Surgical management of acute type A aortic dissection in complicated cases: experience with branch-first aortic arch replacement technique

Type A dissection involving the aortic arch remains an inherently lethal condition.Sun et at.[1] recommended total arch replacement combined with stented elephant trunk implantation as a new“standard”therapy for type A dissection involving repair of the aortic arch.Cannulation of the right axillary artery is used for cardiopulmonary bypass(CPB)and selective cerebral perfusion in this procedure.[1] However,this procedure may not be applied in some special cases,such as aberrant right subclavian arteries,serious involvement of the right subclavian artery,serious involvement of the right common carotid artery,and acute pericardial tamponade.The branch-first aortic arch replacement technique can adequately solve these problems.W e analyzed the surgical data and midterm follow-up outcomes of this technique.