Total Arch Repair for Acute Type A Aortic Dissection With 2 Modified Techniques: Open Single-Branched Stent Graft Placement and Reinforcement of the Dissected Arch Vessel Stump With Stent Graft
- 7 June 2011
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Circulation
- Vol. 123 (22), 2536-2541
- https://doi.org/10.1161/circulationaha.110.008656
Abstract
Background— In total arch replacement for patients with acute type A aortic dissection, anastomoses of the graft to the left subclavian artery and descending aorta are often difficult, and the arch vessel anastomosis is frequently performed at the site of dissection. To make this procedure easier and safer, we developed 2 modified techniques: open single-branched stent graft placement into the left subclavian artery and the descending aorta and reinforcement of the dissected arch vessel stump with a stent graft neointima. The feasibility and initial clinical results of these 2 new techniques are reported. Methods and Results— Total arch repair with the 2 new techniques was performed in 26 patients with acute Stanford type A aortic dissection. Most patients had an uneventful postoperative course, and there were no surgical deaths. All implanted stent grafts were fully opened and not kinked, and there was no space or blood flow surrounding any of the stent grafts. The false lumen of the descending thoracic aorta closed with thrombus formation in 22 of 26 patients. Disappearance of the false lumen and recovery of the true lumen was observed in all of the dissected arch vessels. Conclusions— Open single-branched stent graft placement into the left subclavian artery and the descending aorta and reinforcement of the dissected arch vessel stump with a stent graft neointima are 2 simple and effective techniques that should make total arch repair an easier and safer procedure for acute type A aortic dissection.Keywords
This publication has 12 references indexed in Scilit:
- 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 GraftCirculation, 2010
- Should the “elephant trunk” be skeletonized? Total arch replacement combined with stented elephant trunk implantation for Stanford type A aortic dissectionThe Journal of Thoracic and Cardiovascular Surgery, 2006
- Long-Term Effectiveness of Total Arch Replacement for Type A Aortic DissectionThe Annals of Thoracic Surgery, 2005
- Aortic arch repair for Stanford type A aortic dissection with distal anastomosis to the proximal level of the distal aortic archThe Journal of Thoracic and Cardiovascular Surgery, 2003
- The results of total arch graft implantation with open stent-graft placement for type A aortic dissectionThe Journal of Thoracic and Cardiovascular Surgery, 2002
- Elephant trunk procedure for surgical treatment of aortic dissectionThe Annals of Thoracic Surgery, 1998
- Surgical Management of Aortic Dissection During a 30-Year PeriodCirculation, 1995
- Aortic dissectionThe Journal of Thoracic and Cardiovascular Surgery, 1994
- Significance of distal false lumen after type A dissection repairThe Annals of Thoracic Surgery, 1994
- Aortic DissectionThe New England Journal of Medicine, 1987