Stepwise external wrapping procedure for Stanford type A aortic dissection in extremely high-risk patients: case reports

Abstract

Background: Acute aortic dissection (AAD) is a rare, but a life-threatening condition which can lead to coronary, brachiocephalic or branch vessel malperfusion, as well as aortic valve insufficiency, or aortic rupture. Mortality of surgical treatment in high-risk or elderly patients with Type A Acute aortic dissection (TAAAD) still remains high, and treatment for such patients remains controversial. Case presentation: A new surgical approach which entails "stepwise external wrapping (SEW)" using a zeroporosity artificial graft was developed in extremely high-risk patients with TAAAD. Herein, we described its surgical details and showed two representative cases which was successfully done. Conclusions: Our SEW procedure is a feasible alternative to conventional graft replacement for TAAAD in extremely high-risk or aged patients, although the gold standard consists of surgical replacement of the dissected aorta. (129 words).

Commentary: The ascending aorta and arch in the sights of transcatheter therapy. A time for reappraisal.

“…Suematsu et al reported the utilization of this technique in 82 patients since January 2015 and describe the new surgical approach which entails "stepwise external wrapping" using a zero-porosity artificial graft and applied in extremely high-risk patients. Patient outcomes after external wrapping were excellent with zero in-hospital mortality, successful aorta remodeling, and no aorta-related death during three years of follow up, thus very encouraging results of a feasible alternative to conventional graft replacement surgery [13,14].…”

Hybrid stepwise external wrapping for type a acute aortic dissection with cerebral Malperfusion

“…Intraoperative transesophageal echocardiography demonstrated mild aortic regurgitation. We then proceeded to treat the patient using the new surgical approach devised by us for high-risk patients, reported previously (stepwise external wrapping: SEW) [1,2]. The ascending aorta was carefully separated from the pulmonary arterial trunk and right pulmonary artery.…”

The ascending aorta and arch in the sights of transcatheter therapy: A time for reappraisal

“…Patient outcomes after external wrapping were excellent with zero inhospital mortality, successful aorta remodeling, and no aorta-related death during 3 years of follow-up; thus, results of a feasible alternative to conventional graft replacement surgery were very encouraging. 13,14 While medical management is emerging as a reasonable approach in selected patients who are not surgical candidates, endovascular intervention for the treatment of type A AAD is rapidly progressing. Utilization of transcatheter therapies in the ascending aorta for treating type A AAD has demonstrated technical success in small studies, low early mortality rates, and relatively acceptable aorta-related mortality rates in the long term.…”

“…Suematsu et al reported the utilization of this technique in 82 patients since January 2015 and described the new surgical approach that entails “stepwise external wrapping” using a zero‐porosity artificial graft and is applied in extremely high‐risk patients. Patient outcomes after external wrapping were excellent with zero in‐hospital mortality, successful aorta remodeling, and no aorta‐related death during 3 years of follow‐up; thus, results of a feasible alternative to conventional graft replacement surgery were very encouraging 13,14 …”