Extensive Primary Repair of the Thoracic Aorta in Acute Type A Aortic Dissection by Means of Ascending Aorta Replacement Combined With Open Placement of Triple-Branched Stent Graft

Chen, Liangwan; Dai, Xiao-Fu; Lü, Lin; Zhang, Gui-Can; Cao, Hua

doi:10.1161/circulationaha.110.946012

Cited by 77 publications

(86 citation statements)

References 17 publications

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“…However, although FET and other more complex stent-graft combinations might be found to decrease late aneurysm formation (149,318 -320), the procedures require total or substantial arch replacement, automatically extending cerebral protection time and the period of corporeal circulatory arrest. This might increase stroke and paraplegia risk (320,321,322). One certain indication for FET is ATAAD with DescAo rupture (323), and it might also have a particular role in retrograde dissection (324,325), but beyond these, indications are uncertain and controversial (326 -330).…”

Section: Metal Stenting and Separately Deployed Coveredmentioning

confidence: 99%

Evidence, Lack of Evidence, Controversy, and Debate in the Provision and Performance of the Surgery of Acute Type A Aortic Dissection

Bonser

Ranasinghe

Loubani

et al. 2011

Journal of the American College of Cardiology

207

175

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Acute type A aortic dissection is a lethal condition requiring emergency surgery. It has diverse presentations, and the diagnosis can be missed or delayed. Once diagnosed, decisions with regard to initial management, transfer, appropriateness of surgery, timing of operation, and intervention for malperfusion complications are necessary. The goals of surgery are to save life by prevention of pericardial tamponade or intra-pericardial aortic rupture, to resect the primary entry tear, to correct or prevent any malperfusion and aortic valve regurgitation, and if possible to prevent late dissection-related complications in the proximal and downstream aorta. No randomized trials of treatment or techniques have ever been performed, and novel therapies-particularly with regard to extent of surgery-are being devised and implemented, but their role needs to be defined. Overall, except in highly specialized centers, surgical outcomes might be static, and there is abundant room for improvement. By highlighting difficulties and controversies in diagnosis, patient selection, and surgical therapy, our over-arching goal should be to enfranchise more patients for treatment and improve surgical outcomes.

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Section: Metal Stenting and Separately Deployed Coveredmentioning

confidence: 99%

Evidence, Lack of Evidence, Controversy, and Debate in the Provision and Performance of the Surgery of Acute Type A Aortic Dissection

Bonser

Ranasinghe

Loubani

et al. 2011

Journal of the American College of Cardiology

207

175

View full text Add to dashboard Cite

show abstract

“…Instead of direct surgical repair, our new technique could be performed simply by open placement of a triple-branched stent graft into the proximal descending aorta, aortic arch, and 3 arch vessels. 12 However, this new technique could not be used in all patients with acute type A aortic dissection, mainly because the diameters of the native aortic arch and arch vessels and the distances between 2 neighboring arch vessels did not always match the available sizes of the triple-branched stent grafts. With the intention of making total arch repair a much easier and safer procedure for those patients who were not candidates for a triple-branched stent graft, we developed 2 new techniques: open singlebranched stent graft placement into the left subclavian artery and the descending aorta and reinforcement of the dissected arch vessel stump with a stent graft neointima.…”

Section: Clinical Perspective On P 2541mentioning

confidence: 99%

Total Arch Repair for Acute Type A Aortic Dissection With 2 Modified Techniques: Open Single-Branched Stent Graft Placement and Reinforcement of the Dissected Arch Vessel Stump With Stent Graft

Chen

Lü

et al. 2011

Circulation

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Background-In total arch replacement for patients with acute type A aortic dissection, anastomoses of the graft to the left subclavian artery and descending aorta are often difficult, and the arch vessel anastomosis is frequently performed at the site of dissection. To make this procedure easier and safer, we developed 2 modified techniques: open single-branched stent graft placement into the left subclavian artery and the descending aorta and reinforcement of the dissected arch vessel stump with a stent graft neointima. The feasibility and initial clinical results of these 2 new techniques are reported. Methods and Results-Total arch repair with the 2 new techniques was performed in 26 patients with acute Stanford type A aortic dissection. Most patients had an uneventful postoperative course, and there were no surgical deaths. All implanted stent grafts were fully opened and not kinked, and there was no space or blood flow surrounding any of the stent grafts. The false lumen of the descending thoracic aorta closed with thrombus formation in 22 of 26 patients. Disappearance of the false lumen and recovery of the true lumen was observed in all of the dissected arch vessels. Conclusions-Open single-branched stent graft placement into the left subclavian artery and the descending aorta and reinforcement of the dissected arch vessel stump with a stent graft neointima are 2 simple and effective techniques that should make total arch repair an easier and safer procedure for acute type A aortic dissection. (Circulation. 2011;123:2536-2541.)

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“…We read with great interest the article by Chen et al 1 In our opinion, the authors are to be congratulated for their excellent clinical results with a single-stage hybrid procedure for type A acute aortic dissection (TAAD) repair. The purpose of the authors' technique was to obtain a primary repair of the thoracic aorta during TAAD repair and, by so doing, reduce the risk of late thoracoabdominal aneurysm formation and the need for distal reoperation.…”

Section: To the Editormentioning

confidence: 99%

Letter by Murzi and Glauber Regarding Article, “Extensive Primary Repair of the Thoracic Aorta in Acute Type A Aortic Dissection by Means of Ascending Aorta Replacement Combined With Open Placement of Triple-Branched Stent Graft: Early Results”

Murzi

Glauber

2011

Circulation

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Extensive Primary Repair of the Thoracic Aorta in Acute Type A Aortic Dissection by Means of Ascending Aorta Replacement Combined With Open Placement of Triple-Branched Stent Graft

Abstract: Background-To

Cited by 77 publications

References 17 publications

Evidence, Lack of Evidence, Controversy, and Debate in the Provision and Performance of the Surgery of Acute Type A Aortic Dissection

Evidence, Lack of Evidence, Controversy, and Debate in the Provision and Performance of the Surgery of Acute Type A Aortic Dissection

Total Arch Repair for Acute Type A Aortic Dissection With 2 Modified Techniques: Open Single-Branched Stent Graft Placement and Reinforcement of the Dissected Arch Vessel Stump With Stent Graft

Letter by Murzi and Glauber Regarding Article, “Extensive Primary Repair of the Thoracic Aorta in Acute Type A Aortic Dissection by Means of Ascending Aorta Replacement Combined With Open Placement of Triple-Branched Stent Graft: Early Results”

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