Total arch repair for acute type A aortic dissection with open placement of a modified triple-branched stent graft and the arch open technique

Journal of Cardiothoracic Surgery

Qian-Zhen Li¹  Chao Li¹  Dong-Shan Liao¹  Lin Lu¹  Xiao-Fu Dai¹  Xi-Jie Wu¹  Liang-Wan Chen¹ 

[1] Department of Cardiac Surgery, Union Hospital, Fujian Medical University, Fuzhou 350001, Fujian, China

关键词: Stent;    Surgery;    Dissection;    Aorta;   

Others  :  1152209
DOI  :  10.1186/s13019-014-0135-3

 received in 2014-04-16, accepted in 2014-07-17,  发布年份 2014

【 摘 要 】

Background

In total arch repair with open placement of a triple-branched stent graft for acute type A aortic dissection, the diameters of the native arch vessels and the distances between 2 neighboring arch vessels did not always match the available sizes of the triple-branched stent grafts, and insertion of the triple-branched stent graft through the distal ascending aortic incision was not easy in some cases. To reduce those two problems, we modified the triple-branched stent graft and developed the arch open technique.

Methods and results

Total arch repair with open placement of a modified triple-branched stent graft and the arch open technique was performed in 25 consecutive patients with acute type A aortic dissection. There was 1 surgical death. Most survivors had an uneventful postoperative course. All implanted stents were in a good position and wide expansion, there was no space or blood flow surrounding the stent graft. Complete thrombus obliteration of the false lumen was found around the modified triple-branched stent graft in all survivors and at the diaphragmatic level in 20 of 24 patients.

Conclusions

The modified triple-branched stent graft could provide a good match with the different diameters of the native arch vessels and the various distances between 2 neighboring arch vessels, and it’s placement could become much easier by the arch open technique. Consequently, placement of a modified triple-branched stent graft could be easily used in most patients with acute type A aortic dissection for effective total arch repair.

【 授权许可】

   
2014 Chen et al.; licensee BioMed Central

【 图 表 】

Figure 1.

Figure 2.

Figure 3.

Figure 4.

【 参考文献 】

• [1]Fuster V, Ip JF: Medical aspects of acute aortic dissection. Semin Thorac Cardiovasc Surg 1991, 3:219-224.
• [2]DeSanctis RW, Doroghazi RM, Austen WG, Buckley MJ: Aortic dissection. N Engl J Med 1987, 317:1060-1067.
• [3]DeBakey ME, McCollum CH, Crawford ES, Morris GC Jr, Howell J, Noon GP, Lawrie G: Dissection and dissecting aneurysms of the aorta: twenty-year follow-up of five hundred twenty-seven patients treated surgically. Surgery 1982, 92(6):1118-1134.
• [4]Fann JI, Smith JA, Miller DC, Mitchelll RS, Moore KA, Grunkemeier G, Stinson EB, Oyer PE, Reitz BA, Shumway NE: Surgical management of aortic dissection during a 30-year period. Circulation 1995, 92(9 supp):113-121.
• [5]Haverich A, Miller DC, Scott WC, Mitchell RS, Oyer PE, Stinsion EB, Shumway NE: Acute and chronic aortic dissections–determinants of long–term outcome for operative survivors. Circulation 1985, 72:1122-1134.
• [6]Ergin MA, Philips RA, Galla JD, Lansman SL, Mendelson DS, Quintana CS, Griepp RB: Significance of distal false lumen after type A dissection repair. Ann Thorac Surg 1994, 57:820-825.
• [7]Bachet JE, Termignon JL, Dreyfus G, Goudot B, Martinelli L, Piquois A, Brodaty D, Dubois C, Delentdecker P, Guilmet D: Aortic dissection. Prevalence, cause, and results of late reoperations. J Thorac Cardiovasc Surg 1994, 108:199-206.
• [8]Ochiai Y, Imoto Y, Sakamoto M, Ueno Y, Sano T, Baba H, Sese A: Long-term effectiveness of total arch replacement for type A aortic dissection. Ann Thorac Surg 2005, 80:1297-1302.
• [9]Massimo CG, Presenti LF, Marranci P, Favi PP, Poma AG, Ponzalli M, Viligiardi RG: Extended and total aortic resection in the surgical treatment of acute type A aortic dissection: experience with 54 patients. Ann Thorac Surg 1988, 46:420-424.
• [10]Minale C, Splittgerber FH, Reifschneider HJ: Replcaement of the entire thoracic aorta in a single stage. Ann Thorac Surg 1994, 57:850-855.
• [11]Chen LW, Dai XF, Zhang GZ, Cao H: Extensive primary repair of the thoracic aorta in acute type A aortic dissection by means of ascending aorta replacement combined with open placement of triple-branched stent graft: early results. Circulation 2010, 122:1373-1378.
• [12]Kato M, Ohnishi K, Kaneko M, Ueda T, Kishi D, Mizushima T, Matsuda H, Kato M, Ohnishi K, Kaneko M, Ueda T, Kishi D, Mizushima T, Matsuda H: New graft-implanting method for thoracic aortic aneurysm or dissection with a stented graft. Circulation 1996, 94(suppl):II-188-II-193.
• [13]Kato M, Matsuda T, Kaneko M, Kuratani T, Mizushima T, Seo Y, Uchida K, Kichikawa K, Maeda M, Ohnishi K: Outcomes of stent-graft treatment of false lumen in aortic dissection. Circulation 1998, 98((suppl)):II-305-II-312.
• [14]Liu ZG, Sun LZ, Chang Q, Zhu JM, Dong C, Yu CT, Liu YM, Zhang HT: Should the “elephant trunk” be skeletonized? Total arch replacement combined with stented elephant trunk implantation for stanford type A aortic dissection. J Thorac Cardiovasc Surg 2006, 131:107-113.
• [15]Shimamura K, Kuratani T, Matsumiya G, Kato M, Shirakawa Y, Takano H, Ohta N, Sawa Y: Long-term results of the open stent-grafting technique for extended aortic arch disease. J Thorac Cardiovasc Surg 2008, 135(6):1261-1269.
• [16]Nienaber CA, Fattori R, Lund G, Dieckmann C, Wolf W, von Kodolitsch Y, Nicolas V, Pierangeli A: Nonsurgical reconstruction of thoracic aortic dissection by stent-graft placement. N Engl J Med 1999, 340:1539-1545.
• [17]Mori Y, Hirose H, Takagi H, Umeda Y, Fukumoto Y, Shimabukuro K, Matsuno Y: Aortic arch repair for Stanford type A aortic dissection with distal anastomosis to the proximal level of the distal aortic arch. J Thorac Cardiovasc Sur 2003, 126:415-419.
• [18]De Vries JP, Jager L, Van den Berg JC, Overtoom TT, Ackerstaff RG, Van de Pavoordt ED, Moll FL: Durability of percutaneous transluminal angioplasty for obstructive lesions of proximal subclavian artery: long-term results. J Vasc Surg 2005, 41:19-23.
• [19]Bates MC, Broce M, Lavigne PS, Stone P: Subclavian artery stenting: factors influencing long-term outcome. Catheter Cardiovasc Interv 2004, 61:5-11.
• [20]de Borst GJ, Ackerstaff RG, de Vries JP, vd Pavoordt ED, Vos JA, Overtoom TT, Moll FL: Carotid angioplasty and stenting for postendarterectomy stenosis:lonr-term follow-up. J Vasc Surg 2007, 45:118-123.
• [21]Ando M, Takamoto S, Okita Y, Morota T, Matsukawa R, Kitamura S: Elephant trunk procedure for surgical treatment of aortic dissection. Ann Thorac Surg 1998, 66:82-87.
• [22]Crawford ES, Coselli JS, Svensson LG, Safi HJ, Hess KR: Diffuse aneurysmal disease (chronic aortic dissection, Marfan, and mega aorta syndromes) and multiple aneurysm. Treatment by subtotal and total aortic replacement emphasizing the elephant trunk operation. Ann Surg 1990, 211:521-537.
• [23]Sun LZ, Qi R, Zhu JM, Liu YM, Zheng J: Total arch replacement combined with stented elephant trunk implantation: A new “standard” therapy for type A dissection involving repair of the aortic arch? Circulation 2001, 123:971-978.
• [24]Czermy M, Gottardi R, Zimpfer D, Schoder M, Grabenwoger M, Lammer J, Wolner E, Grimm M: Mid-term results of supraaortic transpositions for extended endovascular repair of aortic arch pathologies. Eur J Cardiothorac Surg 2007, 31:623-627.
• [25]Diethrich EB, Ghazoul M, Wheatley GH, Alpern J, Rodriguez-Lopez J, Ramaiah V, Williams J: Surgical correction of ascending type A thoracic aortic dissection: simultaneous endoluminal exclusion of the arch and distal aorta. J Endovasc Ther 2005, 12:660-666.
• [26]Shimamura K, Kuratani T, Matsumiya G, Shirakawa Y, Takeuchi M, Takano H, Sawa Y: Hybrid endovascular aortic arch repair using branched endoprosthesis: the second-generation “branched” open stent-grafting technique. J Thorac Cardiovasc Surg 2009, 138:46-53.