title: Efficacy of limited proximal arch replacement for type A acute aortic dissection with critical complications.
abstract: OBJECTIVE
  We assessed the efficacy of limited proximal arch replacement for type A acute aortic dissection (AAD) with critical complications.
  
  
  METHODS
  Sixty-four patients with average age of 64.5 ± 13.0 years, who were intubated prior to arriving at hospital due to cardiopulmonary arrest, cardiac tamponade, or vital organ mal-perfusion, were divided into two groups: group PA consisted of 52 patients undergoing proximal arch repair with mild hypothermic circulatory arrest; group TA consisted of 12 patients who underwent total arch replacement with moderate hypothermia and selective cerebral perfusion.
  
  
  RESULTS
  The intimal tear on the distal side of the left subclavian artery was not excised in 11 patients (21.2 %) of group PA. The intimal tear was excised in all patients in group TA. The durations of cerebral protection (PA, 18.7; TA, 70.3 min), cardiopulmonary bypass (PA, 121.5; TA, 206 min), and overall operation (PA, 181.8; TA, 403.8 min) were significantly shorter in group PA. The incidence of postoperative brain damage was significantly lower in group PA (9.6 %) than in group TA (33.3 %). The mortality rate was significantly lower in group PA (5.8 %) than in group TA (58.3 %). Distal arch to descending aortic replacement was required in four patients of group PA during follow-up period. There were no complications or mortality during the reoperation. The actuarial survival rate at 10 years was significantly better in group PA (66.5 %) than in group TA (25 %).
  
  
  CONCLUSIONS
  Limited proximal arch repair is suitable for high-risk patients with AAD, despite no excision of the intimal tear.
authors.affiliation: Department of Cardiovascular Surgery, Nihon University Hospital, 1-6 Kanda Surugadai, Chiyoda-ku, Tokyo, 101-8309, Japan. hata.mitsumasa@nihon-u.ac.jp.
authors.forename: Mitsumasa
authors.initials: M
authors.lastname: Hata
authors.affiliation: Department of Cardiovascular Surgery, Nihon University Hospital, 1-6 Kanda Surugadai, Chiyoda-ku, Tokyo, 101-8309, Japan.
authors.forename: Yukihiko
authors.initials: Y
authors.lastname: Orime
authors.affiliation: Department of Cardiovascular Surgery, Nihon University Hospital, 1-6 Kanda Surugadai, Chiyoda-ku, Tokyo, 101-8309, Japan.
authors.forename: Shinji
authors.initials: S
authors.lastname: Wakui
authors.affiliation: Department of Cardiovascular Surgery, Nihon University Hospital, 1-6 Kanda Surugadai, Chiyoda-ku, Tokyo, 101-8309, Japan.
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Nakamura
authors.affiliation: Department of Cardiovascular Surgery, Nihon University Hospital, 1-6 Kanda Surugadai, Chiyoda-ku, Tokyo, 101-8309, Japan.
authors.forename: Rei
authors.initials: R
authors.lastname: Hinoura
authors.affiliation: Department of Cardiovascular Surgery, Nihon University Hospital, 1-6 Kanda Surugadai, Chiyoda-ku, Tokyo, 101-8309, Japan.
authors.forename: Kenji
authors.initials: K
authors.lastname: Akiyama
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000784:Aortic Dissection / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000601:surgery*; D001921:Brain / Q000098:blood supply; D002545:Brain Ischemia / Q000209:etiology; D002315:Cardiopulmonary Bypass / Q000009:adverse effects; D002560:Cerebrovascular Circulation; D050792:Circulatory Arrest, Deep Hypothermia Induced / Q000009:adverse effects; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D011183:Postoperative Complications; D012086:Reoperation; D013348:Subclavian Artery / Q000601:surgery; D015996:Survival Rate; D058017:Vascular Grafting / Q000009:adverse effects / Q000379:methods*
keywords: Aorta; Aortic dissection; Cardiovascular surgery