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J Thorac Cardiovasc Surg 2002;124:531-540
© 2002 The American Association for Thoracic Surgery

Surgery for Acquired Cardiovascular Disease (ACD)

The results of total arch graft implantation with open stent-graft placement for type A aortic dissection

From the Division of Cardiovascular and Thoracic Surgery,^a Department of Surgery, Saitama Medical School, Saitama, Japan, and the Division of Cardiovascular Surgery,^b Osaka Prefectural Hospital, Osaka, Japan.

Supported by the Research Grant for Cardiovascular Disease (13A-2) from the Ministry of Health and Welfare.

Received for publication Aug 30, 2001. Revisions requested Dec 14, 2001; revisions received Jan 29, 2002. Accepted for publication Feb 7, 2002. Address for reprints: Masaask Kato, MD, Division of Cardiovascular & Thoracic Surgery, Saitama Medical School, 38 Morohonngou Moroyama-Chou, Irima-gunn, Saitama 350-0495, Japan (E-mail: mkato{at}xk9.so-net.ne.jp).

Background: One problem that conventional ascending treatment for type A aortic dissection has not satisfactorily resolved is chronic enlargement of residual dissection in the aortic arch and descending aorta. To address this problem, we have developed a new method for type A aortic dissection: total arch graft implantation with open-style stent-graft placement.
Methods: From October 1994 through October 1999, 19 patients with type A aortic dissection (13 acute and 6 chronic dissections) underwent total arch graft implantation with open-style stent-graft placement. After achievement of general anesthesia and hypothermic extracorporeal circulation, we replaced the dissected ascending aorta and neck vessels with a 4-branched graft and repaired the descending aorta with a stent graft to close the entry site completely and to obtain better peripheral perfusion. We then examined the acute-phase and chronic-phase results and the outcomes of the false lumen and dissected aorta.
Results: There were 1 (5.3%) hospital death and 2 late deaths. The survivals at 1 and 3 years were 89.5% and 82.6%, respectively. The following complications occurred in the perioperative period: 1 stroke, 2 cases of temporary paraparesis, 2 cases of temporary hemodialysis, and 3 cases of mediastinitis. No pulmonary complications were observed. Six months postoperatively, the targeted entry sites were completely closed in all cases, 80% (8/10) of preoperatively patent false lumina were clotted at the level of the end of the stent graft, and 60% (9/15) of the false lumina and 40% (6/15) of the dissected aorta had shrunk significantly. Two (13.3%) of 15 cases of postoperative dilatation in the dissected aorta were observed, and reoperation related to residual dissected aorta was performed in only 1 (1/17 [5.9%]) patient during the mean follow-up period of 2.4 ± 1.6 years.
Conclusion: Our preliminary review of the total arch graft implantation with a stent graft suggests that this new procedure for type A aortic dissection might provide better results in both the acute and the chronic phase, especially with regard to the outcome for the false lumen and dissected aorta.

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