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Ann Thorac Surg 1994;57:669-676
© 1994 The Society of Thoracic Surgeons
Department of Cardiovascular Surgery, National Cardiovascular Center, Osaka, Japan
Accepted for publication June 1, 1993.
* Address reprint requests to Dr Ando, National Cardiovascular Center 5-7-1 Fujishiro-dai, Suita, Osaka 565, Japan.
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 Marian'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.
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