Hybrid two-stage repair of Stanford A dissection with visceral or peripheral malperfusion

Journal of Cardiothoracic Surgery

Bailang Chen¹  Xianmian Zhuang¹  Zanxin Wang²  Minxin Wei²  Junmin Wen³ 

[1] Department of Cardiac Surgery, Fuwai Hospital Chinese Academy of Medical Sciences, Shenzhen, Guangdong, People’s Republic of China;Department of Cardiac Surgery, Fuwai Hospital Chinese Academy of Medical Sciences, Shenzhen, Guangdong, People’s Republic of China;Department of Cardiac Surgery, The University of Hong Kong – Shenzhen Hospital, Shenzhen, Guangdong, People’s Republic of China;Department of Intensive Care, Fuwai Hospital Chinese Academy of Medical Sciences, Shenzhen, Guangdong, People’s Republic of China;

关键词: Aortic dissection;    Malperfusion;    Hybrid procedure;    Thoracic endovascular aortic repair;   

DOI  :  10.1186/s13019-020-01307-8

来源: Springer

【 摘 要 】

BackgroundThe present study aimed to evaluate the effect of two-stage hybrid aortic repair at the distal aorta of Stanford A dissection with malperfusion.MethodsThis retrospective case series included 20 patients with Stanford A dissection administered two-stage thoracic endovascular aortic repair (TEVAR) about 1 month after central repair because of visceral or limb malperfusion. The patients were examined by computed tomography (CT) angiography at 3, 6, 12 and 24 months after operation. Recovery of malperfusion and true lumen index were evaluated during follow-up.ResultsTwenty patients underwent two-stage hybrid aortic repair, including 11 males and 9 females. The follow-up time was 24 ± 7 months. No intervention-related complications were observed, including stent graft-induced new re-entry tears, death, stroke and spinal cord injury. Malperfusion in all cases was corrected. The true lumen was not enlarged enough 1 month after the first surgery. Thrombosis of the false lumen was observed around the elephant trunk at the carina level and the celiac artery. Three months after second stage TEVAR, the false lumen thrombosis was resorbed; in addition, the trunk was fully expanded at the carina level, and the true lumen was enlarged at the celiac artery.ConclusionsTwo-stage hybrid aortic repair for residual true lumen in the distal aorta 1 month after initial surgery is helpful for descending aorta remodeling and effective in treating malperfusion. This procedure may be a good option for patients suffering from Stanford A dissection with small true lumen in the distal aorta and malperfusion.

【 授权许可】

CC BY