[New surgical approach for acute type A aortic dissection; combining classic surgery with descending stent grafting]

The outcome of surgical repair of acute type A dissection has substantially improved, but patients with residual dissection in the descending aorta are facing a risk of late complications such as aneurysm formation and rupture, and often require redo surgery. To minimize late complications, the combined approach with hemi-arch replacement and simultaneous descending stent grafting (SG) was applied and compared with conventional surgery. Between April 2007 and April 2010, 70 consecutive patients with acute type A dissection underwent operation, and 8 with DeBakey type II and 9 undergoing total-arch replacement were excluded from the study. 38 patients (71.7%) underwent combined surgery with SG and 15 (28.3%) underwent conventional surgery. Computed tomography (CT) was performed during the follow-up. Patency, width of the false lumen and the maximal diameter of the descending aorta were compared between these 2 groups. In early CT, the thoracic true lumen was wider than the false lumen in 28 patients (80%) in the SG group and 7 (50%) in the conventional group (p = 0.04). In mid-term CT, dilatation of the thoracic aorta occurred in 5 patients (16.1%) in the SG group and 5 (45.5%) in the conventional group (p < 0.05). This approach is technically feasible and offers the chance of thrombosis and reduction of the distal false lumen.