Acute type I aortic dissection with or without antegrade stent delivery: Mid-term outcomes

Sun

et al. 2020

J Cardiothorac Surg

Background Acute Stanford type A aortic dissection is often fatal, with a high mortality rate and requiring emergency intervention. Salvage surgery aims to keep the patient alive by addressing severe aortic regurgitation, tamponade, primary tear, and organ malperfusion and, if possible, prevent the late dissection-related complications in the proximal and downstream aorta. Unfortunately, no optimal standard treatment or technique to treat this disease exists. Total arch replacement with frozen elephant trunk technique plays an important role in treating acute type A aortic dissection. We aim to describe a modified elephant trunk technique and report its short-term outcomes. Methods From February 2018 to August 2019, 16 patients diagnosed with acute Stanford type A aortic dissection underwent surgery with the modified frozen elephant trunk technique at Xiamen Heart Center (male/female: 9/7; average age: 56.1 ± 7.6 years). All perioperative variables were recorded and analyzed. We measured the diameters of the ascending aorta, aortic arch, and descending aorta on the bifurcation of the pulmonary and abdominal aortas and compared the diameters at admission, before discharge, and 3 months after discharge. Results Fifteen patients (93.8%) had hypertension. The primary tears were located in the lesser curvature of the aortic arch and ascending aorta in 5 (31.3%) and 9 patients (56.3%), respectively, and no entry was found in 2 patients (12.5%). The dissection extended to the iliac artery and distal descending aorta in 14 (87.6%) and 2 patients (12.5%), respectively. The duration of cardiopulmonary bypass (CPB), cross-clamping, and antegrade cerebral perfusion were 215.8 ± 40.5, 140.8 ± 32.3, and 55.1 ± 15.2 min, respectively. Aortic valve repair was performed in 15 patients (93.8%). Bentall procedure was performed in one patient (6.3%). Another patient received coronary artery repair (6.3%). The diameters at all levels were greater on discharge than those on admission, except the aortic arch. After 3 months, the true lumen diameter distal to the frozen elephant trunk increased, indicating false lumen thrombosis and/or aortic remodeling. Conclusions The modified frozen elephant trunk technique for acute Stanford type A aortic dissection is safe and feasible and could be used for organ malperfusion. Short-term outcomes are encouraging, but long-term outcomes require further investigation.

Section: Methodsmentioning

confidence: 99%

A modified frozen elephant trunk technique for acute Stanford type A aortic dissection

Sun

et al. 2020

J Cardiothorac Surg

“…After that, the proximal stump was trimmed with Teflon strips to reconstruct the dissected root. Circulatory arrest was started, and unilateral cerebral perfusion via the innominate artery cannulation [9] [10] was initiated at a rate of 5-10 mL/kg/min at a rectal temperature of 25 °C after valve-sparing was accomplished. The aortic arch was opened and transected at the innominate artery level to determine whether there was any tear in the aortic arch.…”

Section: Methodsmentioning

confidence: 99%

A modified frozen elephant trunk technique for acute Stanford type A aortic dissection

et al. 2020

Preprint

Background Acute Stanford type A aortic dissection is a lethal event with a high mortality rate and requires emergency intervention. The goal of salvage surgery is to keep the patient alive by addressing the problems of severe aortic regurgitation, tamponade, primary tear and malperfusion of organs,and, if possible, to prevent the late dissection-related complications in the proximal and downstream aorta. No standard treatment or techniques have been determined for this disease. We aim to describe a modified elephant trunk technique for acute type A aortic dissection and report the short-term outcomes of this surgical technique. Methods From February 2018 to August 2019, 16 patients who were diagnosed with acute Stanford type A aortic dissection underwent surgery with the modified frozen elephant trunk technique procedure at Xiamen Heart Centre (9men; age, 59.21±11.67 years). All perioperative variables were recorded and analyzed. We measured the diameters of the ascending aorta, aortic arch and descending aorta on the bifurcation of the pulmonary and abdominal aortas and compared the diameters at admission, before discharge, and 3 months after discharge. Results Fifteen patients (93.8%)had hypertension and poor blood control management. Operative mortality was 6.25%. The primary tears were located in the lesser curve of the aortic arch in 5 patients (31.3%), in the ascending aorta in 9 patients (56.3%), and no entry was found in 2 patients (12.5%). The dissection extended to the iliac artery in 14 patients (87.6%) and to the distal descending aorta in 2 patients (12.5%). The time of cardiopulmonary bypass(CPB),cross-clamping and cerebral perfusion were 215± 40.5,140.8±32.3, and 23±6 minutes, respectively. Aortic valve plasty was performed in 15 patients (93.8%). Additionally, the Bentall procedure and coronary artery repair were performed in 1 patient each (6.3%), respectively. The diameters at all levels were greater before discharge than those when on admission to the hospital, except for the diameter of the aortic arch. After 3 months, the diameters at the aortic arch, descending aorta of the diaphragm, bifurcation of the pulmonary artery had increased, but the diameter at the bifurcation level of the common iliac artery had changed little. Only the diameter of the distal stent aorta had increased significantly. Conclusion The modified frozen elephant trunk technique for acute Stanford type A aortic dissection is safe and feasible, and it could be used for organ malperfusion as well. Short-term outcomes are encouraging, but long-term outcomes require further investigation.

“…After reconstructing the root with Te on felt strips, circulatory arrest was started with unilateral cerebral perfusion via innominate artery cannulation [9] [10] at a rate of 5-10mL/kg/min and rectal temperature of 25°C. The aortic arch was opened and transected at the innominate artery level to determine whether there was any tear.…”

Section: Methodsmentioning

confidence: 99%

A modified frozen elephant trunk technique for acute Stanford type A aortic dissection

et al. 2020

Preprint

Background: Acute Stanford type A aortic dissection is often fatal, with a high mortality rate and requiring emergency intervention. Salvage surgery aims to keep the patient alive by addressing severe aortic regurgitation, tamponade, primary tear, and organ malperfusion and, if possible, prevent the late dissection-related complications in the proximal and downstream aorta. Unfortunately, no optimal standard treatment or technique to treat this disease exists. Total arch replacement with frozen elephant trunk technique plays an important role in treating acute type A aortic dissection. We aim to describe a modified elephant trunk technique and report its short-term outcomes.Methods: From February 2018 to August 2019, 16 patients diagnosed with acute Stanford type A aortic dissection underwent surgery with the modified frozen elephant trunk technique at Xiamen Heart Center (male/female: 9/7; average age: 59.21±11.67 years). All perioperative variables were recorded and analyzed. We measured the diameters of the ascending aorta, aortic arch, and descending aorta on the bifurcation of the pulmonary and abdominal aortas and compared the diameters at admission, before discharge, and 3 months after discharge. Results: Fifteen patients (93.8%) had hypertension. The primary tears were located in the lesser curvature of the aortic arch and ascending aorta in 5 (31.3%) and 9 patients (56.3%), respectively, and no entry was found in 2 patients (12.5%). The dissection extended to the iliac artery and distal descending aorta in 14 (87.6%) and 2 patients (12.5%), respectively. The duration of cardiopulmonary bypass (CPB)，cross-clamping, and antegrade cerebral perfusion were 215.8± 40.5, 140.8±32.3, and 55.1±15.2 minutes, respectively. Aortic valve repair was performed in 15 patients (93.8%). Bentall procedure was performed in one patient (6.3%). Another patient received coronary artery repair (6.3%). The diameters at all levels were greater on discharge than those on admission, except the aortic arch. After 3 months, the true lumen diameter distal to the frozen elephant trunk increased, indicating false lumen thrombosis and/or aortic remodeling.Conclusions: The modified frozen elephant trunk technique for acute Stanford type A aortic dissection is safe and feasible and could be used for organ malperfusion. Short-term outcomes are encouraging, but long-term outcomes require further investigation.