Novel and Innovative Hybrid Technique for Type A Aortic Dissection.

Acute Stanford type A aortic dissection (TAAD) is a surgical emergency characterized by a high mortality rate and numerous complications. In the treatment of TAAD, the timing of surgery and the choice of surgical procedure are of paramount importance. Open total aortic arch reconstruction remains the gold standard for aortic arch surgery and is one of the most challenging procedures. However, this approach is invasive, relatively lengthy, and associated with substantial bleeding, which necessitates high levels of operator skill and carries the risk of multiple complications, particularly neurological ones. This report describes a novel hybrid procedure named Open Ascending Aorta Replacement Combined with Fenestrated Total Aortic Arch Stenting. A case was selected in which the lesion did not involve the aortic arch, at least on the greater curvature side of the arch. Ascending aortic replacement was performed, followed by arch intervention with self-modified stent grafts to preserve the aortic arch native branches. This approach allows for a rapid simplification of the procedure, avoids deep hypothermia or circulatory arrest associated with conventional open surgery, and mitigates neurological complications.