• Kay-Hyun Park, Kiick Sung, Kwhanmien Kim, Tae-Gook Jun, Young Tak Lee, and Pyo Won Park.
• Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. drkhpark@yahoo.co.kr
• Ann. Thorac. Surg. 2003 Jun 1;75(6):1785-90; discussion 1790-1.

BackgroundTransaortic repair of the tear was previously proposed as a compromise alternative to total arch replacement for acute type A aortic dissection with an arch tear. However, there are no data about long-term prognosis and radiologic findings after this procedure.MethodsWe reviewed the postoperative course and computed tomographic findings of 13 patients who underwent replacement of the ascending aorta and transaortic repair of an arch tear for acute type A aortic dissection.ResultsThere were no early or late deaths during a mean follow-up period of 36.8 months. Computed tomographic follow-up showed complete thrombosis with or without later regression of the false lumen in the descending thoracic aorta in 9 patients (69.2%). Thrombosis of the false lumen usually occurred within 3 months postoperatively. Repair techniques incorporating the full thickness of the aortic wall in closure of the tear resulted in higher rate of success than approximation of the intima only (7 of 8 versus 2 of 5 patients, p < 0.05).ConclusionsTransaortic repair of the arch tear with replacement of the ascending aorta can be an option in selected patients who have a small intimal tear in the aortic arch. This option would be more viable for less experienced surgeons who would hesitate to replace the total arch.

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