Aortic Valve Replacement and Regrafting of the Ascending Aorta After Ascending Aortic Replacement and Zone 0 Endovascular Aortic Arch Repair for Type A Acute Aortic Dissection

Abstract

Simple ascending aortic replacement is the gold standard for emergency surgery in patients with type A acute aortic dissection (TA-AAD). Some patients require a second intervention because of the aortic arch expansion. Zone 0 thoracic endovascular aneurysm repair (TEVAR) is one such treatment alternative. Herein, we present a case with aortic valve replacement and regrafting of the ascending aorta after emergency ascending aortic replacement and elective zone 0 TEVAR for TA-AAD owing to acute heart failure caused by worsening aortic regurgitation. Because the proximal site of the endograft was detected outside the clamp site of the ascending aortic graft and was critically fractured, the entire ascending aortic graft was planned to be replaced with the reconstruction of the proximal portion of the stent. The proximal site of the stent graft was turned over after removing the frame and sutured at the proximal arch, which was finally anastomosed with a new ascending aortic graft to avoid endoleaks. The patient's post-operative course was uneventful, and computed tomography revealed no endoleak of the residual stent graft.

Keywords

• aortic dissection
• zone 0 tevar
• avr