Partial Arch Replacement Using Common Trunk Perfusion in Type A Acute Aortic Dissection.

Area of Science:

• Cardiovascular Surgery
• Thoracic Surgery
• Vascular Surgery

Background:

• Acute type A aortic dissection is a life-threatening condition requiring prompt surgical intervention.
• A bovine aortic arch presents unique anatomical considerations during aortic dissection repair.
• The common trunk, formed by the innominate and left common carotid arteries, can be a critical structure in aortic arch surgery.

Observation:

• A patient presented with syncope due to an acute type A aortic dissection.
• Imaging revealed a bovine aortic arch with an enlarged innominate artery, with dissection limited to the ascending aorta.
• The common trunk remained unaffected by the dissection.

Findings:

• Surgical intervention involved ascending aorta and partial arch replacement with excision of the dilated innominate artery.
• Cardiopulmonary bypass was successfully achieved using common trunk perfusion.
• The unaffected common trunk served as a viable perfusion site.

Implications:

• Resection and separate reconstruction of the common trunk may be a preventative measure in similar cases.
• This approach could mitigate future vascular events in patients with aortic dissections involving the aortic arch origins.
• Tailoring surgical strategy based on the extent of dissection relative to the common trunk is crucial for optimal outcomes.