[Surgical treatment for Stanford type A acute aortic dissection].

From March 1983 to September 1994, 53 consecutive patients underwent an emergency operation for type A acute aortic dissection. Eighteen patients before 1988 (Group I) underwent simple ascending aortic replacement (n = 13) and composite graft replacement (n = 5) by conventional method. Thirty-five patients after 1989 (Group II) underwent extended ascending aortic replacement (n = 17), hemiarch replacement (n = 6), total arch replacement (n = 8) and composite graft replacement (n = 4) using a brief period of circulatory arrest. The overall hospital mortality rate was 36.8% in Group I and 25.7% in Group II. The survivals after initial operation was 47% at 10 years (Kaplan-Meier) and the event free rate was 78% at ten years, respectively. Computed tomographic scanning and aortogram demonstrated the patent false lumen in 20 patients (64.5%) at the descending thoracic aorta. In conclusion, extended ascending aortic replacement is the useful operative technique to perform accurate resection of intimal disruption and clamp-site aorta because the replacement of the entry site could reduce the risk of operative mortality and reoperation. Total arch replacement is not necessarily required, if the entry is properly resected by extended ascending aortic replacement or hemiarch replacement. Close follow-up must be considered at the patients with patent false lumen, especially in patient with Marfan's syndrome.