Repair of Stanford type A aortic dissection with ascending aorta and hemiarch replacement combined with stent-graft elephant trunk technique by using innominate cannulation

Objective The objective was to report our experience with a simplified procedure of ascending aorta and hemiarch replacement with a stent-graft elephant trunk in type A dissections. The efficacy of innominate artery cannulation was investigated. Methods From January 2007 to January 2010, 46 patients (35 men, 11 women; mean age, 52.7 ± 12.3 years) with acute type A dissection with 3 vessels of the arch free of lesions received ascending aorta and hemiarch replacement with implantation of a stent graft into the descending aorta under hypothermic circulatory arrest and selective antegrade cerebral perfusion. The innominate artery was used for artery cannulation. Results Cardiopulmonary bypass time was 107.9 ± 17.7 minutes, and the time of selective antegrade cerebral perfusion was 35.5 ± 7.1 minutes. The in-hospital mortality was 2.2% (1/46). No permanent neurologic dysfunction and paraplegia were observed. Three patients were lost to follow-up. The average follow-up time was 13.7 ± 7.4 months. Three months after the operation, the false lumen of the distal aorta decreased significantly with thrombosis around the stent graft in all the patients (42/42), at the level of the middle descending aorta in 81.1% (37/42) of the patients, and at the diaphragmatic level in 73.8% (31/42) of the patients. No reoperation related to residual dissected aorta was carried out. Conclusions The simplified procedure of ascending aorta and hemiarch replacement with a stent-graft elephant trunk performed by using innominate artery cannulation is safe and effective in patients with acute type A dissection without involvement of 3 vessels of the arch.