[Long-term results of operation for acute type A aortic dissection]

We report results of surgical treatment in 30 patients with acute type A aortic dissection. The average age of the 25 patients without the Marfan syndrome was 59.2 (range 51-76), and male/female ratio was 11/14. The average age of the five patients with the Marfan syndrome was 36.8 (range 27-48), and male/female ratio was 2/3. As an adjunct, we used deep hypothermic circulatory arrest during ascending aortic replacement, while selective cerebral perfusion was employed during aortic arch replacement. Operative procedures for the non-Marfan patients included 14 ascending aortic replacement and 11 ascending and aortic arch replacement, while the Marfan patients underwent extensive aortic replacement that included three aortic arch replacement combined with the Bentall operation, one extensive replacement from the ascending aorta to the descending thoracic aorta and one ascending and aortic arch replacement. One patient died early after the operation and the early mortality rate was 3.3%. No patient developed new brain complication related to the operation. During the follow-up period, three patients died and two patients required a total of three subsequent distal operations. Cumulative survival rate was 89% at one year, 85% at three years, 85% at five years. Cumulative cardiovascular event-free rate was 89% at one year, 85% at three years, 77% at five years. Early and long-term results of surgical treatment for acute type A aortic dissection was satisfactory. This seems to result from the use of deep hypothermic circulatory arrest and selective cerebral perfusion as an adjunct and application of aortic arch replacement when the aortic arch is dilated or intimal tear is located in the aortic arch or more distally.