BackgroundAcute type B dissection with ascending thoracic aortic dilatation (ATAD) is very common, but remains surgically challenging with the use of the conventional single-stage procedure via median sternotomy or lateral thoracotomy. We report our experience with repair of acute type B dissection with ATAD using a one-stage stented elephant trunk procedure. MethodsWe retrospectively reviewed the medical records of 16 patients (13 males and 3 females) with acute type B dissection with ATAD who underwent ascending thoracic aortic reconstruction combined with a stented elephant trunk procedure under hypothermic cardiopulmonary bypass with selective antegrade cerebral perfusion between February 2009 and February 2013. ATAD included ascending aortic aneurysm in four patients, ascending aortic enlargement+aortic regurgitation in three, and ascending aortic aneurysm+aortic root aneurysm in nine. Lower limb ischemia occurred in one case. ResultsThere was no in-hospital mortality. Drainage of the pericardial sac was indicated for two patients with pericardial effusion. The median durations of ventilator support and intensive care unit stay were 2518 and 48 +/- 7hours, respectively. Lower limber ischemia was alleviated after implantation of a stented elephant trunk. One patient received thoracoabdominal aortic replacement during follow-up and encountered no postoperative complications. ConclusionsSatisfactory surgical results and follow-up outcomes can be achieved using the proposed one-stage stented elephant trunk procedure for acute type B dissection with ATAD. doi: 10.1111/jocs.12616 (J Card Surg 2015;30:756-760)