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[Surgical treatment of type A acute aortic dissection--experience of hypothermic circulatory arrest associated with the cerebroplegia].

From 1992 to July 1996, 19 patients (aged 39 to 78 years) were operated on for type A acute aortic dissection. Our operative strategy is that all patients in whom aortic dissection involves the segment of transverse aortic arch should undergo simultaneous replacement or repair of the aortic arch and ascending aorta. Among these 19 patients, 17 were operated on within 24 hours after onset. In 13 patients, graft replacement extended from the ascending aorta to the transverse portion of the arch. The aortic stumps were prepared with the Teflon left both inside and outside of the aortic wall. Recently these were reconstructed with the aid of the Gelatin-Resorcin-Formaling glue, instilled into the false lumen. Cerebral protection was achieved by hypothermic circulatory arrest associated with the cerebroplegia (thiopental, nicradipine and mannitol). In one patient associated with severe aortic regurgitation, a valved conduit was implanted and the coronary arteries were reimplanted. CABG was performed concomitantly in two patients for involvement of the proximal coronary arteries by the dissection process. The hospital mortality rate was 26% (5/19). However, in two of them, death was not directly related to the operative procedure. One patient died of graft versus host disease (GVHD), another patient died of acute epidural hemorrhage which was undetected until the repair was completed. During the postoperative course, in all but two patients, the false lumens of the aortic arch and/or descending thoracic aorta were confirmed to be totally thrombosed by the examination of CT scan and/or aortography. It is concluded that the surgical treatment of type A acute aortic dissection can be successfully performed, even if the graft replacement extended to the transverse aortic arch.