Sun’s total arch replacement and stent elephant trunk with modified branch-first technique for patients with Stanford type A aortic dissection

Yang, Sihua; Xue, Yuan; Zhang, You-Cong; Gao, Hui‐Qiang; Jiang, Wenjian; Lǐ, Jiànróng; Pan, Xudong; Dong, Siwei; Xu, Shumin; Zheng, Jun; Sun, Li‐Zhong

doi:10.21037/atm-20-3791

Cited by 4 publications

(2 citation statements)

References 24 publications

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“…Secondly, complex surgical skills are required. For instance, anastomosis of the descending aorta can be difficult because of the deep surgical field ( 14 ). Thirdly, the limbs of the 4-branched arch graft have a tendency to bend or undergo stenosis after closure owing to inappropriate trimming and positioning ( 15 ).…”

Section: Discussionmentioning

confidence: 99%

Simplified total arch reconstruction with a stented graft for extended aortic arch dilation

Zheng¹,

Yu²,

Lin³

et al. 2023

J Thorac Dis

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Background: Reconstruction of the aortic arch and its three supra-aortic vessels remains a great surgical challenge with postoperative complications. We present a simplified total arch reconstruction with a modified stent graft (s-TAR) and compared its operative outcomes with conventional total arch replacement (c-TAR).Methods: This retrospective analysis of prospectively collected data from all consecutive patients who had ascending aortic aneurysm with extended aortic arch dilation and underwent simultaneous ascending aorta replacement and aortic arch reconstruction with the s-TAR or c-TAR between 2018 and 2021. The indication for intervention was maximum diameter of ascending aorta >55 mm and aortic arch in zone II >35 mm.Results: A total of 84 patients were analyzed: 43 in the s-TAR group and 41 in the c-TAR group. No inter-group differences were found for sex, age, comorbidities, or EuroSCORE II results. All patients were successfully treated with s-TAR or c-TAR, and none died intraoperatively. Cardiopulmonary bypass, selective cerebral perfusion, and lower-body circulatory arrest time were significantly shorter in the s-TAR group, which also had a lower incidence of prolonged ventilation and transient neurologic dysfunction. No patient in either group experienced permanent neurologic dysfunction. The incidence of recurrent laryngeal nerve injury and paraplegia was markedly increased in the c-TAR group; however, no such events were observed in the s-TAR group. Both perioperative blood loss and the incidence of reoperation for bleeding were significantly lower in the s-TAR group. The in-hospital mortality rate was 0% in the s-TAR group and 4.9% in the c-TAR group. The s-TAR group had significantly shorter ICU stay and lower total hospitalization costs. Conclusions:The s-TAR technique is a safe and effective alternative for total arch reconstruction with shorter operation time, lower rate of postoperative complications and lower total hospitalization costs compared with c-TAR.

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Section: Discussionmentioning

confidence: 99%

Simplified total arch reconstruction with a stented graft for extended aortic arch dilation

Zheng¹,

Yu²,

Lin³

et al. 2023

J Thorac Dis

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“…The in-hospital mortality of this study population was 1.31%, which was lower than recent study (10% reported by Sheng et al [7] and 11.1% reported by Yang et al [35] ). But the mortality was similar to previous reports in our center.…”

Section: Discussionmentioning

confidence: 99%

Postoperative pulmonary complications in patients undergoing aortic surgery: A single-center retrospective study

Yan,

Zhang,

Yao

2023

Medicine

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Postoperative pulmonary complications (PPCs) are among the most common complications after cardiovascular surgery. This study aimed to explore the real incidence of and risk factors for PPC in patients with acute type A aortic dissection (ATAAD) who underwent total aortic arch replacement combined with the frozen elephant trunk (TAR + FET). In total, 305 ATAAD patients undergoing TAR + FET from January 2021 to August 2022 in a single-center were divided into PPCs or non-PPCs group. The incidence of PPCs was calculated, risk factors of PPCs were analyzed, and postoperative outcomes were compared between these 2 groups. The incidence of any PPC was 29.2%. And the incidence of respiratory infection, respiratory failure, pleural effusion, atelectasis, pneumothorax, acute respiratory distress syndrome, aspiration pneumonitis, pulmonary edema and bronchospasm was 23.0%, 12.5%, 10.5%, 1.0%, 0.7%, 1.0%, 0%, 0.7%, 0%, respectively. The logistic regression analysis revealed that the history of diabetes, history of renal dysfunction, preoperative SpO2 <90%, cardiopulmonary bypass duration, fresh frozen plasma volume and platelet concentrates volume were independent risk factors for PPCs. Among 2 groups, postoperative ventilation duration, postoperative length of stay in intensive care unit and hospital were (73.5 ± 79.0 vs 24.8 ± 35.2 hours; P < .001), (228.3 ± 151.2 vs 95.2 ± 72.0 hours; P < .001) and (17.9 ± 8.8 vs 11.5 ± 6.2 days; P < .001). There was no difference between 2 groups of in-hospital mortality rate. Additionally, other short-term outcomes were also significantly poorer in patients with PPCs. PPCs are common in ATAAD patients undergoing TAR + FET, and could be multifactorial. PPCs occurrence are associated with poor patient outcomes postoperatively and worth further investigation.

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Can a ‘branch-first’ approach to aortic arch replacement be safely utilized in Stanford type A acute aortic syndromes?

Kemp,

Zhu

2023

Interdisciplinary CardioVascular and Thoracic Surgery

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Summary A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was: “Can a “branch-first” approach to aortic arch replacement be safely utilised in Stanford Type A acute aortic syndromes?” Altogether 64 papers were found using the reported searches, of which 10 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. All papers included in this BET reported acceptable mortality and/or neurological outcomes in comparison to currently published standards for traditional repair. We conclude that while there is a need for larger series, direct comparison and long term follow-up, the “branch-first” approach to aortic arch replacement has been safely performed in several centres in the setting of acute aortic syndromes with results demonstrating acceptable mortality, neurological outcomes, and mid-term survival.

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Sun’s total arch replacement and stent elephant trunk with modified branch-first technique for patients with Stanford type A aortic dissection

Cited by 4 publications

References 24 publications

Simplified total arch reconstruction with a stented graft for extended aortic arch dilation

Simplified total arch reconstruction with a stented graft for extended aortic arch dilation

Postoperative pulmonary complications in patients undergoing aortic surgery: A single-center retrospective study

Can a ‘branch-first’ approach to aortic arch replacement be safely utilized in Stanford type A acute aortic syndromes?

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