• Naomichi Uchida, Akira Katayama, Kentaro Tamura, Miwa Sutoh, Masatsugu Kuraoka, and Hiroshi Ishihara.
• Division of Cardiovascular Surgery, Hiroshima City Asa General Hospital, Hiroshima, Japan. uchidacvs@yahoo.co.jp
• Eur J Cardiothorac Surg. 2011 Nov 1;40(5):1066-71.

ObjectiveThe aimed to describe the frozen elephant trunk (FET) technique and partial remodeling (PR) for acute type A aortic dissection (ATAAD), considering the long-term prognosis on the basis of our 13 years of experience.MethodsThere were 80 consecutive patients (mean age: 66.4 years) with an FET and PR technique for ATAAD between September 1997 and February 2010. We indicated a PR for all 80 patients without dilatation of the sinuses and a FET for 20 patients with a distal entry in the descending aorta, 14 patients with a dilatation more than 4cm on the distal arch and 46 patients with a narrow true lumen younger than 70 years with a narrow true lumen. During moderate hypothermic circulation with selective cerebral perfusion and distal perfusion from the femoral artery, a stent graft (mean diameter: 27.7mm, mean length: 9.9mm, mean distal depth: thoracic vertebra (Th) 6.0th) was inserted through the transected proximal aortic arch. The plication of the sinotubular junction (N=42) or partial remodeling for right and/or non-coronary cusp (N=38) was performed after total arch replacement with a four-branched prosthesis.ResultsFour patients died in hospital. Early morbidity included two (2.5%) strokes but no spinal cord injury. In long-term follow-up (mean 94.6 months), five patients died of non-aortic events and two re-operations (Bentall and stent grafting to the descending aorta) were required. No patients had patent false lumen on the stent graft and residual aortic regurgitation, according to late follow-up computed tomography (CT) and echogram. The 10-year survival was 75% and the overall 10-year re-operation free rate on the thoracic aorta was 95%.ConclusionFET and modified PR techniques could be effective for improving the long-term outcome on the distal and proximal aorta in an ATAAD.Crown Copyright © 2011. Published by Elsevier B.V. All rights reserved.

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