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Ann Thorac Surg 2005;80:1297-1302
© 2005 The Society of Thoracic Surgeons

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Original article: Cardiovascular

Long-Term Effectiveness of Total Arch Replacement for Type A Aortic Dissection

^a Department of Cardiovascular Surgery, Kyushu Koseinenkin Hospital, Kitakyushu
^b Department of Cardiovascular Surgery, Shimonoseki Municipal Hospital, Shimonoseki, Japan

Accepted for publication April 1, 2005.

^_* Address reprint requests to Dr Ochiai, Department of Cardiovascular Surgery, Kyushu Koseinenkin Hospital, 1-8-1, Kishinoura, Yahatanishi-ku, Kitakyushu, 806-8501, Japan (Email: ochiaiy{at}alto.ocn.ne.jp).

BACKGROUND: With recent improvements in cerebral protection during aortic arch repair, total aortic arch replacement has become an accepted surgical method for acute type A aortic dissection involving the aortic arch. Our surgical strategy is to perform total arch replacement with a branched graft using antegrade selective cerebral perfusion for the patients with type A aortic dissection involving the aortic arch. The objective of this study is to evaluate the effectiveness of this strategy on late outcome.

METHODS: From October 1988 to April 2003, 46 patients underwent total arch replacement for acute type A dissection involving the aortic arch. Operations were performed with hypothermic cardiopulmonary bypass, antegrade selective cerebral perfusion during the arch repair, and open distal anastomosis.

RESULTS: Hospital mortality was 6.5% (3 patients), and permanent neurologic dysfunction was observed in 1 patient. During the follow-up period (mean, 5.4 years; range, 13 months to 15.6 years), 2 patients died, but the causes were not related to the aorta or aortic valve. Survival rates at 5 and 10 years postoperatively were 89.6% ± 5.2% and 82.7% ± 8.2%, respectively. Of the 41 survivors, 3 patients underwent successful reoperation for the distal thoracic aorta. Freedom from reoperation was 93.6% ± 4.6% and 88.7% ± 6.5% at 5 and 10 years, respectively. The residual false lumen in the thoracic aorta was frequently thrombosed (76.2%).

CONCLUSIONS: Total arch replacement for acute type A dissection may decrease the risk of late complications related to the false lumen and lead to excellent long-term survival.

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