[Concomitant composite graft replacement of the aortic root and the aortic arch for type A aortic dissection]

Successful surgical treatment of type A aortic dissection with annuloaortic ectasia (AAE) and severely destroyed aortic root was reported. Between April 1991 and April 1996, 26 patients with type A aortic dissection underwent the surgical treatment in our institute. Among those cases, 4 cases (15%) needed the total aortic root replacement with composite graft. Two cases had Marfan syndrome and AAE and aortic regurgitation. Other two cases had severely destroyed aortic root because of the extension and advancement of the dissection to the aortic root. One was the case of disrupted right coronary ostia. And another was the case of frank rupture and massive bleeding from the aortic root during the operation. Cases of AAE were treated successfully by the routine composite graft that was made before the operation. However, the reconstruction of the aortic root for the cases who had destroyed aortic root with normal relation and size of the aortic root was cumbersome because of non displaced coronary artery ostia and the relatively narrow aortic root. For these cases, composite graft was fixed just below the aortic valve annulus by the sutures enforced with Teflon felt strip from the outside of the aorta and it made the reimplantation of the coronary ostia easier. As for the technique of the reimplantation of the coronary ostia, Carrel patch technique was used because good coaptation and fixation of the suture line around the coronary ostia could be obtained with this technique which prevent the complication such as the pseudoaneurysm or the periostial aneurysm formation around the coronary artery in the long term period. Concomitant procedures were aortic arch replacement in all cases, total arch replacement with four vessels graft in 3 cases and hemiarch replacement in 1 case. Each operations were performed with the aid of selective cerebral perfusion and open distal anastomosis.