Is Emergency Total Arch Replacement With a Modified Elephant Trunk Technique Justified for Acute Type A Aortic Dissection?

Cerebral protection during surgery of the aortic arch

Brain injury represents a primary concern during aortic arch surgery. Valid surgical techniques and reliable methods of brain protection are required to obtain a favorable outcome after such a complex surgery. Our aim was to review available methods of brain protection including deep hypothermia and circulatory arrest, retrograde cerebral perfusion and antegrade cerebral perfusion.

Thoracic aortic dissection: long-term results of endovascular and open repair

Treatment paradigms for aortic dissection are based upon the types of complications with which the patients present. For acute uncomplicated dissection, medical therapy is preferred. Endovascular repair is preferred for patients with acute distal dissection complicated by end-organ malperfusion, rupture, or aneurysmal degeneration. For patients with chronic dissection with aneurysm, open repair is preferred if safe, and endovascular treatment should be limited to highest-risk patients because of the uncertainty of success with this approach. For intermediate-risk patients, hybrid repairs provide a good alternative. Ultimately, improvement in long-term outcomes after treatment of aortic dissection still depends on prevention of end-organ ischemia and aneurysmal degeneration of the chronically dissected distal aorta. Although the evidence base for the roles of various approaches is lacking, data currently being accrued and must be closely analyzed to better estimate both the short- and long-term benefits of these complementary treatment strategies.

Midterm results of aortic arch replacement in a stanford type a aortic dissection with an intimal tear in the aortic arch

Background and Objectives

Stanford type A aortic dissection is a potentially catastrophic event that requires surgical repair, on an emergency basis. The extent of arch repair that should be carried out during emergency surgery of this type is controversial. This study was designed to evaluate the results of arch replacement carried out during acute type A dissection.

Subjects and Methods

28 patients with Stanford type A dissection and who underwent arch replacement between 1995 and 2006 were reviewed.

Results

Hospital mortality was 3.6% (1 patient), and transient neurocognitive dysfunction was observed in 5 patients. During the follow-up period (mean 26±20 months; range 1 to 66 months), 3 patients underwent reoperation due to descending thoracic or abdominal aortic aneurysm. There was no late death. Follow up computed tomography was performed in 15 patients and false lumen disappeared totally or partially in 10 patients (66.7%).

Conclusion

Arch replacement for acute Stanford type A dissection may decrease the risk of late complications related to false lumen and lead to an excellent midterm survival rate.