Total arch replacement combined with stented XXXX trunk implantation: a new "standard" therapy for type a dissection involving repair of the aortic arch?

@entity1 @entity7105 @entity64 @entity1566
BACKGROUND: Appropriate surgical management of type A dissection is a critical factor for achieving satisfactory outcome, but the choice of optimal procedure is controversial. We retrospectively reviewed our experience with aortic arch replacement for type A dissection involving the arch. METHODS AND RESULTS: Excluding 14 cases of subtotal or total aortic replacement, 411 of 544 @entity1 with type A dissection (stented @entity7105 trunk=291, conventional surgical repair=120) underwent aortic arch replacement between January 2003 and September 2008. In-hospital mortality was 3.09% (9 of 291) for stented (acute=4.73%, 7 of 148; chronic=1.40%, 2 of 143) and 5.00% (6 of 120) for conventional repairs (acute=6.06%, 4 of 66; chronic=3.70%, 2 of 54). @entity1566 was 2.41% (7 of 291) in the stented and 0.83% (1 of 120) in the conventional group. The overall prevalence of @entity64 was 1.95% (8 of 411) (stented=2.41%, 7 of 291; conventional=0.83, 1 of 120). Secondary intervention was 2.34% (5 of 214) for acute dissection (stented=1 and conventional=4; P=0.031) and 3.05% (6 of 197) for chronic dissection (stented=4 and conventional=2; P=0.661) during follow-up. Obliteration of the false lumen around the stented @entity7105 trunk occurred in 94.2% (130 of 138) of @entity1 with acute dissection and in 92.0% (126 of 137) of @entity1 with chronic dissection. CONCLUSIONS: Total arch replacement combined with stented @entity7105 trunk implantation demonstrated the superiority of the combination of the surgical and interventional approaches while avoiding the weaknesses associated with the individual methods. The encouraging surgical results could enable this procedure to become the new "standard" therapy for type A dissection involving repair of the aortic arch.
