EXTENDED AORTIC REPLACEMENT FOR ACUTE TYPE-A DISSECTION WITH THE TEARIN THE DESCENDING AORTA

Objective: There has been controversy as to the selection of surgical treatments for acute type A dissection with the tear in the descending thoracic aorta, a subtype of acute aortic dissection in which the lim ited tear is located distal to the left subclavian artery but the diss ection extends retrogradely to the ascending aorta, Methods: Total rep lacement of the ascending aorta and aortic arch was performed in 12 pa tients with acute type A dissection with the tear in the descending th oracic aorta between March 1991 and the end of September 1995. The ind ications for total replacement of the ascending aorta and aortic arch were cardiac tamponade, acute aortic regurgitation, cerebral ischemia, and dilatation of the ascending aorta, The operation was performed wi th the aid of extracorporeal circulation, blood cardioplegia, selectiv e cerebral perfusion, and open distal anastomosis, The surgical proced ure used was total replacement of the ascending aorta and aortic arch with a graft provided with three limbs accompanied by resection of the intimal tear in the descending thoracic aorta. Results: Hospital deat h occurred in two patients (16.7%), In both, death was due to dissecti on/related complications of renal/mesenteric ischemia, The other 10 pa tients have had uneventful postoperative courses over a mean period of 24 months, Conclusions: Total replacement of the ascending aorta and aortic arch accompanied by resection of an intimal tear distal to the left subclavian artery seems to be justified in selected patients with acute type A dissection with the tear in the descending thoracic aort a.