Central Repair With Antegrade TEVAR for Malperfusion Syndromes in Acute Debakey I Aortic Dissection.

Background: In acute DeBakey I aortic dissection presenting with malperfusion syndromes, we assessed whether standard open repair with concomitant antegrade stent grafting (thoracic endovascular aneurysm repair; TEVAR) of the descending thoracic aorta (DTA) improves outcomes compared with standard repair alone.

Methods: From 2005 to 2012, 277 patients with acute DeBakey I dissection underwent emergent operation. Of these, 104 patients (37%) presenting with end-organ malperfusion were divided into those undergoing standard distal repair entailing transverse hemiarch replacement (Standard group, n = 65) versus standard repair with concomitant DTA TEVAR during circulatory arrest (TEVAR group, n = 39).

Hemiarch replacement with concomitant antegrade stent grafting of the descending thoracic aorta versus total arch replacement for treatment of acute DeBakey I aortic dissection with arch tear†.

Objectives: For acute DeBakey I aortic dissection with arch tear, conventional distal reconstruction entails total arch replacement (TAR). Some surgeons at our institution have utilized an alternative reconstructive strategy-primary arch tear repair and transverse hemiarch reconstruction (THR) with concomitant antegrade thoracic endovascular aortic repair (TEVAR). We assessed early and mid-term outcomes comparing these two surgical strategies for arch tear management.

Impact of timing on major complications after thoracic endovascular aortic repair for acute type B aortic dissection.

Objective: Thoracic endovascular aortic repair (TEVAR) has been shown to have survival benefit in patients with complicated type B dissection compared with open surgery or medical therapy. We analyze the impact of timing of intervention from the onset of symptoms to TEVAR, and its relation to complications.

Methods: Between 2005 and 2012, we performed 132 TEVARs for acute and subacute (<6 weeks) type B dissection; 186 other patients were managed with medical therapy only.

Endovascular repair of the ascending aorta in patients at high risk for open repair.

Objective: Although endovascular repair has been widely adopted for treatment of descending thoracic aortic pathologies, its role in ascending aortic pathologies remains undefined. We reviewed our experience with endovascular repair of ascending aortic pathologies in patients facing high or prohibitive risk with open surgical treatment.

Methods: From 2007 to 2013, 6 patients (aged 16-90 years) underwent endovascular repair (pseudoaneurysm, n = 4; acute type A aortic dissection, n = 2).