REPLACEMENT OF THE TRANSVERSE AORTIC-ARCH FOR TYPE-A ACUTE AORTIC DISSECTION

Surgical treatment of acute aortic dissection involving the segment of transverse aortic arch is difficult and often associated with a high mortality and morbidity. The high mortality and morbidity are primaril y related to anatomic features and techniques of cerebral protection e mployed during the period of aortic branch occlusion needed for recons truction. This study reports our experience of 20 consecutive cases of acute type A aortic dissection treated by repair or replacement of th e transverse aortic arch during emergency operation. Ages of the patie nts ranged from 56 to 76 years. All patients were referred to us withi n 2 weeks of onset (mean time, 58 hours). Selective cerebral perfusion or deep hypothermia with complete circulatory arrest was employed dur ing the period of aortic branch occlusion. Duration of cerebral perfus ion, circulatory arrest, myocardial ischemia, and cardiopulmonary bypa ss averaged 106 minutes, 32 minutes, 127 minutes, and 248 minutes, res pectively. There were three operative deaths. All three dissections we re ruptured ones, and the patients died of hemorrhage, deep coma, or m ultiple organ failure. One patient died of infection 3 months after op eration. The remaining patients are alive and well without any detecta ble neurological deficit 1 month to 4 years postoperatively. This expe rience emphasizes that repair or replacement of acute type A aortic di ssection involving the aortic arch can be performed safely by adequate selection of patients, supportive measures, and operative methods.