu
authors.affiliation: Shanghai Institute of Cardiovascular Disease, Zhongshan Hospital, Fudan University, Shanghai, China.|Department of Cardiovascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China.
authors.forename: Shouguo
authors.initials: S
authors.lastname: Yang
authors.affiliation: Shanghai Institute of Cardiovascular Disease, Zhongshan Hospital, Fudan University, Shanghai, China.|Department of Cardiovascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China.
authors.forename: Hao
authors.initials: H
authors.lastname: Lai
authors.affiliation: Department of Cardiovascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China.
authors.forename: Jiayu
authors.initials: J
authors.lastname: Zheng
authors.affiliation: Shanghai Institute of Cardiovascular Disease, Zhongshan Hospital, Fudan University, Shanghai, China.|Department of Cardiovascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China.
authors.forename: Tao
authors.initials: T
authors.lastname: Hong
authors.affiliation: Shanghai Institute of Cardiovascular Disease, Zhongshan Hospital, Fudan University, Shanghai, China. sun.xiaoning@zs-hospital.sh.cn.|Department of Cardiovascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China. sun.xiaoning@zs-hospital.sh.cn.|, Fenglin Road 180, Xuhui District, Shanghai, 200032, China. sun.xiaoning@zs-hospital.sh.cn.
authors.forename: Xiaoning
authors.initials: X
authors.lastname: Sun
authors.affiliation: Shanghai Institute of Cardiovascular Disease, Zhongshan Hospital, Fudan University, Shanghai, China. wang_cs@126.com.|Department of Cardiovascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China. wang_cs@126.com.|, Fenglin Road 180, Xuhui District, Shanghai, 200032, China. wang_cs@126.com.
authors.forename: Chunsheng
authors.initials: C
authors.lastname: Wang
mesh_terms: D000328:Adult; D000368:Aged; D000784:Aortic Dissection / Q000401:mortality / Q000601:surgery*; D001013:Aorta, Thoracic / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000401:mortality / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects* / Q000379:methods / Q000401:mortality; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015607:Stents
keywords: Morbidity; Mortality; Open arch reconstruction; Type A aortic dissection