Acute type A aortic dissection (TAAAD) is the most lethal disease of the aorta
and requires emergency surgery to prevent sudden death caused by an aortic rupture and
secondary end-organ ischemia due to compromised aortic branch vessels. Despite technical
advances in surgery, anesthesia, organ-protection, and critical care, surgical morbidity and
mortality remains high because of hemodynamic instability, of repairing the acutely
dissected aorta, and of manipulating the secondary compromised multiple organs. To save
the life of the patient, a complete resection of the intimal tear and reapproximation of the
proximal and distal edges of the dissected aorta are widely accepted as the primary
objectives of surgery. However, late reoperation after surgery for acute TAAAD has been
frequently reported. Extended aortic arch replacement and concomitant intervening of the
distal aorta can be undertaken to reduce the incidence of late complications of the distal
aorta. Total arch replacement combined with implanting a stented elephant trunk-graft is
recommended to treat TAAAD when the aortic arch requires repair. This technique offers
the superiority of combined surgical and interventional approaches while simultaneously
avoiding the shortcomings of either of these approaches alone. The sooner a patient with
TAAAD is treated, the better will be the remodeling of the two layers of the dissected
aortic wall after a stented elephant trunk-graft has been implanted, and the less end-organ
ischemia secondary to aortic branch vessel compromise there will be.
Keywords: Acute type A aortic dissection, Aortic insufficiency, Aortic root, Aortic
sinus, Cardiopulmonary bypass, Composite valved graft replacement, Deep hypothermic
circulatory arrest, Emergency, False lumen, Hybrid technique, Malperfusion
syndrome, Marfan syndrome, Remodeling, Reoperation, Retrograde cerebral
protection, Selective antegrade cerebral protection, Sinotubular junction, Stented
elephant trunk technique, Total arch replacement, Triple-branched stented graft.
