Chronic type B “residual” after type A: what I would do?

Czerny, Martin; Kreibich, Maximilian; Morlock, Julia; Kondov, Stoyan; Scheumann, Johannes; Schröfel, Holger; Kari, Fabian A.; Berger, Tim; Siepe, Matthias; Beyersdorf, Friedhelm; Rylski, Bartosz

doi:10.21037/jovs.2017.12.06

Cited by 11 publications

(13 citation statements)

References 22 publications

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“…[1][2][3] It provides a proximal platform for second-stage endovascular or surgical (ie, thoracoabdominal) repair and may potentially be used to treat the thoracic aorta in 1 single step. 3,4 Although the FET technique facilitates positive remodeling in downstream aortic segments in a variety of different aortic pathologies, the need for aortic reinterventions following the FET procedure and the potential of the FET technique to truly be a single-step procedure to treat the thoracic aorta remain unclear. [5][6][7] Therefore, the aim of this study was to evaluate the need and outcomes of aortic reinterventions after previous FET implantation.…”

Section: Perspectivementioning

confidence: 99%

Aortic reinterventions after the frozen elephant trunk procedure

Kreibich¹,

Berger²,

Rylski³

et al. 2020

The Journal of Thoracic and Cardiovascular Surgery

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Section: Perspectivementioning

confidence: 99%

Aortic reinterventions after the frozen elephant trunk procedure

Kreibich¹,

Berger²,

Rylski³

et al. 2020

The Journal of Thoracic and Cardiovascular Surgery

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“…The mean delay between the 2 procedures was 52.1 days (0-214 days). The mean proximal landing zone diameter was 32.6 mm (28-40), the mean proximal stent graft diameter was 37.7 mm (32-45 mm), the mean aortic coverage was 239.5 mm (115-340), and the mean oversizing was 15.6% (10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25). Since 2017, we have treated 7 patients with the STABILISE technique when the maximum aortic diameter on the thoraco-abdominal aorta was less than 42 mm.…”

Section: Tevarmentioning

confidence: 99%

“…There are no guidelines regarding the treatment of distal aneurysmal degeneration of chronic RAD. Open surgery with total arch replacement, frozen elephant trunk (FET), hybrid treatment with supra-aortic trunk debranching and TEVAR, or total endovascular solution with fenestrated/branched endoprosthesis are different options [13].…”

Section: Commentmentioning

confidence: 99%

A 10-Year Aortic Center Experience with Hybrid Repair of Chronic “Residual” Aortic Dissection After Type A Repair

Gaudry

Porto

Blanchard

et al. 2021

Cardiovasc Drugs Ther

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Purpose Hybrid aortic arch repair in patients with chronic residual aortic dissection (RAD) is a less invasive alternative to conventional surgical treatment. The aim of this study was to describe the short-term and long-term results of hybrid treatment for RAD after type A repair. Methods In this retrospective single-center cohort study, all patients treated for chronic RAD with hybrid aortic arch repair were included. Indications for treatment were rapid aortic growth, aortic diameter > 55 mm, or aortic rupture. Results Between 2009 and 2020, we performed 29 hybrid treatments for chronic RAD. Twenty-four patients were treated for complete supra-aortic debranching in zones 0 and 5 with left subclavian artery debranching alone in zone 2. There was 1 perioperative death (3.4%): The patient was treated for an aortic rupture. There was no spinal cord ischemia and 1 minor stroke (3.4%). After a median follow-up of 25.4 months (range 3-97 months), the long-term mortality was 10.3% (3/29) with no late aortic-related deaths. Twenty-seven patients (93.1%) developed FL thrombosis of the descending thoracic aorta; the rate of aneurysmal progression on thoraco-abdominal aorta was 41.4% (12/29), and the rate of aortic reintervention was 34.5% (10/29). Conclusion In a high-volume aortic center, hybrid repair of RAD is associated with good anatomical results and a low risk of perioperative morbidity and mortality, including that of patients treated in zone 0. A redo replacement of the ascending aortic segment is sometimes necessary to provide a safer proximal landing zone and reduce the risk of type 1 endoleak after TEVAR.

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“…Ma et al published their experience with 132 FET procedures in the acute phase with a stroke rate of 5.3% and a 30-day mortality rate of 14.4%. 6,7 However, there is still no definite and clear consensus on the indication of the FET during the index operation. Poon et al proposed the FET operation in the acute phase only in the high-volume centers because they found a similar mortality for FET and less invasive index operations (ascending replacement or hemi-arch repair).…”

Section: Frozen Elephant Trunkmentioning

confidence: 99%

“…A recently published study by Ma et al found better survival in the octogenarian acute type A dissection patients for the debranching procedure compared with FET. 7 Patients with chronic dissections were excluded from their analysis. Bavaria et al demonstrated the safety of complete debranching in a cohort of mainly aneurysm patients (arch dissections 11%) with a procedural success of 100% on CPB.…”

Section: Hybrid Proceduresmentioning

confidence: 99%

Hybrid Off-pump Second-Stage Aortic Arch Repair after Type A Dissection

Lescan

Anđić

Krüger

et al. 2018

Thorac cardiovasc Surg

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Background Ascending aorta or hemi-arch repair are common in the acute phase of type A dissection. Postdissection aneurysms can develop with antegrade perfusion of the false lumen in the dissected aortic arch and require reoperation. Methods From 2012 to 2018, we reoperated nine patients with postdissection aneurysms using a hybrid technique without cardiopulmonary bypass. The patients had a EuroSCORE II of 13% and a logistic EuroSCORE I of 45% and were not candidates for frozen elephant trunk surgery. The median interval since the acute ascending repair was 184 (92; 528) days. All patients were treated by median resternotomy, ascending to carotid bypass on a partially clamped ascending graft, and transfemoral endovascular repair with a Relay NBS (nonbare stent) or conformable Gore C-TAG stent graft. Results Technical success was achieved in all cases. Mean follow-up was 405 (220; 672) days. There was no disabling stroke, endoleak, paraplegia, in-hospital, or late mortality. In all patients, the false lumen was completely thrombosed at the aortic arch level with a median aneurysm shrinkage of 13 mm in the distal arch. There was no bird beak or stent graft migration. Distal stent-induced new entry was observed in one case. Reinterventions were not necessary due to diameter stability. Conclusion Complete debranching with transfemoral thoracic endovascular aneurysm repair showed encouraging results in patients with relevant comorbidities. The used stent grafts performed well in the mid-term follow-up period with no endoleaks or migration.

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Chronic type B “residual” after type A: what I would do?

Cited by 11 publications

References 22 publications

Aortic reinterventions after the frozen elephant trunk procedure

Aortic reinterventions after the frozen elephant trunk procedure

A 10-Year Aortic Center Experience with Hybrid Repair of Chronic “Residual” Aortic Dissection After Type A Repair

Hybrid Off-pump Second-Stage Aortic Arch Repair after Type A Dissection

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