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J Thorac Cardiovasc Surg 2009;138:1035-1037
© 2009 The American Association for Thoracic Surgery

Brief Technique Report

Endoprosthetic exclusion of type A aortic dissection through carotid artery

^a Department of Cardiovascular Surgery, University Hospital, Lausanne, Switzerland
^b Department of Anesthesiology, University Hospital, Lausanne, Switzerland
^c Department of Radiology, University Hospital, Lausanne, Switzerland

Received for publication June 3, 2008; accepted for publication November 15, 2008.

^_* Address for reprints: Patrick Ruchat, MD, Department of Cardiovascular Surgery, Centre Hospitalier Universitaire Vaudois, Rue du Bugnon 46, CH-1011 Lausanne, Switzerland. (Email: Patrick.Ruchat@chuv.ch).

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

	Introduction

 
Even today, totally endovascular repair of the ascending aorta remains only anecdotally reported,¹ although arch² and descending aorta endoprosthetic replacements are currently performed. Recognized treatment of type A dissection still remains emergency replacement of the ascending aorta, with adequate aortic valve and coronary ostial management.³ We describe a case in which the surgical strategy had to be somewhat innovative.

	Clinical Summary

 
A 64-year-old white man with a history of subtotal pericardiectomy for constrictive pericarditis had undergone a transseptal mechanical valve replacement 33 years previously to treat a degenerative mitral regurgitation. Because of a severe mediastinal fibrosis, we proceeded through a right anterolateral thoracotomy and right venoarterial femoral cannulation. Because of severe hemodynamic instability during cardiopulmonary bypass, arterial cannulation problems were suspected. Finally, retrograde iatrogenic aortic dissection with involvement . . . [Full Text of this Article]