We have experienced a case of Bentall procedure for aortic root redissection a few years after ascending and arch aortic replacement for acute type A aortic dissection with involvement of the aortic root. Although late aortic redissection and false anastomotic aneurysm following the use of gelatin-resorcin-formaldehyde(GRF) glue has been recently reported in several articles, no pathological evidence is available for the potential toxic effects of GRF glue in our patient. We think that Bentall procedure or an aortic valve reimplantation procedure, David procedure, may be considered as one of the strategies for acute type A aortic dissection with involvement of the aortic root because of a high incidence of aortic root redissection and a high mortality of the reoperation.

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We reviewed our therapeutic strategies and experience for acute type A aortic dissection. The subjects were 38 patients who underwent the emergency surgery for type A aortic dissection during the period from November 2000 to January 2004. Their mean age was 63.2±11.4 years(range 40∼87 years). The subjects were classified into the following three groups according to surgical procedures: replacement of the ascending aorta (n=11), replacement of the hemiarch aorta(n=25) and replacement of the total arch of aorta(n=2). As a rule, the subclavian artery was selected for blood transmission. The target rectal temperature at the time of circulatory arrest was 20°C. Unilateral anterograde brain perfusion was performed perfusion through the right subclavian artery, while retrograde brain perfusion was performed through the superior vena cava. The femoral artery was simultaneously ensured. Four of those who underwent replacement of the hemiarch aorta died. The 34 patients who had no major complications before surgery were discharged from the hospital and 33 of them succeeded in social rehabilitation. There was no significant difference in surgical factors and incidence of cerebral infarction between replacement of the heimiarch aorta and the ascending aorta. As acute emergency surgery for type A aortic dissection, replacement of the hemiarch aorta including isolated brain perfusion seems to be less invasive than replacement of the total arch aorta.

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