Initial Experience of Modified Four-Branched Graft Technique and Antegrade TEVAR in Acute Type A Aortic Dissection

Abstract

IntroductionTotal aortic arch repair represents a high-risk operation and may compromise the surgical decision due to the increased mortality and cerebral complications. The arch first technique with retrograde cerebral perfusion or selective antegrade cerebral perfusion was introduced to extend the safety period from cerebral ischemia during deep hypothermic circulatory arrest. However, profound hypothermia prolonged the myocardial ischemic time and cardiopulmonary bypass (CPB) time, and induced coagulopathy which resulted in deteriorated myocardial function, end-organs dysfunction and excessive postoperative bleeding, 1) and the complex manipulation of antegrade cerebral perfusion may release debris from endo-clamping or snaring of arch vessels and the clustered tubes interrupted the operative field. Our modified four-branched graft technique for arch surgery had been reported in 2012, with advantages to evade selective antegrade cerebral perfusion and deep hypothermia.

Analysis of early and long-term outcomes of acute type A aortic dissection according to the new international aortic arch surgery study group recommendations

“…Unfortunately even extended aortic arch reconstructions can result ineffective, due to the presence of re-entry tears in the descending aorta. From this point of view, recent reports of combined (single-stage) proximal and distal aortic repair with the use of antegrade TEVAR are extremely interesting and could overcome this problem [25]. Another technical strategy that can be used is subintimal flap fenestration [26].…”

Hybrid and frozen elephant trunk for total arch replacement in DeBakey type I dissection

“…7 A limited number of studies have focused on the treatment of aortic dissection, all of which are sporadic case reports or small sample studies. [8][9][10] This large sample analysis is the first to compare hybrid aortic repair with the conventional TAR þ FET approach and to comprehensively evaluate early and midterm clinical outcomes of hybrid TAR in DeBakey type I dissection.…”

One-stage hybrid surgery for acute Stanford type A aortic dissection with David operation, aortic arch debranching, and endovascular graft: a case report

“…Considering its extremely complex surgical strategy and high risk of complications, acute Stanford type A aortic dissection involves ascending aorta, aortic arch, and descending aorta and remains a challenge for cardiovascular surgeons (1). The dissection of Stanford type A aortic involves aortic valve dysfunction, total aortic repair, and aortic valve surgery and is a high-risk operation with high mortality rate and cerebral complications, especially for those with high age and surgical risks (2). Recently, with the development of endovascular interventions, a onestage hybrid operation that combines open surgical and endovascular techniques is widely used to avoid deep hypothermic circulatory arrest and cardiopulmonary bypass (CPB) time; this technique gained excellent outcomes (3,4).…”