Total Aortic Replacement for Chronic Aortic Dissection Occurring in Patients with and without Marfanʼs Syndrome

Abstract

Total aortic replacement including aortic valve was performed successfully in the 2 patients in whom this method of treatment was utilized to correct a chronic dissecting aortic aneurysm. Both patients had moderately severe aortic insufficiency producing increasing heart strain and progressive enlargement of the false lumen of aortic dissection involving the entire aorta despite ideal blood pressure control. In addition, 1 patient had Marfan''s syndrome. The surgical treatment for both patients was performed in 2 stages. At the 1st operation, cardiopulmonary bypass, profound hypothermia and circulatory arrest were employed while the aortic valve, and the ascending and transverse aortic arch were replaced, and the coronary and brachiocephalic vessels were reattached to the composite valve-graft used for replacement. At the 2nd operation, the entire descending thoracic and abdominal aortic segments were replaced with a graft, and the intercostal, lumbar and visceral arteries reattached thereto. Left vocal cord paralysis occurred in both patients and transient mild paraparesis occurred in only one. Both patients are alive and well, 1 at 13 mo. and 1 at 6 wk. This experience suggests an additional treatment modality for selected patients with complications of chronic aortic dissection.