Simplified total arch repair with a stented graft for acute DeBakey type I dissection.

OBJECTIVE: A novel technique for total arch repair was developed, and the safety and feasibility of this simplified technique were compared with those of total arch replacement.

METHODS: With the use of a self-designed stented graft, of which the proximal 10 cm is free of stent, 54 patients with acute type I dissection underwent ascending aorta replacement combined with total arch repair (simplified group). The stented part was implanted into the descending aorta as an elephant trunk, and the part free of stent was sutured inside the arch with exposure of the orifices of 3 arch vessels. A total of 41 patients with acute type I dissection undergoing ascending aorta and total arch replacement with stented elephant trunk (total arch group) were enrolled as controls.

RESULTS: There was no permanent neurologic dysfunction or paraplegia in both groups. The incidence of postoperative transient neurologic dysfunction and prolonged ventilation was lower in the simplified group (P<.05). The hospital mortality was 3.7% (2/54) in the simplified group and 7.3% (3/41) in the total arch group (P=.44). No significant difference was detected in survival between the 2 groups (P=.78). Complete thrombosis in the false lumen of the residual arch was found in all patients undergoing simplified aortic repair. The rate of complete thrombosis in the false lumen of the distal aorta was similar between the 2 groups (P>.05). The risks of aortic event were comparable for both groups (P=.84).

CONCLUSIONS: The simplified technique of total arch repair is an easy and effective surgical strategy for acute type I dissections.