Total aortic arch grafting via median sternotomy using integrated antegrade cerebral perfusion

Simplified surgical approach to improve surgical outcomes in the center with a small volume of acute type A aortic dissection surgery

BACKGROUND:

Despite recent advances in surgical techniques and perioperative management, the surgical mortality of acute type A aortic dissection remains high.

OBJECTIVE:

In a hospital with few acute type A aortic dissection operations, we retrospectively investigated whether simplified surgical approach could obtain proper surgical outcomes.

METHODS:

Between October 2007 and December 2016, we performed emergency surgery in 99 patients who had acute type A aortic dissection, including replacement of the hemi-arch in 62 patients (63%) and total arch in 32 patients (32%) and aortic root surgery in 7 patients (7%). Surgical strategy has been simplified over time.

RESULTS:

We performed right axillary artery perfusion in 61 patients (62%) and antegrade cerebral perfusion in 78 patients (79%). During the last 3 years, in-hospital mortality was decreased to 4% (2/47). Preoperative unresolved shock was an independent predictor of hospital death. Although the patients with total arch replacement or aortic root surgery had a mean significantly long cardiopulmonary bypass or circulatory arrest time, in-hospital mortality or neurologic complications was not increased.

CONCLUSIONS:

Simplified surgical approach could provide a reasonable surgical outcome in acute type A aortic dissection surgery in a center with a small volume of acute aortic dissection surgery.