[Total arch replacement with reconstruction of non-coronary sinus for acute type A aortic dissection after previous coronary artery bypass grafting; report of a case].

A 73-year-old man, who underwent coronary artery bypass grafting (CABG) 2 years previously, had suffered from acute type A aortic dissection with concomitant mild to moderate aortic regurgitation. A median resternotomy was performed. Arterial and venous cannulae were inserted into the femoral artery and vein to institute a cardiopulmonary bypass. The intimal tear was existed just above the sino-tubular junction. As the non-coronary sinus was involved in the dissection severely, it was resected in a scallop-shaped configuration. The aortic graft was tailored accordingly and anastomosis was performed in a curviliner fashion following the edge of scallop and the horizontally between the right and left coronary sinuses. Next, total arch replacement was performed using an aortic arch branched graft. Postoperative course was uneventful. Aortography revealed no aortic regurgitation and good patency of bypass graft.