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The Annals of Thoracic Surgery, Vol 57, 669-676, Copyright © 1994 by The Society of Thoracic Surgeons
M Ando, N Nakajima, S Adachi, M Nakaya and Y Kawashima
We performed simultaneous graft replacement of the total aortic arch and
ascending aorta for type A aortic dissection with a patent false lumen
extending through the arch into the descending or abdominal aorta. During
the past 7 years, this procedure was performed in 42 patients (28 men and
14 women), aged 20 to 72 years (mean age, 50 years). Nineteen patients
underwent the procedure during the acute period, and 23 during the chronic
period. The site of the initial intimal tear was the ascending aorta in 17
patients and the transverse aortic arch in 25 patients. Artificial graft
replacement was initially accomplished by proximal anastomosis, followed by
open distal anastomosis, and finally by anastomosis of each of the three
arch vessels. There were 3 hospital deaths (7.1%), 1 resulting from acute
dissection (5.3%) and 2 from chronic dissection (8.7%). Among the type A
dissections, total arch graft replacement has been indicated in the setting
of rupture of the aortic arch, arch dissection, and Marfan's syndrome.
However, with increasing experience in arch reconstructions and improvement
in outcome, the indications could be expanded to include all type A aortic
dissections with a patent false lumen in the descending aorta.
ARTICLES
Simultaneous graft replacement of the ascending aorta and total aortic arch for type A aortic dissection
Department of Cardiovascular Surgery, National Cardiovascular Center, Osaka, Japan.
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