title: Ascending Aorta and Hemiarch Replacement Combined With Modified Triple-Branched Stent Graft Implantation for Repair of Acute DeBakey Type I Aortic Dissection.
abstract: BACKGROUND
  To simplify extensive repair of acute DeBakey type I aortic dissection, ascending aorta and hemiarch replacement combined with modified triple-branched stent graft implantation was developed. The descriptions and early results of this technique are reported.
  
  
  METHODS
  From August 2014 to September 2015, 116 patients with acute DeBakey type I aortic dissection underwent ascending aorta and hemiarch replacement combined with modified triple-branched stent graft implantation. Clinical data of all patients were retrospectively reviewed. Survivors were followed up prospectively by computed tomography angiography.
  
  
  RESULTS
  The cardiopulmonary bypass time was 131.5 ± 10.7 minutes, the aortic cross-clamp time was 50.0 ± 9.9 minutes, and the selective cerebral perfusion and lower body arrest time was 17.2 ± 2.2 minutes. The in-hospital mortality rate was 3.4%. Two patients were lost during follow-up. One patient died of a cerebrovascular accident 2 months after discharge, and another died of chronic renal failure 5 months after discharge. At the 3-month postoperative scans, complete thrombus formation of the false lumen around the implanted modified triple-branched stent graft occurred in all survivors, at the diaphragmatic level in 69.7% patients, and at the superior mesenteric arterial level in 8.3% patients.
  
  
  CONCLUSIONS
  Extensive thoracic aorta repair of acute type I aortic dissection can be performed simply by combining ascending aorta and hemiarch replacement with modified triple-branched stent graft implantation. This technique can reduce the risk and technical difficulty of extensive thoracic aorta repair to levels close to those seen with ascending aorta and hemiarch graft replacement with open distal anastomosis.
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: Xiao-Fu
authors.initials: XF
authors.lastname: Dai
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: 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
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000784:Aortic Dissection / Q000175:diagnosis / Q000601:surgery*; D001013:Aorta, Thoracic / Q000000981:diagnostic imaging / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000175:diagnosis / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D002681:China / Q000453:epidemiology; D000072226:Computed Tomography Angiography; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D008297:Male; D008875:Middle Aged; D011474:Prosthesis Design; D012189:Retrospective Studies; D015607:Stents; D016896:Treatment Outcome; D055815:Young Adult