Replacement of the entire thoracic aorta in a single stage

Minale, C; Splittgerber, Fred H.; Reifschneider, Hans-Joachim

doi:10.1016/0003-4975(94)90188-0

Cited by 32 publications

(20 citation statements)

References 20 publications

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“…The average mortality in the analyzed series was 4.7 %. These results are similar to those of open aortic arch repair, and these results are considered acceptable when compared with the 9.5 % mortality rate reported after first-stage repair with the conventional elephant trunk procedure [14–19], 10.0 % mortality rate after 1-stage extensive aortic replacement with left thoracotomy [20–25], or 9.8 % mortality rate after TEVAR to the landing zone 0 with total arch rerouting [26–31] (Table 2). …”

Section: Open Stent Grafting For Atherosclerotic Aneurysm Of the Distsupporting

confidence: 67%

Open stent grafting for complex diseases of the thoracic aorta: clinical utility

Uchida

2012

Gen Thorac Cardiovasc Surg

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Open stent grafting is an alternative treatment for extensive thoracic aortic replacement. However, this procedure is associated with a high incidence of spinal cord injury, which has limited its application. Multiple factors have been suggested to explain the risk of spinal cord injury, including deep delivery of the stent graft, history of operation of the downstream aorta, and postoperative low blood pressure. Cerebrospinal fluid drainage or a hybrid operation in combination with trans-femoral thoracic stent grafting is useful for preventing spinal cord injury. Open stent grafting remains an alternative treatment for atherosclerotic aneurysms with dilatation of the ascending aorta. Open stent grafting for acute aortic dissection is effective for remodeling of the false lumen. The graft diameter for aortic dissection should be 90 % of the total diameter of the aorta, and the distal landing zone should be limited to the T7 vertebral level to prevent new intimal tears or spinal cord injury. Open stent grafting seems a feasible bailout strategy for the treatment of retrograde aortic dissection after TEVAR for type B aortic dissection. Newly designed devices for open stent grafts include the Matsui-Kitamura stent graft or branched open stent graft, which is produced in Japan. The effectiveness of open stent grafting in the treatment of Marfan syndrome remains unclear. A commercially available device for open stent grafting would be desired in Japan. In conclusion, an open stent graft remains an alternative treatment for complex thoracic aortic pathologies.

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Section: Open Stent Grafting For Atherosclerotic Aneurysm Of the Distsupporting

confidence: 67%

Open stent grafting for complex diseases of the thoracic aorta: clinical utility

Uchida

2012

Gen Thorac Cardiovasc Surg

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“…In order to improve the outcomes, few methods of single-stage repair have been proposed. Most of them are performed through a clamshell incision [15][16][17]. The surgical invasiveness of the bilateral anterior thoracotomy is not innocuous and it is potentially associated with a high incidence of pulmonary complications.…”

Section: Discussionmentioning

confidence: 99%

Treatment of complex disease of the thoracic aorta: the frozen elephant trunk technique with the E-vita open prosthesis☆

Bartolomeo

Marco

Armaro

et al. 2009

European Journal of Cardio-Thoracic Surgery

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The frozen elephant trunk technique with the new E-vita open prosthesis combines surgical and interventional technologies and represents a feasible and efficient option in the treatment of complex aortic pathologies. Strict monitoring of the patient has to be carried out in order to detect possible evolution of the aortic lesion, which can require prompt treatment. However, long-term follow-up is required.

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“…As Table 2 shows, lower mortality rates, especially in patients undergoing redo surgery for chronic aortic dissection involving the distal aortic arch and the proximal descending aorta, have thus been reported [28][29][30][31][32][33][34]. However, the long operating times associated with extensive one stage or total replacements of the entire aorta [33,34]; the higher pulmonary complication rates, ranging from 15% to 50%; the need to sacrifice both internal mammary arteries; the postoperative pain; and the inability to extend resection to segments downstream from the diaphragm, have limited their applicability and acceptance considerably. Today, one-stage repair is only performed at a small number of centers.…”

Section: Conventional Et Techniquementioning

confidence: 94%

Elephant trunk procedure 27 years after Borst: what remains and what is new?

Ius¹,

Hagl²,

Haverich³

et al. 2011

European Journal of Cardio-Thoracic Surgery

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The treatment of complex aortic pathology involving both the ascending and descending aortic segments at the same time represents a surgical challenge, with high postoperative morbidity and mortality rates reported. Over the past 27 years, different open surgical and endovascular techniques have been introduced and applied in various two-stage- or one-stage approaches to such cases. Thus, in 1983, Hans Borst significantly changed the traditional two-stage approach by introducing his elephant trunk technique. Leaving a segment of Dacron prosthesis reaching into the descending aorta during the first stage, the second-stage replacement of the residual dilated descending aorta was made far easier. The presence of interval mortality between the two stages, the unaffected need for two large operations to complete aortic repair, and the general failure of some patients to return for the second-stage repair set the scene for the development of one-stage procedures, both open surgical or hybrid surgical and endovascular, such as the frozen elephant trunk. However, the size of the operation, on the one hand, and the risk of spinal cord injury and need for surgical or endovascular completion during follow-up, on the other, have dampened enthusiasm. Recently, the introduction of supra-aortic debranching and endovascular aortic arch stent-graft repair has yet extended treatment to high-risk patients unsuitable to the more aggressive surgery, but mid- and long-term follow-up results are lacking. The lack of randomization and the presence of procedural and complication-related limitations for each technique do not allow for definitive conclusions about the ideal procedure to treat complex aortic pathology. However, the technical revolution experienced over the past 27 years, along with the improvement in perioperative management, has produced outstanding morbidity and mortality results even in this challenging patient population, but the decision regarding which pathology correlates with what operation remains highly debated and dependent also on regional competence.

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Replacement of the entire thoracic aorta in a single stage

Cited by 32 publications

References 20 publications

Open stent grafting for complex diseases of the thoracic aorta: clinical utility

Open stent grafting for complex diseases of the thoracic aorta: clinical utility

Treatment of complex disease of the thoracic aorta: the frozen elephant trunk technique with the E-vita open prosthesis☆

Elephant trunk procedure 27 years after Borst: what remains and what is new?

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