Staged repair of chronic type A aortic dissection with small true lumen at the descending aorta

Background: Surgical strategy for treating chronic type A dissection with small true lumen at the descending aorta has not been reported. In this retrospective study, we reviewed our experience of applying a two-stage procedure for treating chronic type A dissection with small true lumen at the descending aorta.

Methods: Between February 2016 and December 2019, seven patients suffering from chronic type A dissection with small true lumen at the descending aorta underwent this procedure. Preoperative computed tomographic angiography (CTA) was performed to carefully assess the diameter of the descending aorta, tear site, and visceral arteries. The interval between the two procedures is determined by the condition of the patients' recovery and illustration of postoperative CTA after the first stage procedure.

Results: All patients underwent first- and second-stage procedures. No mortality was observed among the seven patients. One patient who had a transient neurological deficit after the first stage recovered completely before hospital discharge. In two patients, the diameter of the descending aorta was enlarged postoperatively after the first-stage procedure. The interval between the two procedures was 2-3 months. However, no adverse events, such as stroke, paraparesis, visceral malperfusion, and lower extremity malfunction, were observed.

Conclusions: The two-staged procedure for the repair of chronic type A dissection with small true lumen at the descending aorta is adaptable with low prevalence of mortality and complication.