A Modified and Less Invasive Procedure in Aortic Arch Replacement

Gao, Feng; Chen, Jing; Zhou, Qian; Lin, Fang‐Yue

doi:10.1016/j.athoracsur.2016.08.066

Cited by 2 publications

(2 citation statements)

References 6 publications

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“…Besides, the incidence of these dysfunction is positively correlated with the duration of DHCA [13][14][15][16]. Hybrid surgery can reduce the difficulty of the operation and recent complications by avoiding DHCA, but it also leads to a relatively high incidence of late complications [17,18], due to its lack of one important step of Sun's procedure that the expandable stent graft can be firmly fixed to the distal 4-branched prosthetic graft using the suture line. One study reported that the incidence of late complications was up to 48%, including delayed type I endoleak, stent migration, stent fracture and so on.…”

Section: Discussionmentioning

confidence: 99%

One minute of circulatory arrest for acute type A aortic dissection --------- a simple operation for acute type A aortic dissection (AAAD)

Jiang

Huo

Liu

et al. 2020

J Cardiothorac Surg

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Background Sun’s procedure is currently recognized as the standard procedure for acute type A aortic dissection (AAAD). But the operation istoo difficult for beginners. We hope to reduce the difficulty and complications of this operation. Methods The aortic arch was immediately cross-clamped after the stented graft was inserted into the distal aorta. Thereafter, the lower-body perfusion was restored. Then, anastomosis was performed between the proximal stent graft and the distal 4-branched Dacron graft. The other arteries were anastomosed to the arched branch of the 4-branched graft. Results The cardiopulmonary bypass (CPB) time was (207 ± 52) min, and the aortic cross-clamp time was (114 ± 39) min. The circulatory arrest time was (38 ± 16) sec. One patient (4%) died. The incidence of complications was stroke (4%), renal dysfunction requiring dialysis (4%), prolonged intubation(12%). Conclusions The time of circulatory arrest in this operation is less than 1 min, which can avoid the complications caused by DHCA and decrease risk of bleeding and complexity by shifting anastomosis more proximally. The effect of our operation is similar to and even better than that of Sun’s procedure. It does not even require relatively advanced skill, much experience and excellent psychological quality, especially suitable for beginners.

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Section: Discussionmentioning

confidence: 99%

One minute of circulatory arrest for acute type A aortic dissection --------- a simple operation for acute type A aortic dissection (AAAD)

Jiang

Huo

Liu

et al. 2020

J Cardiothorac Surg

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“…If the left common carotid artery is occluded by a torn intima, the first anastomosis can be performed between the left subclavian artery and graft branch [ 3 ].…”

Section: Commentsmentioning

confidence: 99%

Modification in aortic arch replacement surgery

Gao

Zhang

et al. 2018

J Cardiothorac Surg

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ObjectiveWe modified the conventional aortic arch replacement procedure to avoid circulation arrest and a prolonged extracorporeal circulation time, especially in cases of acute aortic dissection. We herein present our experience with a modified branch-first approach to acute aortic dissection, with anastomosis of the supra aortic vessels prior to commencing cardiopulmonary bypass.MethodsSince 2012, 41 patients (aortic dissection, 36; arch aneurysm, 5) have undergone the modified procedure. Procedurally, the implanted graft was used as a landing zone for second-stage endovascular stent-graft deployment intended to manage the residual descending dissection. Antegrade and retrograde systemic perfusion was instituted during cardioplegic arrest. The brain was actively perfused via the graft throughout the procedure.ResultsArch replacement surgery could generally be completed within approximately 4 h. During a 2-year period of aortic dissection or arch aneurysm treatment, only four anastomoses were required during the first stage of operation: two in the aorta, and one each in the innominate and left common carotid arteries. No patient died of surgical causes, and no stent grafts were deployed into the false lumen, a characteristic of procedures using traditionally antegrade deployment.ConclusionWe recommend that our procedure for acute aortic dissection be performed in two stages (graft replacement first and stent graft deployment second), particularly for patients underwent preoperative hypotesion. If malperfusion syndrome still exists after graft replacement, stent graft should be deployed in one stage. The arch aneurysm can be treated in one stage because there is no concern about false lumen deployment.Electronic supplementary materialThe online version of this article (10.1186/s13019-017-0689-y) contains supplementary material, which is available to authorized users.

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A Modified and Less Invasive Procedure in Aortic Arch Replacement

Cited by 2 publications

References 6 publications

One minute of circulatory arrest for acute type A aortic dissection --------- a simple operation for acute type A aortic dissection (AAAD)

One minute of circulatory arrest for acute type A aortic dissection --------- a simple operation for acute type A aortic dissection (AAAD)

Modification in aortic arch replacement surgery

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