PETTICOAT Assisted Two Stage Retrograde Hybrid Arch Repair for Type A Aortic Dissection with Malperfusion Syndrome.

The presence of malperfusion syndrome in acute type A aortic dissection (TAAD) is associated with an extremely high mortality rate. Although emergency proximal reconstruction could prevent aortic rupture and relieve dynamic malperfusion, it may not work for static occlusion and cannot immediately resolve existing ischaemic injury. The use of provisional extension to induce complete attachment (PETTICOAT) as a first line strategy before staged retrograde hybrid arch repair can be life saving for such patients.