Surgical management of acute type A aortic dissection: branch-first arch replacement with total aortic repair

Acute type A dissection (ATAAD) remains a morbid condition with reported surgical mortality as high as 25%. We describe our surgical approach to ATAAD and discuss the indications for adjunct techniques such as the frozen elephant trunk or complete aortic repair with endovascular methods. Arch replac...

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Bibliographic Details
Published in:Annals of cardiothoracic surgery 2016-05, Vol.5 (4), p.236-244
Main Authors: Galvin, Sean D., Perera, Nisal K., Matalanis, George
Format: Article
Language:English
Subjects:
Art of Operative Techniques
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Summary:Acute type A dissection (ATAAD) remains a morbid condition with reported surgical mortality as high as 25%. We describe our surgical approach to ATAAD and discuss the indications for adjunct techniques such as the frozen elephant trunk or complete aortic repair with endovascular methods. Arch replacement using the “branch-first technique” allows for complete root, ascending aorta, and arch replacement. A long landing zone is created for proximal endografting with a covered stent. Balloon-assisted intimal disruption and bare metal stenting of all residual dissected aorta to the level of the aortic bifurcation is then performed to obliterate the false lumen (FL) and achieve single true lumen (TL) flow. Additional branch vessel stenting is performed as required.
ISSN:2225-319X
2304-1021
DOI:10.21037/acs.2016.05.11