Total Aortic Arch Reconstruction With Triple-Branched Stent Graft or Hemiarch Replacement for Acute Debakey Type I Aortic Dissection: Five-Years Experience With 93 Patients

Objective We compared the outcomes of a new triple-branched stent graft reconstruction technique of total aortic arch with those of the conventional strategy of replacing the hemiarch during the surgical treatment of acute Debakey type I aortic dissection over five years. Methods Fifty-two patients with acute Debakey type I aortic dissection underwent ascending aorta replacement combined with triple-branched stent graft reconstruction of the aortic arch from June 2008 to February 2010. Concurrently, 41 cases of Debakey type I aortic dissection underwent ascending aorta replacement combined with hemiarch replacement. Both groups received hypothermic cardiopulmonary bypass and selective cerebral perfusion. Results Patient characteristics and in-hospital mortality of the two groups were similar. Postoperative data were not different between the groups. During the five years after surgery, there were no deaths in the stent graft group and three deaths in the hemiarch group. The late reinterventions/events during follow-up in the stent graft group were significantly less than those in the hemiarch group. On postoperative computed tomography, the aortic diameter of both groups was significantly reduced compared to the postoperative aortic diameter. There was no difference in diameter between one month and five years postoperatively in the stent graft group, although in the hemiarch group the diameter was significantly greater at five years than at one month postoperatively. Conclusion The triple-branched stent graft reconstruction of the aortic arch is an effective and simplified procedure for the treatment of acute Debakey type I aortic dissection. doi: 10.1111/jocs.12608 (J Card Surg 2015;30:749–755)