Abstract 756: Less invasive total arch replacement for acute type A aortic dissection -Total Arch Replacement with Branched Open Stentgrafting Technique -
Objectives Entry closure is essential to complete the treatment for aortic dissection. Therefore total arch replacement (TAR) should be performed for acute type A aortic dissection (AD(A)) when the intimal tear is located in the transverse arch. The procedure is, however, burdensome and associated with high operative risk. We had performed TAR with open stent grafting technique (stent grafting into the descending aorta through the opened aortic arch) since 1994 and modified the procedure in 2004 by using the branched stent graft for reconstruction of cerebral vessels (Branched open stent grafting technique; BOS). The concept of BOS is less invasive TAR which is as simple as hemiarch replacement. The objective of this study is to elucidate the efficacy and less invasiveness of BOS for acute AD(A) in comparison with conventional graft replacement of ascending aorta and hemiarch replacement (Asc/Hemi-).
Methods From January 2000 to January 2008, 115 patients with acute AD (A) underwent emergent operation at our institutions. In this seriese, 9 patients were treated with BOS and 50 patients were treated with Asc/Hemi. Patients with shock, cerebral infarction, and concomitant procedures such as valve replacement or CABG were excluded. The patients underwent MDCT or angiography preoperatively to detect the location of the intimal tear. BOS was performed when the tear was in the arch and Asc/Hemi was performed when the tear was in the ascending aorta. All the cases were treated with deep hypothermic circulatory arrest for brain protection.
Results; BOS vs Asc/Hemi There were no significant differences in operative time and cardiopulmonary bypass time between the two groups (466 vs 442 min, 184 vs 192 min, respectively) and the circulatory arrest time was almost the same (38 vs 33min). Neither of the groups had postoperative death within 30 days. We found no difference in the incidence of postoperative morbidities between the groups. BOS showed better clotting of the false lumen postoperatively compared with Asc/Hemi (100 % vs 50 % p<0.01).
Conclusions BOS for acute AD (A) could be performed as less invasively as Asc/Hemi, and showed satisfactory result by achieving better thrombosis in distal false lumen. This technique could be one of the standard procedures for AD(A).