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): Nicholas T. Kouchoukos Chris K. Rokkas Suzan F. Murphy Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Kouchoukos, N. T. Articles by Murphy, S. F. Search for Related Content PubMed PubMed Citation Articles by Kouchoukos, N. T. Articles by Murphy, S. F. Related Collections Great vessels

J Thorac Cardiovasc Surg 2001;122:578-582
© 2001 The American Association for Thoracic Surgery

Surgery for Acquired Cardiovascular Disease (ACD)

Single-stage reoperative repair of chronic type A aortic dissection by means of the arch-first technique

From the Division of Cardiovascular and Thoracic Surgery, Missouri Baptist Medical Center, St Louis, Mo.

Received for publication Jan 16, 2001. Revisions requested Feb 13, 2001; revisions received March 1, 2001. Accepted for publication March 8, 2001. Address for reprints: Nicholas T. Kouchoukos, MD, 3009 N Ballas Rd, Suite 266C, St Louis, MO 63131 (E-mail NTKouch{at}aol.com).

Abstract

Objective: Management of the enlarged, chronically dissected aorta after previous repair of acute aortic dissection or after a previous cardiac operation may present a formidable technical challenge. Marked enlargement of the proximal descending thoracic aorta precludes safe use of staged procedures, including the elephant trunk technique.
Methods: Sixteen patients with chronic type A aortic dissection (mean age, 56 years) underwent resection of the ascending aorta, the aortic arch, and varying segments of the descending thoracic aorta. We used single-stage replacement, with perfusion of the aortic arch first to minimize the duration of brain ischemia, with a bilateral anterior thoracotomy (clamshell) incision. Eleven patients had undergone previous repair of acute type A dissection. Five patients had type A dissection after aortic valve replacement (2 patients) and coronary artery bypass (3 patients). Marked enlargement of the aorta distal to the left subclavian artery precluded a 2-stage repair. The mean interval between the initial and reoperative procedures was 62 months (range, 5-137 months).
Results: There was 1 (6.2%; 70% confidence limits, 0.3%-24.7%) hospital death. Four patients required reoperation for bleeding. One patient required a right ventricular assist device that was successfully removed. Six patients required assisted ventilation for more than 72 hours, and 3 patients required a tracheostomy. All were successfully weaned from ventilatory support. No patient had a stroke or other adverse neurologic outcome.
Conclusion: The single-stage, arch-first replacement technique is a safe and effective procedure for patients who require extensive reoperations for chronic expanding type A dissection.

This article has been cited by other articles:

				L.-Z. Sun, R.-D. Qi, Q. Chang, J.-M. Zhu, Y.-M. Liu, C.-T. Yu, B. Lv, J. Zheng, L.-X. Tian, and J.-G. Lu Is total arch replacement combined with stented elephant trunk implantation justified for patients with chronic Stanford type A aortic dissection? J. Thorac. Cardiovasc. Surg., October 1, 2009; 138(4): 892 - 896. [Abstract] [Full Text] [PDF]

				N. T. Kouchoukos, P. Masetti, M. C. Mauney, M. C. Murphy, and C. F. Castner One-Stage Repair of Extensive Chronic Aortic Dissection Using the Arch-First Technique and Bilateral Anterior Thoracotomy Ann. Thorac. Surg., November 1, 2008; 86(5): 1502 - 1509. [Abstract] [Full Text] [PDF]

				M. Karck and H. Kamiya Progress of the treatment for extended aortic aneurysms; is the frozen elephant trunk technique the next standard in the treatment of complex aortic disease including the arch? Eur. J. Cardiothorac. Surg., June 1, 2008; 33(6): 1007 - 1013. [Abstract] [Full Text] [PDF]

				J. P. Schwartz, M. Bakhos, A. Patel, S. Botkin, and S. Neragi-Miandoab Repair of aortic arch and the impact of cross-clamping time, New York Heart Association stage, circulatory arrest time, and age on operative outcome Interactive CardioVascular and Thoracic Surgery, June 1, 2008; 7(3): 425 - 429. [Abstract] [Full Text] [PDF]

				T. B. Reece, G. R. Green, and I. L. Kron Aortic Dissection Card. Surg. Adult, January 1, 2008; 3(2008): 1195 - 1222. [Full Text]

				M. A. Pichlmaier, O. E. Teebken, H. Baraki, and A. Haverich The frozen elephant trunk technique MMCTS, March 29, 2007; 2007(0329): 1990. [Abstract] [Full Text] [PDF]

				M. Gorlitzer, W. Wislocki, J. Meinhart, and M. Grabenwoger Treatment of chronic aortic type A dissection with a new designed hybridprosthesis Eur. J. Cardiothorac. Surg., February 1, 2007; 31(2): 315 - 317. [Abstract] [Full Text] [PDF]

				H. Baraki, C. Hagl, N. Khaladj, K. Kallenbach, J. Weidemann, A. Haverich, and M. Karck The Frozen Elephant Trunk Technique for Treatment of Thoracic Aortic Aneurysms Ann. Thorac. Surg., February 1, 2007; 83(2): S819 - S823. [Abstract] [Full Text] [PDF]

				M. Karck, A. Chavan, N. Khaladj, H. Friedrich, C. Hagl, and A. Haverich The frozen elephant trunk technique for the treatment of extensive thoracic aortic aneurysms: operative results and follow-up Eur. J. Cardiothorac. Surg., August 1, 2005; 28(2): 286 - 290. [Abstract] [Full Text] [PDF]

				M. Sasaki, A. Usui, M. Yoshikawa, T. Akita, and Y. Ueda Arch-first technique performed under hypothermic circulatory arrest with retrograde cerebral perfusion improves neurological outcomes for total arch replacement Eur. J. Cardiothorac. Surg., May 1, 2005; 27(5): 821 - 825. [Abstract] [Full Text] [PDF]

				H. J. Soukiasian, S. S. Raissi, T. Kleisli, A. T. Lefor, G. P. Fontana, L. S. C. Czer, and A. Trento Total Circulatory Arrest for the Replacement of the Descending and Thoracoabdominal Aorta Arch Surg, April 1, 2005; 140(4): 394 - 398. [Abstract] [Full Text] [PDF]

				N. T. Kouchoukos, M. C. Mauney, P. Masetti, and C. F. Castner Single-stage repair of extensive thoracic aortic aneurysms: Experience with the arch-first technique and bilateral anterior thoracotomy J. Thorac. Cardiovasc. Surg., November 1, 2004; 128(5): 669 - 676. [Abstract] [Full Text] [PDF]

				M. Doss, T. Woehleke, J. P. Wood, S. Martens, G. W. Greinecker, and A. Moritz The clamshell approach for the treatment of extensive thoracic aortic disease J. Thorac. Cardiovasc. Surg., September 1, 2003; 126(3): 814 - 817. [Abstract] [Full Text] [PDF]

				G. R. Green and I. L. Kron Aortic Dissection Card. Surg. Adult, January 1, 2003; 2(2003): 1095 - 1122. [Full Text]

				D. Spielvogel, M. N. Mathur, and R. B. Griepp Aneurysms of the Aortic Arch Card. Surg. Adult, January 1, 2003; 2(2003): 1149 - 1168. [Full Text]

				T. Kazui, K. Yamashita, N. Washiyama, H. Terada, A. H. M. Bashar, T. Suzuki, and K. Ohkura Impact of an aggressive surgical approach on surgical outcome in type A aortic dissection Ann. Thorac. Surg., November 1, 2002; 74(5): S1844 - 1847. [Abstract] [Full Text] [PDF]

				N. T. Kouchoukos, P. Masetti, and C. K. Rokkas Single-stage replacement of the thoracic aorta Ann. Thorac. Surg., October 1, 2002; 74(4): 1292 - 1292. [Full Text] [PDF]

				T. M. Beaver and T. D. Martin Reply Ann. Thorac. Surg., October 1, 2002; 74(4): 1293 - 1293. [Full Text] [PDF]