• Liang-Wan Chen, Xi-Jie Wu, Xiao-Fu Dai, Dong-Shan Liao, Yun-nan Hu, Hui Zhang, Yi Dong, and Qi-Min Wang.
• Department of Cardiac Surgery, Union Hospital, Fujian Medical University, Fuzhou, Fujian, China. Electronic address: chenliangwan@tom.com.
• Ann. Thorac. Surg. 2016 Feb 1; 101 (2): 644-9.

BackgroundIn the conventional ascending replacement for acute type A aortic dissection, the distal aortic anastomosis is frequently performed at the dissected site, and postoperative residual dissection in the arch and downstream aorta still occurs in most patients. We used open placement of a fenestrated stent graft during this operation.MethodsDuring the conventional ascending replacement in 41 patients with acute type A aortic dissection, a fenestrated stent graft was inserted into the arch and the proximal descending aorta through the distal ascending transection. The distal ascending transection incorporating the proximal end of the fenestrated stent graft was directly anastomosed to the Dacron (DuPont, Wilmington, DE) tube graft. Survivors were examined by computed tomography angiography.ResultsThe cardiopulmonary bypass time was 134.46 ± 19.03 minutes, aortic cross-clamp time was 46.38 ± 8.57 minutes, and selective cerebral perfusion and lower body arrest time was 12.50 ± 2.19 minutes. There was 1 in-hospital death but no difficult bleeding from the distal aortic anastomosis. On postoperative computed tomography, the false lumen closed, with complete thrombus formation around the inserted fenestrated stent graft found in all survivors (100%), at the diaphragmatic level in 28 patients (70%), and at the superior mesenteric arterial level in 3 (8%).ConclusionsAn open fenestrated stent graft placement provided extensive primary repair of the thoracic aorta and a strong distal aortic stump during the conventional ascending aorta replacement for acute type A aortic dissection but did not increase the risk or technical difficulty of the operation.Copyright © 2016 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

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