Routine extended graft replacement for an acute type A aortic dissection and the patency of the residual false...

Recent surgical progress has had an impact on the mortality of acute type A aortic dissection. Routine aortic arch replacement, irrespective of the location of the intimal tears, may improve not only the outcome of the residual dissection but the operative mortality, because complete resection of intimal tears, including those invisible through the aortotomy in the ascending aorta is achieved.

During the past 7 years, total aortic arch replacement was performed in 50 consecutive patients with acute type A aortic dissection. Cerebral protection was achieved by deep hypothermia associated with pharmacologic cerebroplegia. Computed tomography and aortic angiography were performed to examine 48 patients for the possible presence of residual false channels before discharge.

The duration of circulatory arrest ranged from 30 to 84 minutes. The hospital mortality was 10%, and a cerebral complication was observed in 1 patient. No evidence of a persisting false channel was detected in 27 patients (54%) who were totally thrombosed. During the follow-up period (range: 2 months to 7 years), 2 patients died of hepatoma or pneumonia, respectively, and 2 patients underwent reoperation for recurrence of a dissection at the sinus of Valsalva. The Kaplan-Meier method estimated a 7-year survival of 82%, and a 7-year freedom from reoperation of 93%.

These results suggest that our aggressive use of routine aortic arch grafting can be accomplished with an acceptable risk and that our strategy not only improved the late results but the mortality associated with repairs for acute type A aortic dissection.