Total Arch Replacement Combined With Stented Elephant Trunk Implantation
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- 8 March 2011
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Circulation
- Vol. 123 (9), 971-978
- https://doi.org/10.1161/circulationaha.110.015081
Abstract
Background— Appropriate surgical management of type A dissection is a critical factor for achieving satisfactory outcome, but the choice of optimal procedure is controversial. We retrospectively reviewed our experience with aortic arch replacement for type A dissection involving the arch. Methods and Results— Excluding 14 cases of subtotal or total aortic replacement, 411 of 544 patients with type A dissection (stented elephant trunk=291, conventional surgical repair=120) underwent aortic arch replacement between January 2003 and September 2008. In-hospital mortality was 3.09% (9 of 291) for stented (acute=4.73%, 7 of 148; chronic=1.40%, 2 of 143) and 5.00% (6 of 120) for conventional repairs (acute=6.06%, 4 of 66; chronic=3.70%, 2 of 54). Spinal cord injury was 2.41% (7 of 291) in the stented and 0.83% (1 of 120) in the conventional group. The overall prevalence of stroke was 1.95% (8 of 411) (stented=2.41%, 7 of 291; conventional=0.83, 1 of 120). Secondary intervention was 2.34% (5 of 214) for acute dissection (stented=1 and conventional=4; P=0.031) and 3.05% (6 of 197) for chronic dissection (stented=4 and conventional=2; P=0.661) during follow-up. Obliteration of the false lumen around the stented elephant trunk occurred in 94.2% (130 of 138) of patients with acute dissection and in 92.0% (126 of 137) of patients with chronic dissection. Conclusions— Total arch replacement combined with stented elephant trunk implantation demonstrated the superiority of the combination of the surgical and interventional approaches while avoiding the weaknesses associated with the individual methods. The encouraging surgical results could enable this procedure to become the new “standard” therapy for type A dissection involving repair of the aortic arch.This publication has 25 references indexed in Scilit:
- One-Stage Repair of Extensive Chronic Aortic Dissection Using the Arch-First Technique and Bilateral Anterior ThoracotomyThe Annals of Thoracic Surgery, 2008
- Distal aortic surgery following arch replacement with a frozen elephant trunk☆European Journal of Cardio-Thoracic Surgery, 2008
- The Elephant Trunk Technique for Staged Repair of Complex Aneurysms of the Entire Thoracic AortaThe Annals of Thoracic Surgery, 2006
- 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
- Single-stage repair of extensive thoracic aortic aneurysms: Experience with the arch-first technique and bilateral anterior thoracotomyThe Journal of Thoracic and Cardiovascular Surgery, 2004
- The potatoes and the bottleEuropean Journal of Cardio-Thoracic Surgery, 2004
- Combined Surgical and Endovascular Treatment of Acute Aortic Dissection Type A: Preliminary ResultsThe Annals of Thoracic Surgery, 2002
- Long-term effectiveness of operations for ascending aortic dissectionsThe Journal of Thoracic and Cardiovascular Surgery, 2000
- Extended aortic replacement for acute type a dissection with the tear in the descending aortaThe Journal of Thoracic and Cardiovascular Surgery, 1996
- Extensive Aortic Replacement using “Elephant Trunk” ProsthesisThe Thoracic and Cardiovascular Surgeon, 1983