HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Hitoshi Ogino Kenji Minatoya Hitoshi Matsuda Motomi Ando Soichiro Kitamura Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Watanuki, H. Articles by Kitamura, S. Search for Related Content PubMed PubMed Citation Articles by Watanuki, H. Articles by Kitamura, S. Related Collections Great vessels

---

Original Articles: Cardiovascular

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

^a Department of Cardiovascular Surgery, National Cardiovascular Center, Osaka, Japan
^b Department of Thoracic Surgery, Fujita Health University, Osaka, Japan

Accepted for publication June 15, 2007.

^_* Address correspondence to Dr Ogino, Department of Cardiovascular Surgery, National Cardiovascular Center, 5-7-1 Fujishirodai, Suita, Osaka, 565-8565, Japan (Email: hogino{at}hsp.ncvc.go.jp).

Presented at the Poster Session of the Forty-third Annual Meeting of The Society of Thoracic Surgeons, San Diego, CA, Jan 29–31, 2007.

Background: We assess the outcome of emergency total arch replacement with a modified elephant trunk technique for acute type A aortic dissection to clarify whether our aggressive approach is justified in certain patients.

Methods: Between 2000 and 2006, 54 patients (55.1% of all) underwent emergency total arch replacement for acute type A aortic dissection. The surgery was performed using open distal anastomosis with selective antegrade cerebral perfusion under hypothermia. Total arch replacement with individual arch-vessel reconstruction was applied in the following settings: the intimal tear in the transverse arch or the proximal descending aorta, massive arch dissection, Marfan syndrome, arch aneurysm, and atheromatous arch. At the distal anastomosis, a modified elephant trunk procedure was added for secure anastomosis and early thrombosed closure of the false channel in the descending aorta.

Results: Only 2 patients (3.7%) died of low cardiac output, in whom cardiac arrest had developed preoperatively owing to rupture of the arch or to left coronary artery malperfusion. There were 4 late deaths from nonaortic events. On the follow-up computed tomographic scanning, a high incidence of early thrombosed closure of the false channel in the dissected descending aorta was found. Only 2 patients, whose tear had not been resected in the first surgery, required reoperation of the descending aorta.

Conclusions: Total arch replacement with an elephant trunk procedure, which permits immediate survival and provides early thrombosed closure of the distal false channel, is justified in certain patients with acute type A dissection.

This article has been cited by other articles:

				A. Pochettino, W. T. Brinkman, P. Moeller, W. Y. Szeto, W. Moser, K. Cornelius, F. W. Bowen, Y. J. Woo, and J. E. Bavaria Antegrade thoracic stent grafting during repair of acute DeBakey I dissection prevents development of thoracoabdominal aortic aneurysms. Ann. Thorac. Surg., August 1, 2009; 88(2): 482 - 489. [Abstract] [Full Text] [PDF]

				H. Tanaka, K. Okada, Y. Kawanishi, M. Matsumori, and Y. Okita Clinical significance of anastomotic leak in ascending aortic replacement for acute aortic dissection Interactive CardioVascular and Thoracic Surgery, August 1, 2009; 9(2): 209 - 212. [Abstract] [Full Text] [PDF]

				H. Takayama, C. R. Smith, M. E. Bowdish, and A. S. Stewart Open distal anastomosis in aortic root replacement using axillary cannulation and moderate hypothermia. J. Thorac. Cardiovasc. Surg., June 1, 2009; 137(6): 1450 - 1453. [Abstract] [Full Text] [PDF]

				H. Hata, K. Toda, Y. Shudo, S. Kainuma, K. Yoshida, K. Yamamoto, and K. Taniguchi Repair for acute type A aortic dissection with a long elephant trunk technique. J. Thorac. Cardiovasc. Surg., March 1, 2009; 137(3): 777 - 778. [Full Text] [PDF]

				K.-H. Park, C. Lim, J. H. Choi, E. Chung, S. I. Choi, E. J. Chun, and K. Sung Midterm Change of Descending Aortic False Lumen After Repair of Acute Type I Dissection Ann. Thorac. Surg., January 1, 2009; 87(1): 103 - 108. [Abstract] [Full Text] [PDF]