Restoration of the thoracic aorta in Type A dissection with hybrid prothesis

Abstract

Following successful repair of Type A dissection, late morbidity and mortality depend on the progression of residual chronic Type B dissection. To avoid the development of late aneurysms of the descending thoracic aorta, a persistent aortic false lumen around the stent-graft can be prevented by remodeling the thoracic aorta. Ten consecutive patients (mean age: 56 years) with acute Type A dissection underwent a "frozen elephant trunk operation" with the E-vita hybrid prosthesis, under deep hypothermic circulatory arrest, between October 2009 and April 2010. The thoracic aorta was restored to its original size. Computed tomography was used to size the aortic diameter. All patients survived and were routinely discharged. Postoperative computed tomography showed no remaining false lumen and no distal organ ischemia in any patient. No new neurological complication was recorded. Two patients suffered postoperative pulmonary arterial embolism; one underwent embolectomy. Restoration of the thoracic aorta is a safe procedure to close the false lumen during the primary operation for acute Type A dissection. However, the diameter of the stent should reflect the overall aortic size, independent of the diameter of the true lumen.

Thoracic stent graft sizing for frozen elephant trunk repair in acute type A dissection

“…Stents with diameters of 24 to 30 mm are available combined with a 130-or 150-mm stent and stents with diameters of 33 to 40 mm are available combined with stents 130 or 160 mm long. 8,9 To determine the stent graft size, the total diameter of the descending aorta at the level of the left atrium was determined from the preoperative CT angiography or echocardiography studies (Figure 1). To determine the vessel diameter on CT angiography, we used curved multiplanar reformations along the vessels' centerline.…”

Long-term results of simplified frozen elephant trunk technique in complicated acute type A aortic dissection: A case–control study

“…The supraaortic vessels may be anastomosed end-to-end to side branches of the graft or as a patch. [6][7][8][9][10][11][12][13] Unfortunately, some delivery systems are quite cumbersome and deployment of the stented portion of the graft might be imprecise, therefore causing a far more distal landing than intended.…”

Aiming at One-Stage Corrective Surgery for Extended Thoracic Aortic Dilatation

“…The technique has recently been well established among clinics of expertise in Europe. [1][2][3][4][5][6] In our patients, an additional stent of the distal aorta was inserted to induce complete remodeling or exclusion of the entire diseased aorta whenever the frozen elephant trunk Evita prosthesis itself was not sufficient in length. This strategy is in alignment with a recently presented technique including combined proximal stent grafting plus distal bare metal stenting for management of aortic dissection.…”