Extended aortic replacement for acute type a dissection with the tear in the descending aorta

Objective: There has been controversy as to the selection of surgical treatments for acute type A dissection with the tear in the descending thoracic aorta, a subtype of acute aortic dissection in which the limited tear is located distal to the left subclavian artery but the dissection extends retrogradely to the ascending aorta, Methods: Total replacement of the ascending aorta and aortic arch was performed in 12 patients with acute type A dissection with the tear in the descending thoracic aorta between March 1991 and the end of September 1995. The indications for total replacement of the ascending aorta and aortic arch were cardiac tamponade, acute aortic regurgitation, cerebral ischemia, and dilatation of the ascending aorta, The operation was performed with the aid of extracorporeal circulation, blood cardioplegia, selective cerebral perfusion, and open distal anastomosis, The surgical procedure used was total replacement of the ascending aorta and aortic arch with a graft provided with three limbs accompanied by resection of the intimal tear in the descending thoracic aorta. Results: Hospital death occurred in two patients (16.7%), In both, death was due to dissection/related complications of renal/mesenteric ischemia, The other 10 patients have had uneventful postoperative courses over a mean period of 24 months, Conclusions: Total replacement of the ascending aorta and aortic arch accompanied by resection of an intimal tear distal to the left subclavian artery seems to be justified in selected patients with acute type A dissection with the tear in the descending thoracic aorta.