Is total arch replacement combined with stented elephant trunk implantation justified for patients with chronic Stanford type A aortic dissection?

Objective: Surgical treatment of chronic Stanford type A aortic dissection using total arch replacement combined with stented elephant trunk implantation is controversial owing to the visceral arteries and intercostal arteries originating from the false lumen.

Methods: Eighty-nine patients (mean age, 45.67 +/- 10.

Surgery for acute type A dissection with the tear in the descending aorta using a stented elephant trunk procedure.

Background: Surgical management of acute type A dissection with the tear in the descending aorta is challenging because of the technical difficulty in managing proximal and distal aortic lesions through a median sternotomy or lateral thoracotomy using a single-stage procedure.

Methods: Thirty-three patients with acute type A dissection with the tear in the descending aorta underwent total arch replacement combined with stented elephant trunk implantation through a median sternotomy from April 2003 to June 2007. Preoperative complications included acute cardiac tamponade (n = 1), acute left heart failure (n = 1), acute myocardial infarction (n = 1), cerebral ischemia (n = 1), acute renal failure (n = 2), chronic renal dysfunction (n = 2), and acute mesenteric ischemia (n = 1) and lower extremity ischemia (n = 3).

Should the "elephant trunk" be skeletonized? Total arch replacement combined with stented elephant trunk implantation for Stanford type A aortic dissection.

Objectives: To eliminate the residual false lumen in the descending thoracic aorta and improve long-term outcomes of surgical intervention for Stanford type A aortic dissection, we performed the skeletonized "elephant trunk" procedure in the ascending aorta and aortic arch replacement combined with transaortic stented graft implantation into the descending aorta for both acute and chronic type A aortic dissection, and the short-term results were compared.

Methods: Between April 2003 and November 2004, 60 consecutive patients (mean age, 53 +/- 16.7; approximate range, 28-78 years) with acute (n = 36) or chronic (n = 24) type A aortic dissection underwent this procedure.

[Total arch replacement combined with stented elephant trunk implantation for Stanford type A aortic dissection].

Objective: To improve the long term outcomes of the surgery for Stanford type A aortic dissection, we performed ascending aorta and total aortic arch replacement combined with transaortic stented graft implantation into the descending aorta for acute and chronic type A aortic dissection.

Methods: From April 2003 to March 2004, 40 consecutive patients with acute or chronic Stanford type A aortic dissection underwent this procedure. Right axillary artery cannulation was routinely used for cardiopulmonary bypass and selected cerebral perfusion.