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J Thorac Cardiovasc Surg 2000;119:558-565
© 2000 Mosby, Inc.

SURGERY FOR ACQUIRED CARDIOVASCULAR DISEASE

EXTENDED TOTAL ARCH REPLACEMENT FOR ACUTE TYPE A AORTIC DISSECTION: EXPERIENCE WITH SEVENTY PATIENTS

Teruhisa Kazui, MDa, Naoki Washiyama, MDa, Bashar Abul Hasan Muhammad, MBBSa, Hitoshi Terada, MDa, Katsushi Yamashita, MDa, Makoto Takinami, MDa, Yukihiko Tamiya, MDb

From the First Department of Surgery, Hamamatsu University School of Medicine,a Hamamatsu, and the Second Department of Surgery,b Sapporo Medical University, Sapporo, Japan.

Address for reprints: Teruhisa Kazui, MD, First Department of Surgery, Hamamatsu University School of Medicine, 3600 Handa-Cho, Hamamatsu, Japan, 431-3192 (E-mail: surg1ss{at}hama-med.ac.jp ).

Objective: We sought to report the clinical experience with extended total arch replacement for acute type A aortic dissection and to determine the factors that influence early mortality, late survival, and late reoperation.
Methods: Between December 1988 and August 1998, 70 patients underwent emergency graft replacement of both the ascending aorta and the total aortic arch for acute type A aortic dissection. All operations were performed with hypothermic extracorporeal circulation, selective cerebral perfusion for cerebral protection during aortic arch repair, and open distal anastomosis. Concomitant procedures included aortic valve resuspension in 18 patients, composite graft replacement in 10 patients, and coronary artery bypass grafting in 5 patients.
Results: The early mortality rate was 16% (11 of 70 patients). Multivariable analysis showed that renal-mesenteric ischemia and coronary artery bypass grafting were independent determinants for early death. Survival rates at 3 and 5 years postoperatively, including the early deaths, were 75% ± 5% and 73% ± 6%, respectively. Multivariable analysis showed that renal-mesenteric ischemia and en bloc repair were independent determinants for late death. Freedom from reoperation was 91% ± 4% and 77% ± 8% at 3 and 5 years, respectively. Multivariable analysis showed that anastomotic leakage was the only significant determinant for late reoperation.
Conclusions: Extended total arch replacement for acute type A aortic dissection could be justified in properly selected patients.




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