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.