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Journal of Cardiothoracic Surgery
Published in: Journal of Cardiothoracic Surgery 1/2014

Open Access 01-12-2014 | Research article

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

Authors: Liang-Wan Chen, Xi-Jie Wu, Xiao-Fu Dai, Lin Lu, Dong-Shan Liao, Chao Li, Qian-Zhen Li

Published in: Journal of Cardiothoracic Surgery | Issue 1/2014

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Abstract

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.
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Literature
1.
Fuster V, Ip JF: Medical aspects of acute aortic dissection. Semin Thorac Cardiovasc Surg. 1991, 3: 219-224.PubMed
2.
DeSanctis RW, Doroghazi RM, Austen WG, Buckley MJ: Aortic dissection. N Engl J Med. 1987, 317: 1060-1067.CrossRefPubMed
3.
DeBakey ME, McCollum CH, Crawford ES, Morris GC, 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.PubMed
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.CrossRef
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.CrossRefPubMed
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.PubMed
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.CrossRefPubMed
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.CrossRefPubMed
10.
Minale C, Splittgerber FH, Reifschneider HJ: Replcaement of the entire thoracic aorta in a single stage. Ann Thorac Surg. 1994, 57: 850-855.CrossRefPubMed
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.CrossRefPubMed
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.CrossRefPubMed
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.CrossRefPubMed
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.CrossRefPubMed
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.CrossRef
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.CrossRefPubMed
19.
Bates MC, Broce M, Lavigne PS, Stone P: Subclavian artery stenting: factors influencing long-term outcome. Catheter Cardiovasc Interv. 2004, 61: 5-11.CrossRefPubMed
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.CrossRefPubMed
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.CrossRefPubMed
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.CrossRefPubMedPubMedCentral
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.CrossRef
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.CrossRef
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.CrossRefPubMed
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.CrossRefPubMed
Metadata
Title
Total arch repair for acute type A aortic dissection with open placement of a modified triple-branched stent graft and the arch open technique
Authors
Liang-Wan Chen
Xi-Jie Wu
Xiao-Fu Dai
Lin Lu
Dong-Shan Liao
Chao Li
Qian-Zhen Li
Publication date
01-12-2014
Publisher
BioMed Central
Published in
Journal of Cardiothoracic Surgery / Issue 1/2014
Electronic ISSN: 1749-8090
DOI
https://doi.org/10.1186/s13019-014-0135-3

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