Application of the modified stented elephant trunk procedure in type B aortic dissection

Abstract

Background: Considering the progressive nature of complicated Stanford type B aortic dissection (TBAD), operation must anticipate the need for later interventions. Recently we have used a modified stent elephant trunk (SET) procedure to treat these patients. And we review the indications, considerations for planning, and operative details for this this modified SET procedure. Methods: Ten patients (seven males and three females) with complicated TBAD underwent a modified SET procedure in Anzhen Hospital, Beijing in the period between January 2019 and December 2019. The patients, whose ages ranged from 29-52 (42±7.23), suffered complications with hypertension. Under deep hypothermic circulatory arrest, all the patients received SET implantation via an incision of the aortic arch. Before the patients were discharged, a computed tomography angiography (CTA) was performed to ensure the safety and accuracy of the procedure. Results: The average surgery time was 4.0-5.5 (4.65±0.47) hours, cardiopulmonary bypass (CPB) time was 115-163 (138.6±15.64) minutes, aortic cross-clamping time was 32-59 (42±7.72) minutes, and selective cerebral perfusion (SCP) time was 15-32 (21.7±5.56) minutes. The SCP flow and nasopharyngeal temperature were 5-8 (6.8±1.23) mL/kg/min and 23.5-26.8 (25.22±0.96) ℃, respectively. During SCP, the blood pressure of the left upper limb was 20-31 (25.5±3.81) mmHg. Aorta cannulation position: vascular graft was anastomosed to the innominate artery (IA) and left subclavian artery (LSA) in seven cases, and with IA, LSA, and the right femoral artery in three cases. Ventilation time was 5-15 (8.8±2.94) h, retention time in ICU was one day, and post-operative hospitalization time was 6-8 (6.9±0.74) days. None of the patients died, or experienced endoleakage or neurological complications. Conclusions:The application of a modified stented elephant trunk procedure in the treatment of TBAD is safe and efficient.

Clinical Validation of the Impact of Branch Stent Extension on Hemodynamics in ISF-TEVAR Involving LSA Reconstruction

“…By quantifying the impact of LSA sealing on hemodynamic parameters during TEVAR virtually, blood flow was investigated in a type B aortic dissection undergoing ISF-TEVAR with LSA reconstruction ( 25 ). The amount of blood flow crossing the LSA was between 3.52 and 5.28% in healthy young humans, which should vary from 4.01 to 6.14% under ideal conditions ( 26 ). However, the present outcome showed that merely 2.36% of the total inlet flow was assigned to the fenestration LSA, which was lower than expected.…”