Efficacy of limited proximal arch replacement for type A acute aortic dissection with critical complications.

Abstract

We assessed the efficacy of limited proximal arch replacement for type A acute aortic dissection (AAD) with critical complications. Sixty-four patients with average age of 64.5±13.0years, who were intubated prior to arriving at hospital due to cardiopulmonary arrest, cardiac tamponade, or vital organ mal-perfusion, were divided into two groups: group PA consisted of 52 patients undergoing proximal arch repair with mild hypothermic circulatory arrest; group TA consisted of 12 patients who underwent total arch replacement with moderate hypothermia and selective cerebral perfusion. The intimal tear on the distal side of the left subclavian artery was not excised in 11 patients (21.2%) of group PA. The intimal tear was excised in all patients in group TA. The durations of cerebral protection (PA, 18.7; TA, 70.3min), cardiopulmonary bypass (PA, 121.5; TA, 206min), and overall operation (PA, 181.8; TA, 403.8min) were significantly shorter in group PA. The incidence of postoperative brain damage was significantly lower in group PA (9.6%) than in group TA (33.3%). The mortality rate was significantly lower in group PA (5.8%) than in group TA (58.3%). Distal arch to descending aortic replacement was required in four patients of group PA during follow-up period. There were no complications or mortality during the reoperation. The actuarial survival rate at 10years was significantly better in group PA (66.5%) than in group TA (25%). Limited proximal arch repair is suitable for high-risk patients with AAD, despite no excision of the intimal tear.