Reoperations after Operation on Acute Type A Aortic Dissection

Hirotsugu Fukuda Yuji Miyamoto Hiroshi Takami
Kei Sakai Kenji Ohnishi

(Department of Cardiovascular Surgery, Sakurabashi-Watanabe Hospital, Osaka, Japan)

Reoperations after operations for acute type A aortic dissection were performed in two cases under deep hypothermic circulatory arrest. In case 1, the aortic arch replacement was performed with an inclusion technique seven years ago. The reason for reoperation was the leak from the suture lines of all anastomosis sites. Three sites of leak were closed putting sutures with pledgets. In case 2 the graft replacement of the ascending aorta was performed five years ago. The reason for reoperation was the persistent dissection from the aortic arch to the thoracic descending aorta due to the new entry formation at the site of the aortic clamp. At first the graft replacement of the thoracic descending aorta was performed, followed by arch replacement. As these conditions are preventable, we should perform the open distal anastomosis technique without using a clamp and graft replacement of aortic arch with the branched graft. Moreover, deep hypothermic circulatory arrest may appear to be a valuable adjunct for reoperation after operation on acute type A dissection.   
 Jpn. J. Cardiovasc. Surg. 31: 217-220 (2002)