Replacement of the aortic arch for acute dissection. A new approach in the surgical technique

In 15 to 20 per cent of Type A dissections of the aorta the initial tear is situated in the aortic arch. Between January 1st 1988 and May 1st 1989, our group has performed 5 prosthetic replacements of the aortic arch for this type of lesion. The indication of prosthetic replacement of the aortic arch was taken on different criteria: regressive neurological deficits (2 cases); radiological signs of dissection of the supraaortic vessels (2 cases), and at surgery in 1 case in which the intimal tear extended beyond the origin of the brachiocephalic artery. The originality of the technique is due to the use of a prefabricated prosthesis with three branches for termino-terminal anastomosis in normal tissues of the supraaortic arteries. The insertion of the prosthesis was performed during cardiac standstill (average 35 minutes) at 17 degrees C, and was accompanied in 3 out of 5 cases by replacement of segments 0 and I of the aorta using Cabrol's technique. The mortality in the first 30 days was nil. There was one definitive neurological complication leading to the death of one patient at 4 months and one totally regressive paraplegia at the 2nd month with the patient recovering independent walking function. There is no morbidity in the survivors with an average follow-up period of seven months.