Stented elephant trunk procedure combined with ascending aorta and arch replacement for acute type A aortic dissection

Mizuno, Tomohiro; Toyama, Masaaki; Tabuchi, Noriyuki; Wu, Haison; Sunamori, Makoto

doi:10.1016/s1010-7940(02)00429-3

Cited by 62 publications

(49 citation statements)

References 14 publications

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“…Even though this result is in line with those of endovascular stent grafting of descending aortic aneurysms it is still intriguing in view of the significant paraplegia rates reported with open surgical approaches similar to ours [11][12][13][14]. One aspect that could have reduced the risk of spinal cord injury in our series was keeping exclusion criteria with regard to the extent of descending aortic aneurysm to be treated together with a stent graft fabrication, that was adjusted specifically to the patients' individual pathology.…”

Section: Discussionsupporting

confidence: 79%

The frozen elephant trunk technique for the treatment of extensive thoracic aortic aneurysms: operative results and follow-up☆

Kretzler

Chavan

Khaladj

et al. 2005

European Journal of Cardio-Thoracic Surgery

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Objective: The 'frozen' elephant trunk technique allows for single-stage repair of combined aortic arch and descending aortic aneurysms using a 'hybridprosthesis' with a stented and a non-stented end. This report summarizes the operative-and follow-up data (mean follow-up 14 months) with this new treatment. Methods: Between 09/01 and 4/04, 22 patients (62G9 years; 9 female) with different aortic pathologies (15 aortic dissections, 7 aneurysms) were operated on after approval from the local institutional review board. The stented end of the hybridprosthesis was deployed in the descending aorta through the opened aortic arch during hypothermic circulatory arrest and selective antegrade cerebral perfusion. Results: All patients survived the procedure but one patient died of acute hemorrhage due to rupture of the false lumen in the descending aorta on the second postoperative day. Two patients required reexploration of the chest for bleeding complications. In 2 of 4 patients who developed neurological dysfunction, symptoms resolved completely. In one of them, the descending aorta was perforated intraoperatively due to misplacement of the stented end of the hybridprosthesis. In all follow-up CT-scans thrombus formation in the descending aortic aneurysm excluded by the stented end of the hybridprosthesis has been observed. Conclusions: This procedure is performed through median sternotomy and combines the concepts of the elephant trunk operation and endovascular stenting of descending aortic aneurysms. Favourable intraoperative and postoperative results during follow-up with regard to thrombus formation around the stented descending aortic segment encourage us to evaluate all patients with thoracic aneurysms extending to proximal and distal of the left subclavian artery for this treatment.Q 2005 Published by Elsevier B.V.

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Section: Discussionsupporting

confidence: 79%

The frozen elephant trunk technique for the treatment of extensive thoracic aortic aneurysms: operative results and follow-up☆

Kretzler

Chavan

Khaladj

et al. 2005

European Journal of Cardio-Thoracic Surgery

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“…4,19 Overall, the elephant trunk graft dimensions were consistent with other published series, 1,9 whereas the length of the distal repair was based on the distal extent of aortic disease. Both Usui et al 20 and Mizuno et al 21 reported paraplegia (2 cases) and stroke (1 case) after similar types of repairs. The lack of paraplegia or stroke in the present series provides us with some optimism, yet the 3 cases of paraparesis caused us concern, particularly in the setting of extensive aortic coverage (none occurred in patients without mesenteric bypass or prior aortic repair).…”

Section: Discussionmentioning

confidence: 85%

Hybrid Approaches to Thoracic Aortic Aneurysms

et al. 2005

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Background-Thoracic aortic aneurysm affecting the arch and proximal descending thoracic aorta requires 2-stage repairs that include proximal elephant trunk graft placement and completion of thoracic or thoracoabdominal repair. The application of endovascular grafting to complete the proximal procedure avoids a thoracotomy and may improve the morbidity and mortality of the patient population at risk. Methods and Results-A retrospective review of 399 thoracic endovascular grafts at our institution between 2000 and 2004 identified 22 patients who required elephant trunk and endovascular completion. Three patients underwent mesenteric bypass in addition to their proximal repairs. Mean follow-up was 10 months (range 1 to 42 months); there were no ruptures, and all patients returned for follow-up. Technical success was achieved in all patients. The 1-, 12-, and 24-month mortality rates (by Kaplan-Meier analysis) were 4.5%, 15.8%, and 15.8%, respectively. Caudal migration of the endograft occurred in 1 patient, and all but 2 aneurysms decreased or remained stable in size. The 2 patients with growth included a type III endoleak (which resolved after treatment) and pressurization through an expanded PTFE stentgraft. Three cases of transient paraparesis occurred (all in patients requiring mesenteric bypass or abdominal aortic aneurysm repair), and there were no paraplegias or strokes. Conclusions-Endovascular completion of elephant trunks is feasible and can be accomplished with minimal mortality.Meticulous imaging follow-up is required to detect persistent aneurysm pressurization and to verify the integrity of the repair. Improvements in implant design and delivery systems will further simplify the second-stage portion of these complex aneurysm repairs.

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“…In most situations, replacement of total-arch was the operation of choice for Debakey type Ⅰ aortic dissection, with a simultaneous use of stented-elephant trunk technique [2][3][4][5] . Open surgeries were performed in patients suffering from diseased descending aorta with involvement of important branches that entails re-implantation.…”

Section: Selection Of Proceduresmentioning

confidence: 99%

“…Since other operative techniques were well described, total arch replacements in combination with stented-elephant trunk technique [3][4][5] were detailed in this article. Patients were anesthetized under endotracheal general anesthesia.…”

Section: Surgical Techniquesmentioning

confidence: 99%

Surgical treatment of aortic aneurysm and aortic dissection: A retrospective analysis of 122 cases

Sun

Jiang

Zhang

et al. 2009

J. Huazhong Univ. Sci. Technol. [Med. Sci.]

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The study summarizes the clinical experience of surgical treatments of various types of thoracic aneurysm and aortic dissection. Clinical data of 122 patients with thoracic aneurysm and aortic dissection during July 2005 to July 2008 were retrospectively analyzed. The elective operations were performed in 107 patients while emergency surgery was done in 15 cases. Different surgical strategies were employed on the basis of diseased region, including simple ascending aortic replacement (n=3), aortic root replacement (n=43), hemi-arch replacement /total arch replacement+elephant trunk technique (n=32), thoracic/thoracoabdominal aortic replacement (n=8) and endovascular repair (n=36). In this series, there is 4 cases of perioperative death due to massive cerebral hemorrhage (n=1), respiratory failure (n=1) and multiple organ dysfunction syndrome (MODS) (n=2). Three cases developed post-operative massive cerebral infarction and the relatives of the patients abandoned treatment. Instant success rate of endovascular repair was 100%. The intimal rupture was sealed. Blood flow was unobstructed in true lumen and no false lumen was visualized. It was concluded that aggressive surgery should be considered in the patients with thoracic aneurysm and aortic dissection. Surgical procedures should vary with the location and the nature of the lesions.

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Stented elephant trunk procedure combined with ascending aorta and arch replacement for acute type A aortic dissection

Cited by 62 publications

References 14 publications

The frozen elephant trunk technique for the treatment of extensive thoracic aortic aneurysms: operative results and follow-up☆

The frozen elephant trunk technique for the treatment of extensive thoracic aortic aneurysms: operative results and follow-up☆

Hybrid Approaches to Thoracic Aortic Aneurysms

Surgical treatment of aortic aneurysm and aortic dissection: A retrospective analysis of 122 cases

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