Aortic Root Remodelling, Debranching of Arch, Ascending Aorta Replacement (Lupiae) and CABGX3 Prior TEVAR for Type B Aortic Dissection
The first aortic arch surgery was performed in 1957 as resection of fusiform aneurysm of aortic arch with replacement by homograft (1). However, during last 63 years, there were significant developments in terms of operative techniques, prosthesis materials, and imaging techniques with digital technology. Subsequently, the endovascular stent-grafts across the primary entry tear, for the management of acute aortic dissection originating in the descending thoracic aorta, was introduced in 1999 (2, 3).
Aortic cardiac surgeons encounter various aortic pathologies with aortic dissections. There are many combinations, and surgeon management of these conditions depends on the clinical scenario. Stanford type A aortic dissection is typically treated surgically, while Stanford type B is primarily treated conservatively, and complicated type B dissection is frequently treated with emergency EVAR stent (4). Furthermore, chronic type B aortic dissection with aneurysmal degeneration was treated safely with TEVAR (5). DeBakey type I aortic dissection is a catastrophic event that can be managed with combined surgical and endovascular treatment with arch preservation (6). Though, TEVAR in type B dissection may lead to retrograde type A dissection (7).
Hybrid aortic arch debranching procedures are a safe alternative to open repair (8, 9). In the treatment of acute Stanford type A aortic dissection, patients older than 60 years undergoing hybrid debranching surgery had shorter hospital lengths of stay, lower rates of neurologic events and renal insufficiency, and a higher mid-term survival rate compared with the total arch replacement procedure (10). Therefore, no single technique is ideal as no two aortas and their pathology are the same.