Results
Facing on an sub-acute type A aortic dissection in 35-years old patient, after an accurate evaluation and discussion with patient, we decide to perform a complete aortic root, ascending aorta and aortic arch replacement. A classical sternotomy approach was performed with CPB in ipothermia at 22 °C, deep circulatory arrest and selective cerebral perfusion. Arterial cannulation was performed on left common femoral artery. Myocardial protection was archived by infusion of retrograde cold blood intermittent cardioplegia. On aortic cross-clamp, after opening the ascending aorta we observed a circumferential dissection of the aorta and a complete avulsion of right coronary ostium dissected protruding about 1 cm into the right sinus of Valsalva. (Fig.3). The aortic valve was also affected. Right and non-coronary commissure were completely detached. Thus, a Tirone-David valve sparring procedure was performed. Ascending aorta was replaced with 28 mm prostetic conduit. Right coronary artery course was isolated ad obliterated within the proximal portion. Coronary artery bypass was also performed using great saphenous vein on right coronary artery and proximal anastomosis on aortic root. At 22 °C, on circulatory arrest and cerebral perfusion we performed aortic acrh raplacemant with 26 mm vascular prothesis and the distal anastomosis on discending thoracic aorta with elephant-trunk technique. Reimplantation of epiaortic vessels was also obtained in open fascion by “island” technique. On CPB, as rewarming, an anastomosis between the two vascular prosthesis was performed. CPB weaning wasn’t really easy: the patient developed a right side post operatory dysfunction and required few days on inotropes during ICU stay. Anyway at discharge, the right side dysfunction was completely resolved with no residual regional dyskinesia. No aortic incompetence were noted. The patient also underwent a CT scan control at 1 month after the surgery that confirmed a good flow in aortic root and aortic arch.