Extending hybrid approach to residual Stanford type A dissecting aortic aneurysm

Residual Stanford type A dissecting aortic aneurysm was frequently encountered several years after emergent repair. Surgical approach remained challenging and hazardous, not only due to the extensive involvement of the dilated false lumen but also the high comorbidity of redo sternotomy and extensive thoraco-abdominal procedure. We present a modified hybrid technique incorporating arch replacement with bifurcated graft to relocate supra-aortic branches followed by anastomosis with reverse sleeve graft of elephant trunk over distal arch. After stent graft insertion over proper landing zone, all the communicating holes could be sealed and the compressed true lumen of descending aorta would be fully dilated. This technique not only simplified some laborious situations but also simultaneously resolved the entire thoracic dissection segment with an acceptable and optimal midterm result.