Transapical endovascular ascending repair for inoperable acute type a dissection.

Acute aortic dissection remains a surgical emergency. The conventional approach involves graft replacement of the ascending aorta under circulatory arrest with variable extension into the root or arch depending on morphology at presentation. A significant proportion of patients are deemed too high-risk for surgery and are managed medically, but the 30-day mortality is over 58% (1). A 55-year-old woman had previously undergone emergency open repair of a descending aortic dissection complicated by aorto-esophageal fistula. Multiple reoperations included re-replacement of the descending aorta, esophagectomy, delayed reconstruction with a substernal colon interposition, and hybrid thoracoabdominal repair with visceral debranching and stent grafting. She presented, eight years since the initial type B dissection, with an acute type A dissection with