Combining aortic arch dissection stent implantation and root surgery for aortic dissection type A

Journal of Cardiothoracic Surgery

Research

Hayato Ise¹  Payam Akhyari¹  Sebastian Johannes Bauer¹  Moritz Benjamin Immohr¹  Yukiharu Sugimura¹  Artur Lichtenberg¹  Arash Mehdiani¹ 

[1] Department of Cardiac Surgery, Medical Faculty, University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Moorenstrasse 5, 40225, Düsseldorf, Germany;

关键词: Acute aortic dissection type A;    AMDS;    Aortic root surgery;    Dissection stent;   

DOI  :  10.1186/s13019-023-02154-z

 received in 2022-10-29, accepted in 2023-01-24,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundAcute aortic dissection type A (AADA) is associated with high perioperative morbidity and mortality. A novel non-covered hybrid prosthesis (AMDS, CryoLife, Kennesaw, USA) can be easily implanted to stabilize the true lumen. However, the role of AMDS for patients requiring additional aortic root surgery has not been described.MethodsBetween 2010 and 2020 a total of n = 370 patients underwent surgery for AADA in our department. Of those, n = 120 underwent treatment for aortic root in addition to proximal arch replacement without resection of the aorta beyond the innominate artery (Control, n = 111) and were compared to patients who received additional AMDS implantation (AMDS, n = 9).ResultsAortic valve repair was performed in 48.6% (Control) and in 55.6% of AMDS patients. Cardiopulmonary bypass (Control: 248 ± 76 min, AMDS: 313 ± 53 min, P < 0.01) time as well as circulatory arrest time of the lower body (Control: 30 ± 15 min, AMDS: 52 ± 12 min, P < 0.01) was prolonged in the AMDS group. Nevertheless, postoperative in-hospital morbidity such as dialysis (Control: 22.4%, AMDS: 11.1%, P = 0.68) and stroke (Control: 17.0%, AMDS: 22.2%, P = 0.65) were comparable. In-hospital death (Control: 21.8%, AMDS: 11.1%, P = 0.68) and the compound end-point MACCE (Control: 38.7%, AMDS: 44.4%, P = 0.74) did also not differ.ConclusionsAddressing the arch by implantation of AMDS prolongs cardiopulmonary bypass and circulatory arrest time, however without relevant impairments of short-term outcome. Combining root surgery with replacement of the proximal aortic arch and AMDS implantation seems feasible and safe as it did not impair the early postoperative outcome.

【 授权许可】

CC BY   
© The Author(s) 2023

【 图 表 】

Fig. 2