Surgical management of aortic root in type A acute aortic dissection: a propensity-score analysis

Castrovinci, Sebastiano; Pacini, Davide; Marco, Luca Di; Berretta, Paolo; Cefarelli, Mariano; Murana, Giacomo; Alfonsi, Jacopo; Pantaleo, Antonio; Leone, Alessandro; Eusanio, Marco Di; Bartolomeo, Roberto Di

doi:10.1093/ejcts/ezw038

Cited by 49 publications

(44 citation statements)

References 24 publications

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“…Regarding the aortic valve, replacement was performed in a high number of patients (109/295, 36.9%) while valve reimplantation (David technique) was carried out only in 3.7% of cases (11 patients). This strategy has been shown to be protective for long-term aortic valve re-intervention, mainly for regurgitation, 14 which occurred in three of the patients.…”

Section: Among Patients With Either Type a Or Type B Aasmentioning

confidence: 98%

Long-term Follow up of Patients with Acute Aortic Syndromes: Relevance of both Aortic and Non-aortic Events

Corsini

Pacini

Lovato

et al. 2018

European Journal of Vascular and Endovascular Surgery

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Section: Among Patients With Either Type a Or Type B Aasmentioning

confidence: 98%

Long-term Follow up of Patients with Acute Aortic Syndromes: Relevance of both Aortic and Non-aortic Events

Corsini

Pacini

Lovato

et al. 2018

European Journal of Vascular and Endovascular Surgery

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“…Aggressive total arch replacement (TAR) is required to avoid a residual dissected aorta with a false lumen patent, particularly in younger patients. Although a previous report demonstrated similar outcomes of conservative and aggressive AAD management, the extent of aortic replacement and prolonged surgical procedure time are considered as significant risk factors of early and late in-hospital death [4–6]. The frozen elephant trunk (FET) technique is a promising surgical approach to promote false lumen obliteration without increasing operative risk [7–12].…”

Section: Introductionmentioning

confidence: 99%

Aortic remodeling with frozen elephant trunk technique for Stanford type A aortic dissection using Japanese J-graft open stent graft

et al. 2018

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The frozen elephant trunk (FET) technique allows single-stage extended surgical repair of Stanford type A aortic dissection and has shown promotion of aortic remodeling by maintaining the true lumen flow and facilitating its expansion and by promoting false lumen thrombosis. However, few studies have compared the effectiveness of FET technique, in terms of the downstream aortic remodeling. Between 2005 and 2017, 50 patients underwent total arch replacement for Stanford type A aortic dissection, including that with (n = 22) and without FET technique (n = 28). We compared distal aortic remodeling in patients who underwent total arch replacement with (using a J-Graft open stent graft) or without the technique. The false lumen complete thrombosis rate and the ratio of true lumen area at three levels of the descending aorta were evaluated post operation. In FET group, the diameter and length of the stent graft were 29.0 ± 3.9 mm and 70.9 ± 17.4 mm, respectively. The in-hospital death with and without the FET technique was 0 and 3, respectively, with no late death in both groups. Eight patients (28.6%) only in the non-FET group required additional surgical treatment for downstream aorta. In the FET group, the ratio of true lumen area at the level of bronchial carina and false lumen complete thrombosis rate at the levels of bronchial carina and aortic valve were significantly higher than non-FET group. A more favorable remodeling in the descending aorta was observed in patients who underwent FET associated with a total arch replacement compared to those who underwent total arch replacement alone.

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“…8,[28][29][30] For the traditional sandwich technique, suture line dehiscence and pseudoaneurysm formation might also occur, leading to reoperation. 31,32) Using our new technique, the aortic root was securely reinforced and stabilized with two vascular graft rings placed both inside and outside the aortic root. Satisfactory midterm follow-up results were also achieved using our new technique, with no request for reoperations of aortic root during the followup.…”

Section: Discussionmentioning

confidence: 99%

A New Aortic Root Reinforcement Technique for Acute Type A Aortic Dissection Surgery

et al. 2019

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Reinforcing the dissected and fragile aortic root is critical in acute type A aortic dissection (ATAAD) surgery. This study introduces our new aortic root reinforcement technique and reports our early operative results and midterm follow-up results. A retrospective analysis study was performed on 235 patients (aged 53.2 ±15.5 years) who were admitted to our hospital for ATAAD surgery and underwent the procedure with our new technique between October 2011 and June 2016. Two vascular graft rings were placed inside and outside aortic root, followed by a running horizontal mattress suture, placed just above the coronary artery ostiums and aortic valve commissures, with another horizontal suture at distal end of the aortic root stump, to reinforce the inner vascular graft, aortic wall, and outside vascular graft. Then additional 3-5 vertical mattress sutures were placed for further reinforcement within the reconstructed aortic root. Computed tomography angiography was performed at discharge and annually during follow-up. The patients' 30-day mortality was 5.1% (12/235). There was no uncontrollable intraoperative bleeding from the aortic root, and re-exploration for bleeding occurred in 0.79% (2/235). The survival rate was 90.2% during follow-up of 4.2 ± 2.1 years. There were no requests for aortic root reoperations during follow-up. All patients were free from aortic root disruptions, proximal anastomosis complications, and re-dissections of the reconstructed aortic root. Our new aortic root reinforcement technique provides a safe and effective technique for aortic root in ATAAD surgery, by reinforcing friable aortic root tissues and minimizing aortic root complications.

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Surgical management of aortic root in type A acute aortic dissection: a propensity-score analysis

Abstract: Conservative and aggressive root management in acute aortic dissection provided similar results for early and late mortality. Nevertheless, a more extensive root intervention appeared to be protective against aortic reintervention.

Cited by 49 publications

References 24 publications

Long-term Follow up of Patients with Acute Aortic Syndromes: Relevance of both Aortic and Non-aortic Events

Long-term Follow up of Patients with Acute Aortic Syndromes: Relevance of both Aortic and Non-aortic Events

Aortic remodeling with frozen elephant trunk technique for Stanford type A aortic dissection using Japanese J-graft open stent graft

A New Aortic Root Reinforcement Technique for Acute Type A Aortic Dissection Surgery

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