Urgent total arch graft replacement in an elderly patient with acute type A dissection: report of a case

There are many controversies regarding the treatment of acute aortic dissections. We herein present the case of an elderly patient over 80 years of age who underwent an urgent total arch graft replacement for a Stanford type A acute thrombosed aortic dissection complicating cardiac tamponade. An 81-year-old woman with chest discomfort and shock that developed 1 day earlier was transferred to our hospital by ambulance. A plain chest computed tomogram, aortogram, and an echocardiography revealed mild pericardial effusion and an ascending aortic aneurysm measuring 5 cm in diameter, but no evidence of an intimal tear in the ascending aorta and aortic arch. At operation, after the bloody pericardial effusion had been decompressed, her blood pressure was elevated and a type A acute thrombosed aortic dissection with the intimal tear in the aortic arch was confirmed, with a false channel filled with clotted blood. She underwent a successful emergency total arch graft replacement using selective cerebral perfusion and open distal anastomosis. The postoperative course was uneventful and the false lumen was closed. We thus conclude that early graft replacement should be performed on patients with Stanford type A acute thrombosed aortic dissection complicating cardiac tamponade, even in elderly patients over 80 years old.