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J Thorac Cardiovasc Surg 2009;138:1032-1035
© 2009 The American Association for Thoracic Surgery

Brief Technique Report

Ascending aortic arch replacement with aortic valve resuspension under deep hypothermic arrest combined with endoluminal stenting of the descending thoracic aorta and the entire abdominal aorta

^a University of Southampton School of Medicine, Southampton General Hospital, Southampton, United Kingdom
^b Department of Vascular Surgery, St Vincent's Hospital, Melbourne, Australia
^c Department of General Surgery, St Vincent's Hospital, Melbourne, Australia
^d Department of Medical Imaging, St Vincent's Hospital, Melbourne, Australia
^e Department of Cardiothoracic Surgery, St Vincent's Hospital, Melbourne, Australia
^f Department of Medical and Molecular Bio-Sciences, University of Technology, Sydney, Australia

Received for publication June 8, 2008; accepted for publication June 19, 2008.

^_* Address for reprints: Maqsood M. Elahi, FACS, University of Southampton, School of Medicine, Southampton General Hospital, Tremona Rd, Southampton 5016, UK. (Email: manzoor_elahi@hotmail.com).

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

	Introduction

 
While the use of hybrid approaches to the treatment of Type-A dissection is growing, the combined use of surgical ascending aortic repair and bare stenting of the residually dissected aorta is relatively novel. In this report we discuss the application of a self-expanding dissection specific bare stent used in combination with surgery for repair of the entire aorta.

	Clinical Summary

 
A 57-year-old man with no previous illnesses presented with type A dissection that extended from the noncoronary leaflet of the aortic valve throughout the thoracoabdominal aorta into both common iliac arteries. The intimal flap extended into the innominate, left subclavian, and superior mesenteric arteries with the celiac and left renal arteries arising from the false lumen (Figure 1 , A).

View larger version (65K):   Figure 1. A, Multislice computed tomography performed on transfer of the patient to the tertiary referral institution with an initial diagnosis of aortic dissection. B, Arch of the aorta showing the 30-mm intervascular woven graft and great vessels. The dissected aortic, ascending aorta, and arch were excised, leaving an island of head and neck vessels and the distal aorta. The wall was reconstituted, and the graft was fashioned to fit the arch.