HomeCirculationVol. 123, No. 22Letter by Murzi and Glauber Regarding Article, “Extensive Primary Repair of the Thoracic Aorta in Acute Type A Aortic Dissection by Means of Ascending Aorta Replacement Combined With Open Placement of Triple-Branched Stent Graft: Early Results” Free AccessLetterPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessLetterPDF/EPUBLetter by Murzi and Glauber Regarding Article, “Extensive Primary Repair of the Thoracic Aorta in Acute Type A Aortic Dissection by Means of Ascending Aorta Replacement Combined With Open Placement of Triple-Branched Stent Graft: Early Results” Michele Murzi and Mattia Glauber Michele MurziMichele Murzi Department of Adult Cardiac Surgery G. Paquinucci Heart Hospital Fondazione CNR–G. Monasterio Massa, Italy (Murzi, Glauber) Search for more papers by this author and Mattia GlauberMattia Glauber Department of Adult Cardiac Surgery G. Paquinucci Heart Hospital Fondazione CNR–G. Monasterio Massa, Italy (Murzi, Glauber) Search for more papers by this author Originally published7 Jun 2011https://doi.org/10.1161/CIRCULATIONAHA.110.001941Circulation. 2011;123:e619To the Editor:We read with great interest the article by Chen et al.1 In our opinion, the authors are to be congratulated for their excellent clinical results with a single-stage hybrid procedure for type A acute aortic dissection (TAAD) repair. The purpose of the authors' technique was to obtain a primary repair of the thoracic aorta during TAAD repair and, by so doing, reduce the risk of late thoracoabdominal aneurysm formation and the need for distal reoperation. Despite the fact that this technique is extremely attractive, we have some conceptual and technical concerns regarding the application of this operative strategy during emergent TAAD repair. Introducing a stented graft into an acutely dissected aorta may be cumbersome, carrying the risk of aortic disruption, peripheral embolization, paraplegia, and malperfusion syndrome. Moreover, some retrospective studies have shown that the incidence of significant dilatation of the descending aorta after conventional TAAD repair appears to be relatively low. Geirsson et al2 reported only 12 reinterventions for thoracoabdominal aneurysm in a series of 212 patients who had conventional TAAD repair. Similarly, Dobrilovic and Elefteriades,3 who reviewed the database of the Yale Center for Thoracic Aortic Disease, identified only 4 reinterventions on the descending aorta among 200 TAAD repair procedures. In addition, the act of taking down a residual patent false lumen in the descending aorta with a stented graft is still a question of importance. Some studies have demonstrated that a patent lumen in the descending aorta was not necessarily associated with a worse long-term outcome in patients who had standard surgical repair of TAAD.4 These findings are consonant with the recently published results of the first randomized study on elective stent-graft placement in survivors of uncomplicated type B aortic dissection (INSTEAD trial), which failed to improve 2-year survival and adverse event rates in patients treated with stent grafting.5 For these reasons, it appears that adjunctive descending endovascular stent grafting during emergent surgical repair could be seen as a procedure to stabilize something that is rarely going to cause a surgical problem. In other words, we believe that only a few patients in the series reported by Chen et al will really benefit from this hybrid approach, whereas all of their patients received a supplementary risk to an already complex procedure with a high mortality rate.Michele Murzi, MDMattia Glauber, MD Department of Adult Cardiac Surgery G. Paquinucci Heart Hospital Fondazione CNR–G. Monasterio Massa, ItalyDisclosuresNone.