Is total arch replacement combined with stented elephant trunk implantation justified for patients with chronic Stanford type A aortic dissection?

Objective Surgical treatment of chronic Stanford type A aortic dissection using total arch replacement combined with stented elephant trunk implantation is controversial owing to the visceral arteries and intercostal arteries originating from the false lumen. Methods Eighty-nine patients (mean age,...

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Bibliographic Details
Published in:	The Journal of thoracic and cardiovascular surgery 2009-10, Vol.138 (4), p.892-896
Main Authors:	Sun, Li-Zhong, MD, Qi, Rui-Dong, MD, Chang, Qian, MD, Zhu, Jun-Ming, MD, Liu, Yong-Min, MD, Yu, Chun-Tao, MD, Lv, Bin, MD, Zheng, Jun, MD, Tian, Liang-Xin, MD, Lu, Jin-Guo, MD
Format:	Article
Language:	eng
Subjects:	Adult Aged Aged, 80 and over Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy Aneurysm, Dissecting - diagnostic imaging Aneurysm, Dissecting - surgery Aortic Aneurysm - diagnostic imaging Aortic Aneurysm - surgery Biological and medical sciences Blood Vessel Prosthesis Blood Vessel Prosthesis Implantation - adverse effects Cardiology. Vascular system Cardiothoracic Surgery Chronic Disease Female Humans Male Medical sciences Middle Aged Pneumology Postoperative Complications Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects) Stents Tomography, X-Ray Computed Young Adult
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Summary:	Objective Surgical treatment of chronic Stanford type A aortic dissection using total arch replacement combined with stented elephant trunk implantation is controversial owing to the visceral arteries and intercostal arteries originating from the false lumen. Methods Eighty-nine patients (mean age, 45.67 ± 10.18 years; range, 21–68 years) with chronic type A dissection underwent total arch replacement combined with stented elephant trunk implantation between April 2003 and March 2007. Careful assessment of the visceral arteries and location of entry and re-entry was done before surgery. Postoperative patency of the visceral arteries and diameter of the aortic artery and the residual false lumen were evaluated by computed tomography. Results One (1.12%) hospital death and 2 (2.25%) late deaths occurred at a mean follow-up of 28.5 months (range, 8–52 months). Visceral malperfusion was not observed. Two patients had spinal cord injury and recovered during follow-up. One patient had a transient neurologic deficit and recovered completely before discharge. One patient underwent thoracoabdominal aortic replacement for aneurysmal dilatation of the residual descending aorta 3 months after the operation. Thrombus obliteration of the false lumen at the distal edge of the stented elephant trunk and at the diaphragmatic level was 94.2% (81/86) and 61.6% (53/86), respectively. Conclusions Satisfactory results with low morbidity and mortality were obtained. No visceral malperfusion and a low risk of postoperative spinal cord injury favor this technique in patients with chronic type A dissection.
ISSN:	0022-5223 1097-685X