Prosthetic replacement of the aortic arch

Griepp, Randall B.; Stinson, Edward B.; Hollingsworth, Jefferson F.; Buehler, Donald

doi:10.1016/s0022-5223(19)39653-9

Cited by 662 publications

(222 citation statements)

References 18 publications

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“…5,[8][9][10][11] The original technique to treat acute type A aortic dissection entailed aortic cross-clamping at the level of the innominate artery with simultaneous repair of the proximal and distal ascending aortic pathology. 1,2,12 Open distal anastomosis with hypothermic circulatory arrest (HCA) has since been advocated, 8,13,14 with retrograde cerebral perfusion (RCP) introduced as an adjunct in the mid-1990s. [15][16][17] In more recent years, antegrade cerebral perfusion has been used for elective aortic arch procedures, 9,18 but to a lesser degree in acute dissection.…”

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confidence: 99%

Importance of Blood Pressure Control After Repair of Acute Type A Aortic Dissection: 25‐Year Follow‐Up in 252 Patients

Melby

Zierer

Damiano

et al. 2012

J of Clinical Hypertension

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The purpose of this study was to evaluate factors that impact outcome following repair of type A aortic dissection. Over 25 years , 252 patients underwent repair of acute type A dissection. Mean follow-up for reoperation or death was 6.9AE5.9 years. Operative mortality was 16% (41 of 252). Multivariate analysis identified one risk factor for operative death: presentation malperfusion (P=.003). For operative survivors, 5-, 10-, and 20-year survival was 78%AE3%, 59%AE4%, and 24%AE6%, respectively. Late death occurred earlier in patients with previous stroke (P=.02) and chronic renal insufficiency (P=.007). Risk factors for late reoperation included male sex (P=.006), Marfan syndrome (P<.001), elevated systolic blood pressure (SBP, P<.001), and absence of b-blocker therapy (P<.001). Kaplan-Meier analysis demonstrated at 10-year follow-up that patients who maintained SBP <120 mm Hg had improved freedom from reoperation (92AE5%) compared with those with SBP 120 mm Hg to 140 mm Hg (74%AE7%) or >140 mm Hg (49%AE14%, P<.001). At 10-year follow-up, patients on b-blocker therapy experienced 86%AE5% freedom from reoperation compared with only 57%AE11% for those without (P<.001).Operative survival was decreased with preoperative malperfusion. Long-term survival was dependent on comorbidities but not operative approach. Reoperation was markedly increased in patients not on b-blocker therapy and decreased with improved SBP control. Strict control of hypertension with b-blocker therapy is warranted following repair of acute type A dissection. J Clin Hypertens (Greenwich). 2013; 15:63-68. Ó2012 Wiley Periodicals, Inc.Despite contemporary surgical advances, patients with acute type A aortic dissection still present significant operative challenges both in terms of short-and longterm outcomes. Reported operative mortality rates are high (15%-28%) with stroke rates of 2% to 15%.

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confidence: 99%

Importance of Blood Pressure Control After Repair of Acute Type A Aortic Dissection: 25‐Year Follow‐Up in 252 Patients

Melby

Zierer

Damiano

et al. 2012

J of Clinical Hypertension

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“…Within an interval of 6 weeks to 3 vertebral levels F8 to L-2 are reattached to enable reestablishment of blood flow to the spinal cord by the artery of Adamkiewicz and higher thoracic spinal radicular arteries. The operative technique for the second stage procedure is essentially the same as that for the standard descending thoracic or thoracoabdominal aortic aneurysm repairs as described previously.6.8…”

Section: Operative Techniquementioning

confidence: 99%

“…This increased surface area and tightening of the suture line results in a reduced risk of bleeding at the distal anastomosis. Since it is easier to suture the distal anastomosis as shown by Griepp et al 3 with the graft inverted in the descending thoracic aorta, there is no need for torsion on the needle to suture through the graft and the aortic wall within the confines of the crevice between the graft and aortic lumen. Thus, the risk of tearing of the aorta is considerably lessened.…”

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confidence: 99%

Rationale and Technique for Replacement of the Ascending Aorta, Arch, and Distal Aorta Using a Modified Elephant Trunk Procedure

Svensson

1992

J Cardiac Surgery

121

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Replacement of the aortic arch during repair of either extensive aortic aneurysmal disease or aortic dissection can be a major undertaking. Borst introduced an "elephant trunk" technique whereby a tubular aortic graft prosthesis was inserted into the distal aorta while repairing the ascending aorta and aortic arch. The distal elephant trunk prosthesis was then used for a second stage operation that involved replacement of sections of the distal aorta. Since then, a few problems have been encountered with the standard elephant trunk procedure and this has led to a modification of the elephant trunk technique, which enables a more accurate and secure distal aortic arch anastomosis to be performed. Using the standard technique described by Borst, the surgeon has to suture in the groove between the tubular graft and the aortic wall, which can increase the risk that torsion on the suture needle will tear the aortic wall resulting in aortic rupture. Indeed, this complication has been noted in the postoperative period when performing the standard technique. Subsequently, the technique was modified with inversion of the graft in itself, placement of the graft in the descending aorta, and performance of the distal anastomosis using a technique similar to that described by Griepp. This has improved the ease of performing the procedure and the results of the technique such that a better than 90% survival rate can be expected for the first and the second stage repairs.

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“…Since its introduction, deep hypothermic circulatory arrest (DHCA) has been widely used for cerebral protection during aortic arch surgery. 1 Circulatory arrest can be guided by nasopharyngeal or core temperature measurements; however, these measurements may not be reliable indicators of brain temperature. 2 For this reason, we rely on a physiologic measurement of electroencephalogram (EEG) to guide circulatory arrest during aortic arch surgery.…”

mentioning

confidence: 99%

Intraoperative Electroencephalogram-Guided Deep Hypothermia Plus Antegrade and/or Retrograde Cerebral Perfusion During Aortic Arch Surgery

Murashita

Pochettino

2016

J Card Surg

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Prosthetic replacement of the aortic arch

Cited by 662 publications

References 18 publications

Importance of Blood Pressure Control After Repair of Acute Type A Aortic Dissection: 25‐Year Follow‐Up in 252 Patients

Importance of Blood Pressure Control After Repair of Acute Type A Aortic Dissection: 25‐Year Follow‐Up in 252 Patients

Rationale and Technique for Replacement of the Ascending Aorta, Arch, and Distal Aorta Using a Modified Elephant Trunk Procedure

Intraoperative Electroencephalogram-Guided Deep Hypothermia Plus Antegrade and/or Retrograde Cerebral Perfusion During Aortic Arch Surgery

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