Sun’s procedure for type A aortic dissection involving aortic arch after Bentall

Objective Stanford type A aortic dissection(TAAD) involving aortic arch in following prior Bentall procedure in patients with Marfan syndrome(MFS) is uncommon. The purpose of the study was to assess the early and long-term outcomes of this kind of patients underwent total arch replacement and frozen elephant trunk(TAR + FET). Methods Between February 2009 and February 2016, 141 patients with Marfan syndrome(confirmed by revised Ghent Criteria) underwent TAR+ FET for TAAD, of those 11(7.8%) patients(8 acute) following a prior Bentall procedure and without dissection in distal aorta. Mean age at FET was(43.2±8.6) years and 10 were males. Hypertension was seen in 4(36.4%) and family history was seen in 7(63.6%). The interval from Bentall procedure to FET averaged(11.3±5.8) years. Two groups were segregated by the maximal diameter of descending aorta more than 40 mm or not. The early and long-term outcomes were analyzed and risk factors identified for late adverse events. Results Operative mortality was 27.3%(3/11). No spinal cord injury occurred. The cause of death was long time of surgery, multiorgan failure, stroke and cerebral hemorrhage and rupture of distal aorta. Follow-up was complete in 100%, averaging(5.3±2.0)years(range 2.1-8.1 years). Obliteration of the false lumen was seen in 100% across the proximal FET and 75.0% in the unstented descending aorta. Distal aortic dilation occurred in 3 patients which were waiting open thoracoabdominal aortic repair(TAAAR) but no reoperation yet. Of those 8 patients, 2 died of non-cardiac reason. The DMax of FET segment has significant grow in DA more than 40mm group than less than 40mm group(P= 0.01). Another segment of distal aorta has no significant different. Survival were 81.8%, 72.7% and 63.6% at 1month, 1 year and 6 years after surgery. Conclusion Using Sun’s procedure for Marfan patients for type A aortic dissection involving aortic arch following previous Bentall procedure was safe and technically feasible with good long-term outcomes, but higher early death. The DMax of descending aorta more than 40mm was at higher risk for early death, late distal aortic dilation, and reoperation.