Arch replacement and downstream stent grafting in complex aortic dissection: first results of an international registry☆

Tsagakis, Konstantinos; Pacini, Davide; Bartolomeo, Roberto Di; Benedı́k, Jaroslav; Černý, Štěpán; Gorlitzer, Michael; Grabenwöger, Martin; Mestres, Carlos A.; Jakob, Heinz

doi:10.1016/j.ejcts.2010.03.070

Cited by 69 publications

(52 citation statements)

References 20 publications

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“…No significant changes were observed in the untreated part of the aorta at the diaphragm . These observations concur with those of the IEOR, according to which 93% of patients developed a complete thrombosis in the region of the stent (Tsagakis et al 2011). (Figure 9).…”

Section: Fate Of the False Lumensupporting

confidence: 80%

“…As regards overall survival after 36 months, no significant difference was registered between acute and chronic dissections (79% vs. 87%; p=0.69) (Figure 6). An additional intervention in the aorta could be avoided in 91% of patients after 12 months, and in 87% after 36 months (Figure 7) (Tsagakis et al 2011). …”

Section: Aortic Disease No (%)mentioning

confidence: 99%

“…Five European centres (Hietzing Hospital Vienna, Western Germany Heart Centre Essen, University of Bologna, Na Homolce Hospital in Prague, and the University of Barcelona) participated in this multicentre trial (Tsagakis et al 2011). Fifty-five of them had been operated on for an acute type A dissection, 51 for a chronic dissection, and 22 because of extensive aneurysms.…”

Section: E-vita Open Registermentioning

confidence: 99%

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Combined Surgical and Endovascular Approach for the Treatment of Complex Thoracic Aortic Pathologies

Gorlitzer¹,

Weiss²,

Waldenberger³

et al. 2011

Diagnosis and Treatment of Abdominal and Thoracic Aortic Aneurysms Including the Ascending Aorta and the Aortic Arch

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Section: Fate Of the False Lumensupporting

confidence: 80%

Section: Aortic Disease No (%)mentioning

confidence: 99%

Section: E-vita Open Registermentioning

confidence: 99%

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Combined Surgical and Endovascular Approach for the Treatment of Complex Thoracic Aortic Pathologies

Gorlitzer¹,

Weiss²,

Waldenberger³

et al. 2011

Diagnosis and Treatment of Abdominal and Thoracic Aortic Aneurysms Including the Ascending Aorta and the Aortic Arch

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“…Although the percentage of patients with a persisting patent primary entry tear after surgery for acute type A dissection was low, the number of patients requiring intervention of any kind along the thoracoabdominal aorta was impressively high. These findings underline the potential role of combined approaches such as the frozen elephant trunk procedure in order to treat the entire thoracic aortic disease to avoid late complications [13,14]. Ongoing evaluations of these approaches will confirm their broader use in the future or will put them into question [15,16].…”

Section: Commentmentioning

confidence: 92%

What makes the difference between the natural course of a remaining type B dissection after type A repair and a primary type B aortic dissection?

Czerny¹,

Roost-Krähenbühl²,

Sodeck³

et al. 2012

Thorac cardiovasc Surg

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OBJECTIVES: To analyse the outcome and need for intervention [surgery or thoracic endovascular aortic repair (TEVAR)] in patients after surgery for remaining type B dissection after type A repair and primary type B aortic dissection. METHODS:Within a 10-year period, 247 patients with remaining type B after type A, and 112 patients with primary type B aortic dissection were analysed. We assessed the clinical outcome as well as the need for intervention (surgery or TEVAR) within the aortic arch and the thoracoabdominal aorta as well as risk factors. RESULTS:The median follow-up was 23 months (interquartile range 5-52). There was a significant difference with regard to the status of the primary entry tear between patients after surgical repair of an acute type A aortic dissection and primary acute type B aortic dissection ( patent vs. non-patent entry 35 vs. 83%, P < 0.001). The overall need for any kind of intervention (surgery or TEVAR) was 19%. Multivariate Cox regression analysis revealed a patent primary entry tear in patients after surgery for acute type A aortic dissection as an independent predictor for intervention (surgery or TEVAR) during follow-up [odds ratio (OR) 6.4; confidence interval (CI) 1.39-29.81, P = 0.017]. Multivariate Cox regression analysis did not reveal a patent primary entry tear in patients after acute type B aortic dissection as an independent predictor for intervention (surgery or TEVAR) during follow-up (OR 0.67; CI 0.27-1.69, P = 0.671). Finally, the thrombosis status of the false lumen was not an independent predictor for intervention (surgery or TEVAR) either in patients after surgery for acute type A aortic dissection (OR 3.46; CI 0.79-15.16, P = 0.100) or in patients after acute type B aortic dissection (OR 0.77; CI 0.31-1.93, P = 0.580).CONCLUSIONS: A remaining type B dissection after type A repair and a primary type B aortic dissection represent two distinct pathophysiological entities with regard to late outcome. The need for any kind of intervention in the thoracoabdominal aorta is significantly higher in primary type B aortic dissections. A remaining patent primary entry tear independently predicts the need for intervention (surgery or TEVAR) in patients after surgery for acute type A aortic dissection and, thereby, remains the main target of initial therapy. The thrombosis status of the false lumen seems to be of secondary importance.

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“…Great care has to be taken when assessing the extent of the intimal flap, the relationship between the true and false lumen, the location of entry and re-entry tears and the origin of visceral vessels from the false lumen. In fact, in patients with visceral arteries arising from the false lumen that do not communicate with the true lumen due to the presence of near re-entry tears, organ malperfusion can be a lethal complication after FET (34). Moreover, oversizing of the stent graft is not indicated in patients with aortic dissection, whereas a 10-20% oversizing should be performed in patients with degenerative aneurysms.…”

Section: Technique Of Aortic Arch Replacementmentioning

confidence: 99%

When and how to replace the aortic arch for type A dissection

Bartolomeo

Leone

Marco

et al. 2016

Ann. Cardiothorac. Surg.

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Acute type A aortic dissection (AAAD) remains one of the most challenging diseases in cardiothoracic surgery and despite numerous innovations in medical and surgical management, early mortality remains high.The standard treatment of AAAD requires emergency surgery of the proximal aorta, preventing rupture and consequent cardiac tamponade. Resection of the primary intimal tear and repair of the aortic root and aortic valve are well-established surgical principles. However, the dissection in the aortic arch and descending untreated aorta remains. This injury is associated with the risk of subsequent false lumen dilatation potentially progressing to rupture, true lumen compression and distal malperfusion. Additionally, the dilatation of the aortic arch, the presence of a tear and retrograde dissection can all be considered indication for a total arch replacement in AAAD. In such cases a more aggressive strategy may be used, from the classic aortic arch operation to a single stage frozen elephant trunk (FET) technique or a two-stage approach such as the classical elephant trunk (ET) or the recent Lupiae technique. Although these are all feasible solutions, they are also complex and time demanding techniques requiring experience and expertise, with an in the length of cardiopulmonary bypass and both myocardial and visceral ischemia. Effective methods of cerebral, myocardial as well visceral protection are necessary to obtain acceptable results in terms of hospital mortality and morbidity. Moreover, a correct assessment of the anatomy of the dissection, through the preoperative angio CT scan, in addition to the clinical condition of the patients, remain the decision points for the best arch repair strategy to use in AAAD.

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Arch replacement and downstream stent grafting in complex aortic dissection: first results of an international registry☆

Abstract: By combining arch replacement with downstream stent grafting, one-stage repair of complex aortic dissection with almost unanimous thoracic FL thrombosis can be achieved at acceptable perioperative risk.

Cited by 69 publications

References 20 publications

Combined Surgical and Endovascular Approach for the Treatment of Complex Thoracic Aortic Pathologies

Combined Surgical and Endovascular Approach for the Treatment of Complex Thoracic Aortic Pathologies

What makes the difference between the natural course of a remaining type B dissection after type A repair and a primary type B aortic dissection?

When and how to replace the aortic arch for type A dissection

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