Aortic arch repair for Stanford type A aortic dissection with distal anastomosis to the proximal level of the distal aortic arch

Mori, Yoshio; Takagi, Hisato; Umeda, Yohtaro; Fukumoto, Yukiomi; Shimabukuro, Katsuya; Matsuno, Yukihiro

doi:10.1016/s0022-5223(02)73600-3

Cited by 18 publications

(19 citation statements)

References 15 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…However, follow-up is often incomplete, and the potential for aortarelated mortality might be higher than the re-operation rate suggests (212). The re-operation rate after AscAoR or hemiarch replacement might not be appreciably higher than rates reported after more extended arch replacement (263)(264)(265). The factors that might pre-dispose to aneurysm are: pre-existing aortic dilation (213,259); uncontrolled hypertension (259); non-resection of an entry tear (102,110,246,259); the presence of larger-dimension FL diameters (in some but not all reports) (247,262) and area (262,266); and as seen in type B dissection (267), partial FL thrombosis (268).…”

Section: Surgical Management Of the Distal Aortamentioning

confidence: 99%

“…It is unlikely that this more complex approach could be generalized to the whole cardiovascular surgical community and registry data could continue to demonstrate that TAR is associated with increased surgical risk (46). Modifications that might simplify TAR are reported, but longer-term outcomes are not yet formally reported (265,294).…”

Section: Extension Of the Aortic Replacement Into Thementioning

confidence: 99%

See 1 more Smart Citation

Evidence, Lack of Evidence, Controversy, and Debate in the Provision and Performance of the Surgery of Acute Type A Aortic Dissection

Bonser

Ranasinghe

Loubani

et al. 2011

Journal of the American College of Cardiology

216

175

View full text Add to dashboard Cite

Acute type A aortic dissection is a lethal condition requiring emergency surgery. It has diverse presentations, and the diagnosis can be missed or delayed. Once diagnosed, decisions with regard to initial management, transfer, appropriateness of surgery, timing of operation, and intervention for malperfusion complications are necessary. The goals of surgery are to save life by prevention of pericardial tamponade or intra-pericardial aortic rupture, to resect the primary entry tear, to correct or prevent any malperfusion and aortic valve regurgitation, and if possible to prevent late dissection-related complications in the proximal and downstream aorta. No randomized trials of treatment or techniques have ever been performed, and novel therapies-particularly with regard to extent of surgery-are being devised and implemented, but their role needs to be defined. Overall, except in highly specialized centers, surgical outcomes might be static, and there is abundant room for improvement. By highlighting difficulties and controversies in diagnosis, patient selection, and surgical therapy, our over-arching goal should be to enfranchise more patients for treatment and improve surgical outcomes.

show abstract

Section: Surgical Management Of the Distal Aortamentioning

confidence: 99%

Section: Extension Of the Aortic Replacement Into Thementioning

confidence: 99%

Evidence, Lack of Evidence, Controversy, and Debate in the Provision and Performance of the Surgery of Acute Type A Aortic Dissection

Bonser

Ranasinghe

Loubani

et al. 2011

Journal of the American College of Cardiology

216

175

View full text Add to dashboard Cite

show abstract

“…[26,27] For patients with intimal tears located in the aortic arch, although the treatment is still controversial, we still recommend that total arch replacement can result in better long-term prognosis. [28,29] …”

Section: Discussionmentioning

confidence: 99%

Preoperative evaluation value of aortic arch lesions by multidetector computed tomography angiography in type A aortic dissection

et al. 2016

View full text Add to dashboard Cite

The purpose of this study was to preoperatively evaluate the value of aortic arch lesions by multidetector computed tomography (MDCT) angiography in type A aortic dissection (AD).From January 2013 to December 2015, we enrolled 42 patients with type A AD who underwent MDCT angiography in our hospital. The institutional database of patients was retrospectively reviewed to identify MDCT angiography examinations for type A AD. Surgical corrections were conducted in all patients to confirm diagnostic accuracy.In this study, the diagnostic accuracy of MDCT angiography was 100% in all 42 patients. The intimal tear site locations that were identified in patients included the ascending aorta (n = 25), aortic arch (n = 12), and all other sites (n = 5). Compared with the control group, there were significant differences in the aortic arch anatomy among the cases. Regarding the distance between the left common carotid and left subclavian arteries, compared with the control group, most cases with type A AD had a significant variation.MDCT angiography plays an important role in detecting aortic arch lesions of type A AD, especially in determining the location of the intimal entry site and change of branch blood vessels. Surgeons can formulate an appropriate operating plan, according to the preoperative MDCT diagnosis information.

show abstract

“…After an acute dissection, the dissected arch vessel wall is so fragile that the anastomosis between a dissected arch vessel stump and the graft branch often results in intraoperative or postoperative hemorrhage owing to tissue tearing at the suture lines. 11 Reinforcement of the dissected arch vessel stump is an effective way to secure good hemostasis at the suture line. Although little has been published on reinforcement of the arch vessel stump, methods that have been widely used to reinforce the aortic stump have also been used to reinforce the dissected arch vessel stump.…”

Section: Discussionmentioning

confidence: 99%

“…After an acute dissection, the dissected arch vessel wall is so fragile that the anastomosis between a dissected arch vessel stump and the graft branch often results in intraoperative or postoperative hemorrhage caused by tissue tearing at the suture lines. 11 In an effort to reduce such problems in total arch replacement for acute type A aortic dissection, we developed a triplebranched stent graft placement technique. Instead of direct surgical repair, our new technique could be performed simply by open placement of a triple-branched stent graft into the proximal descending aorta, aortic arch, and 3 arch vessels.…”

Section: Clinical Perspective On P 2541mentioning

confidence: 99%

Total Arch Repair for Acute Type A Aortic Dissection With 2 Modified Techniques: Open Single-Branched Stent Graft Placement and Reinforcement of the Dissected Arch Vessel Stump With Stent Graft

Chen

Lü

et al. 2011

Circulation

View full text Add to dashboard Cite

Background-In total arch replacement for patients with acute type A aortic dissection, anastomoses of the graft to the left subclavian artery and descending aorta are often difficult, and the arch vessel anastomosis is frequently performed at the site of dissection. To make this procedure easier and safer, we developed 2 modified techniques: open single-branched stent graft placement into the left subclavian artery and the descending aorta and reinforcement of the dissected arch vessel stump with a stent graft neointima. The feasibility and initial clinical results of these 2 new techniques are reported. Methods and Results-Total arch repair with the 2 new techniques was performed in 26 patients with acute Stanford type A aortic dissection. Most patients had an uneventful postoperative course, and there were no surgical deaths. All implanted stent grafts were fully opened and not kinked, and there was no space or blood flow surrounding any of the stent grafts. The false lumen of the descending thoracic aorta closed with thrombus formation in 22 of 26 patients. Disappearance of the false lumen and recovery of the true lumen was observed in all of the dissected arch vessels. Conclusions-Open single-branched stent graft placement into the left subclavian artery and the descending aorta and reinforcement of the dissected arch vessel stump with a stent graft neointima are 2 simple and effective techniques that should make total arch repair an easier and safer procedure for acute type A aortic dissection. (Circulation. 2011;123:2536-2541.)

show abstract

Aortic arch repair for Stanford type A aortic dissection with distal anastomosis to the proximal level of the distal aortic arch

Cited by 18 publications

References 15 publications

Evidence, Lack of Evidence, Controversy, and Debate in the Provision and Performance of the Surgery of Acute Type A Aortic Dissection

Evidence, Lack of Evidence, Controversy, and Debate in the Provision and Performance of the Surgery of Acute Type A Aortic Dissection

Preoperative evaluation value of aortic arch lesions by multidetector computed tomography angiography in type A aortic dissection

Total Arch Repair for Acute Type A Aortic Dissection With 2 Modified Techniques: Open Single-Branched Stent Graft Placement and Reinforcement of the Dissected Arch Vessel Stump With Stent Graft

Contact Info

Product

Resources

About