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J Thorac Cardiovasc Surg 2009;137:1290-1292
© 2009 The American Association for Thoracic Surgery

Brief Communication

Aortic dissection type A after supra-aortic debranching and implantation of an endovascular stent-graft for type B dissection: A word of caution

^a Department of Cardiac Surgery, Heidelberg University Hospital, Heidelberg, Germany
^b Department of Radiology, Heidelberg University Hospital, Heidelberg, Germany

Received for publication July 22, 2008; accepted for publication October 4, 2008.

^_* Address for reprints: Payam Akhyari, MD, Department of Cardiac Surgery, University Clinic Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg. (Email: payam.akhyari@med.uni-heidelberg.de).

The first 20% of the full text of this article appears below.

Combined procedures involving an endovascular stenting technique and transposition of the aortic arch vessels have been proposed for the treatment of aneurysms or chronic dissections involving the descending thoracic aorta and the aortic arch. This novel concept abandons the use of extracorporeal circulation and can be applied without a full-length sternotomy.¹ Reductions in surgical trauma and periprocedural morbidity and mortality have therefore been proposed as advantages for this novel technique.² Here we report on 2 cases of Stanford type A aortic dissection that occurred during supra-aortic debranching and endovascular stenting of the aortic arch and the descending aorta.

Clinical Summary

In April 2008, 2 patients, both with no signs of Marfan syndrome, were admitted to our department with type A aortic dissection.

Patient 1
A 49-year-old man with an expanding chronic type B aortic dissection (maximum diameter 6.0 cm; Figure 1, A ) underwent a prosthetic bypass from the ascending aorta to the innominate artery with a crossover bypass to the left subclavian artery and insertion of the left common carotid artery into the crossover bypass through a partial sternotomy. The . . . [Full Text of this Article]

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