Journal
SEMINARS IN CARDIOTHORACIC AND VASCULAR ANESTHESIA
Volume 20, Issue 4, Pages 314-321Publisher
SAGE PUBLICATIONS INC
DOI: 10.1177/1089253216659144
Keywords
DeBakey type I aortic dissection; chronic aortic dissection; reoperation; aortic arch repair; open surgery
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The progressive expansion of residual, chronic DeBakey type I dissection often necessitates repair of the aortic arch and the distal aorta (ie, descending thoracic and thoracoabdominal aorta). The vast majority of patients with chronic aortic dissection facing aortic arch surgery are survivors of emergent proximal aortic repair for acute dissection, and thus, these patients now face a reoperative procedure necessitating a redo median sternotomy. One approach for repairing the chronic type I aortic dissection incorporates total transverse aortic arch replacement with and without an elephant trunk extension; an elephant trunk extension is a useful strategy, because the proximal descending thoracic aorta is commonly ectatic or aneurysmal at the time of aortic arch repairusing an elephant trunk approach facilitates subsequent repair in the distal aorta. Patients with chronic DeBakey type I dissection should participate in an imaging surveillance protocol.
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