Dr. Sun's Procedure for Type A Aortic Dissection: Total Arch Replacement Using Tetrafurcate Graft With Stented Elephant Trunk Implantation

Ma, Wei-Guo; Zheng, Jun; Liu, Yongmin; Zhu, Jun; Sun, Li‐Zhong

doi:10.12945/j.aorta.2013.13.015

Cited by 74 publications

(80 citation statements)

References 22 publications

(36 reference statements)

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“…The aortic arch, proximal DA and arch vessels were dissected on CPB before circulatory arrest. The surgical technique, known as the Sun's procedure, has been previously described in detail (17,(25)(26)(27). Briefly, right axillary artery cannulation is used for CPB and unilateral selective antegrade cerebral perfusion under moderate hypothermic circulatory arrest at 25 ℃ is utilized.…”

Section: Surgical Techniquementioning

confidence: 99%

“…Briefly, right axillary artery cannulation is used for CPB and unilateral selective antegrade cerebral perfusion under moderate hypothermic circulatory arrest at 25 ℃ is utilized. The aortic arch is transected between the left carotid and left subclavian arteries (26). After the FET (Cronus ® , MicroPort Medical, Shanghai, China) is deployed in the DA, TAR is performed with a 4-branched vascular graft (Maquet, Rastatt, Germany).…”

Section: Surgical Techniquementioning

confidence: 99%

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Total arch replacement and frozen elephant trunk for type A aortic dissection after Bentall procedure in Marfan syndrome

Chen

Zheng

et al. 2018

J. Thorac. Dis.

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Background: We seek to report the long-term outcomes of the total arch replacement and frozen elephant trunk (TAR + FET) technique for type A aortic dissection (TAAD) following prior Bentall procedure in patients with Marfan syndrome (MFS). Methods: Between 2003 and 2015, we performed TAR + FET for 26 patients with MFS who developed TAAD following a prior Bentall procedure. Mean age at FET 36.9±9.7 years and 24 were males. TAAD was acute in 8 (30.8%, all new dissections from precious root aneurysm) and chronic in 18 (69.2%, 15 residual and 3 new). The interval from Bentall procedure to FET averaged 6.4±5.8 years, which was significantly longer in the acute group (10.3±6.3 vs. 4.6±4.9, P=0.021). The early and long-term outcomes were compared between two groups and risk factors identified for late adverse events.Results: Operative mortality was 11.5% (3/26). Stroke, lower limb ischemia and reexploration for bleeding occurred in 1 patient each (3.8%). Follow-up was complete in 100% (23/23) at mean 5.1±2.3 years (range, 0.9-11.2 years). The maximal diameter (DMax) of distal aorta in the chronic group was significantly greater at the unstented descending aorta [DA, (56.4±15.5 vs. 35.6±12.2 mm, P=0.006)] compared to acute patients. The false lumen was obliterated in 95.7% across the FET and 56.5% in the unstented DA. Distal aortic dilation occurred in 13 patients (11 chronic, 68.8%). Of those 11 patients, 4 underwent an open thoracoabdominal aortic repair and 3 died of distal aortic rupture. Late death occurred in 7 patients at mean 3.9±2.5 years. At 6 years, the incidence was 18% for death, 11% for distal aortic reoperation, and 71% for reoperationfree survival. Survival did not differ between two groups (75.0% vs. 71.3%, P=0.851), while acute patients had significantly higher freedom from late rupture and reoperation at 6 years (100% vs. 61.9%, P=0.046). Bentall procedure in patients with MFS. Early and late survival did not differ with acute and chronic dissections, while freedom from late rupture and reoperation is significantly higher in patients with acute TAAD. Patients with hypertension and aged <35 years are at higher risk for late distal aortic dilation, reoperation and death.

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Section: Surgical Techniquementioning

confidence: 99%

Section: Surgical Techniquementioning

confidence: 99%

Total arch replacement and frozen elephant trunk for type A aortic dissection after Bentall procedure in Marfan syndrome

Chen

Zheng

et al. 2018

J. Thorac. Dis.

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“…Методика доктора Li-Zhong Sun, предложенная в 2002 г., представляет собой вариант «замороженного хобота слона» без использования специ-альных префабрикованных комбинированных протезов и предназначена, в первую очередь, для лечения расслоения аорты I типа и мегааорты. В качестве эндопротеза, погру-жаемого в нисходящую аорту, Sun использует стент-графт китайского производства, основной особенностью кото-рого является сантиметровая площадка свободного син-тетического протеза на обоих краях устройства, предна-значенная для наложения анастомоза с протезом дуги аорты [7]. Нами частично взята тактика протезирования самой дуги -использование многобраншевого протеза и последовательность действий.…”

Section: Discussionunclassified

“…При этом внутрибольничная летальность составляла 6,27% (7,98% при экстренных и срочных операциях, 3,98% -при плановых) [7]. Описан широкий спектр показаний к этой операции: расслоение аорты А типа как острое, так и хроническое [6], при этом тромбоз ложного канала на-ступает у 93% пациентов [7]; мегааорта (аневризма восхо-дящей аорты, дуги, нисходящей аорты); расслоение аорты B типа с вовлечением в процесс дистальной части дуги аорты [11], ретроградное расслоение; врожденная патоло-гия аорты, требующая вмешательства на дуге и нисходя-щей аорте [7]. Успешно методика применяется у пациен-тов с синдромом Марфана [10].…”

Section: рис 1 мультиспиральная компьютерная томограмма (аксиальныйunclassified

Sun’s procedure for aortic arch replacement using multi-branched prosthesis

Комаров¹,

Belov²,

Karavaykin³

et al. 2015

Kardiol. serdechno-sosud. khir.

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“…The details of the procedure were described previously (7,8). Operative mortality was 7.0% (70/1,003) and 25 hospital survivors were lost to follow-up (2.7%).…”

Section: Patientsmentioning

confidence: 99%

Dr. Sun's Procedure for Type A Aortic Dissection: Total Arch Replacement Using Tetrafurcate Graft With Stented Elephant Trunk Implantation

Cited by 74 publications

References 22 publications

Total arch replacement and frozen elephant trunk for type A aortic dissection after Bentall procedure in Marfan syndrome

Total arch replacement and frozen elephant trunk for type A aortic dissection after Bentall procedure in Marfan syndrome

Sun’s procedure for aortic arch replacement using multi-branched prosthesis

Endovascular repair of residual intimal tear or distal new entry after frozen elephant trunk for type A aortic dissection

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