eReply. Re: Addition of the frozen elephant trunk to the ascending aorta and aortic arch replacement in case of Stanford type A aortic dissection occurring in the presence of Kommerell's diverticulum

We appreciate your interest in our paper [1,2]. During the operation for acute Stanford type A aortic dissection, the primary entry should undoubtedly be excluded at the initial operation. However, as is described in our report, considering both early and late risks and benefits, it was decided to leave the primary entry and orifice of the aberrant subclavian artery, both of which lead to the inflow of blood into the false lumen. If we could have made the aortic anastomosis distal to the orifice of the right subclavian artery, the second operation may not have been required. At the time that we decided to make the aortic anastomosis between the origins of the left and right subclavian arteries, we anticipated postoperative distal arch expansion, and therefore, we worked out a strategy for the second-stage operation and created a bypass to the right axillary artery. Regarding the second question, the definition of remodelling here is a decrease in the diameter of the descending aorta. The descending aortic diameter has come down after thoracic endovascular aneurysm repair (TEVAR) but chronic type B aortic dissection with patent false lumen downstream remains because of re-entries including the branching of the visceral arteries. Needless to say, this case requires optimal medical treatment and regular computed tomography follow-up for chronic aortic dissection.

Conflict of interest: none declared.