A self-adaptive triple-branched stent graft for arch repair during open type A dissection surgery

Abstract

The simple implantation of a self-adaptive triple-branched stent graft with the aid of the arch open technique can be used safely in most patients with acute type A aortic dissection for effective individual total arch repair.

Ascending Aorta and Hemiarch Replacement Combined With Modified Triple-Branched Stent Graft Implantation for Repair of Acute DeBakey Type I Aortic Dissection

“…Although implantation of the triple-branched stent graft took a few minutes, the cardiopulmonary bypass time, aortic cross-clamp time, and selective cerebral perfusion and lower body arrest time in our series were comparable to those in the simplest ascending aorta and hemiarch replacement with open distal aortic anastomosis [13,14]. The reason is that our modified triplebranched stent graft provided a strong distal aortic stump, thus obviating the need for distal aortic stump reinforcement in the ascending aorta and hemiarch replacement [6,9].…”

“…In the present modified technique, the three arch vessel orifices and the true lumen of the descending aorta were clearly seen after the aortic arch was transected obliquely and most of the lesser curvature was removed, and this resulted in easier and safer implantation of the modified triple-branched stent graft. Moreover, the aortic arch stent, which was routinely necessary in the previous open triple-branched stent graft implantation technique, was obviated in our present modified technique because the total native aortic arch was preserved [8,9]. In the previous open triple-branched stent graft implantation technique, the diameter match between the native aortic arch and the proximal main stent graft of the triplebranched stent graft was an important factor in effective dissected aortic arch repair, but this match was not necessary in the present modified technique because most of the lesser curvature of the native aortic arch was removed.…”

“…Unfortunately, the aortic arch vessel orifices and the true lumen of the descending aorta could not be clearly seen through the distal ascending incision in some of our cases, and this resulted in difficult implantation of the triple-branched stent graft [6,7]. To facilitate exposure of the aortic arch vessel orifices and the true lumen of the descending aorta, an arch open and closed technique has been recommended [8,9]. Performing this open and closed procedure at the dissected aortic arch increases the selective cerebral perfusion and lower body arrest time and may result in intraoperative or postoperative hemorrhage secondary to tissue tearing at the suture line.…”

Midterm cerebral outcomes of Stanford type A aortic dissection in patients who underwent novel triple‐branched stent graft implantation combined with intraoperative monitoring of regional cerebral oxygen saturation

“…Other methods to prevent cerebral hypoxia included increasing the pump flow, increasing the FiO 2 and performing allogeneic blood transfusion. The patients in group B received conventional brain protection strategy without the guidance of intraoperative rcSO 2 monitoring …”

“…Although the duration of a systemic circulatory arrest has been significantly shortened by the novel triple‐branched stent graft implantation and the cerebrovascular perfusion technique has been modified, cerebral dysfunction is still one of the most common and serious complications resulting from Stanford type A aortic dissection (AAD) surgery in our department (with rates of complications ranging from 8.6% to 10.7%) It is currently known that the main mechanism of postoperative cerebral dysfunction is the disbalance of oxygen metabolism in the brains of patients. Compared with conventional monitoring methods, regional cerebral oxygen saturation (rcSO 2 ) can provide much earlier warning indications of cerebral hypoxia.…”