SINGLE-STAGE REPAIR OF DISTAL AORTIC-ARCH AND THORACOABDOMINAL DISSECTING ANEURYSMS USING AORTIC TAILORING AND CIRCULATORY ARREST

The adjuncts of profound hypothermic circulatory arrest and aortic tai loring are combined with standard graft replacement of the noncritical portions of the aorta. This combination permits single-stage replacem ent of the arch, thoracic, and abdominal aorta in patients with postdi ssection aneurysm. Reconstruction is begun with repair of the mid to d istal aortic arch and Dacron graft replacement of the proximal descend ing thoracic aorta, usually under profound hypothermic circulatory arr est. The proximal graft is then cannulated and the patient partially w armed while the middle segment is ''tailored.'' Aortic tailoring consi sts of longitudinal aortotomy and removal of the dissection membrane(s ) from the distal third of the descending thoracic aorta to below the renal arteries. The aorta is then closed creating a single channel 2 t o 3 cm in diameter and containing the origins of the important interco stal, lumbar, and visceral arteries. A Dacron graft is used to replace the infrarenal segment. Five patients have successfully undergone sin gle-stage, total repair of the aorta including the arch, thoracic, and abdominal segments. All survived without paraplegia or significant vi sceral ischemia. Follow-up has not shown dilatation of the tailored se gment. We believe that reduction in diameter of the tailored aortic se gment and thus wall tension, growth of neointima on all luminal aortic surfaces, and active collagen deposition contribute to the success of this procedure.