Early outcomes with a hybrid technique for repair of a non-A non-B aortic dissection

This study reports the early outcomes of patients with acute non-A non-B aortic dissection that involved the aortic arch but not the ascending aorta. From January 2013 to December 2018, 825 patients presented with aortic dissection. Of these, 28 patients with non-A non-B dissection (classified as dissection extending into the aortic arch with entry between the left common carotid artery and the left subclavian arteries) underwent a novel hybrid surgery. Self modified stent-grafts (Micropart Corp, Shanghai, China) were implanted via median sternotomy. Clinical presentation, postoperative data, and early outcomes were recorded. All patients underwent an emergency operation. There were no in-hospital mortalities, reexplorations for hemorrhage, reports of paraplegia, cerebral infarctions, endoleaks, or left subclavian artery occlusions. No blood products were required during or after the operations. During the early follow-up at 39.12 ± 15.04 months (6.0-74.0 months), 1 patient was lost to follow-up, and 1 patient died suddenly. Computed tomography angiography showed false lumen patency persisted in the aortic arch and descending aorta without any symptoms. The 6-month computed tomography angiography showed significantly smaller distal aortic arch diameters (31.94 ± 6.95 mm) and descending aorta diameters (34.84 ± 4.15 mm) than measured preoperatively (36.76 ± 4.15 mm and 37.31 ± 4.7 mm, respectively). No paraplegia, cerebral infarction, upper limb ischemia, or left subclavian artery ischemia events were reported. Our inclusion aortic arch technique is a safe, effective, and simple treatment for non-A non-B aortic dissections that can avoid endoleaks, requires no blood products, and has satisfactory early outcomes. Adoption of the hybrid technique for patients with non-A non-B AD. The intimal tear was first found under direct vision. Tightly suture the intimal tear with mattress sutures of 4-0 Prolene. The SG was implanted anterogradely into the true lumen of descending aorta. The proximal end of the stent was deployed distal to the origin of the LSA. The vascular graft free of the stent was located inside the natural arch for the inclusion that was to follow. The greater curvature of the vascular graft was cut longitudinally to expose the orifices of 3 vessels thoroughly. Suture the vascular graft to the anterior and posterior aortic arch wall. No blood products were used in any patient. There were no early events including endoleaks and retrograde. Complete