Clinical outcomes and fate of the distal aorta following 1-stage repair of extensive chronic thoracic aortic dissection

Kouchoukos, Nicholas T.; Kulik, Alexander; Castner, Catherine F.

doi:10.1016/j.jtcvs.2013.07.031

Cited by 14 publications

(10 citation statements)

References 23 publications

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“…Furthermore, many patients do not return for the second operation. [8][9][10][11] They might die due to rupture of the residual aortic lesions while awaiting second procedures or comorbidities preclude another procedure through a lateral thoracotomy. 12 In contrast, the risk of spinal cord complications may be reduced by staged operations.…”

Section: Discussionmentioning

confidence: 99%

“…Very few reports have been published regarding 1-stage replacement from the aortic arch to thoracoabdominal aorta. 11,18,19 Svensson and colleagues 20 reported a successful case in a 68-year-old patient who underwent replacement of the entire aorta from the aortic valve to the aortic bifurcation via deep hypothermia with circulatory arrest and retrograde perfusion of the brain. Massimo and colleagues 6 reported that 7 patients underwent replacement of the aorta from aortic valve to bifurcation.…”

Section: Discussionmentioning

confidence: 99%

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One-stage replacement of the aorta from arch to thoracoabdominal region

Matsueda

Ikeno

Yokawa

et al. 2018

The Journal of Thoracic and Cardiovascular Surgery

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

One-stage replacement of the aorta from arch to thoracoabdominal region

Matsueda

Ikeno

Yokawa

et al. 2018

The Journal of Thoracic and Cardiovascular Surgery

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“…The need for a retrograde deployment of an additional stent graft in a second stage procedure as well as the high costs would complete the list of differences between this hybrid procedure and conventional surgery. On the other hand, the updated results after Kouchoukos's one-stage repair of extensive chronic thoracic aortic dissection demonstrated that, in addition to excellent surgical results, there is a very high freedom from reoperation for aneurysmal growth of the distal aorta [6].…”

Section: Discussionmentioning

confidence: 99%

Open aortic arch surgery in chronic dissection with visceral arteries originating from different lumens

Urbanski

Bougioukakis

Deja

et al. 2015

Eur J Cardiothorac Surg

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OBJECTIVES: Surgical management of chronic aortic dissection is controversial, especially when the dissection extends into the abdominal aorta in which the visceral arteries originate from different lumens and is combined with aortic arch pathology necessitating surgery. The aim of the study was to evaluate the results of open surgery in this complex aortic pathology. METHODS:Between June 2002 and 2015, a total of 17 patients (median age 57, range 32-76 years) necessitating complete arch replacement presented complex chronic dissection of the thoraco-abdominal aorta with the visceral arteries originating from different lumens. Fourteen patients (82%) had had previous cardiac surgery, which was performed on the proximal aorta in all but one because of acute type A dissection. Nine patients without considerable dilatation of the descending aorta received aortic arch replacement with distal resection of the dissection membrane, and 8 patients with progressive dilatation of the thoracic aorta underwent aortic arch and descending aorta replacement via clamshell approach. RESULTS:No early (defined as 30-day, 90-day and in-hospital period) deaths, strokes or spinal cord injuries occurred. Only 1 patient (6%) presented temporary neurological dysfunctions (delirium, agitation), which resolved completely before discharge, and an injury of the recurrent laryngeal nerve was documented in 2 patients (12%). Temporary dialysis was necessary in 1 case. The follow-up was complete for all patients. All but one patient, who died due to leukaemia 23 months after surgery, were alive at the last follow-up (median duration 33 months, range 2-118 months). No patient needed a reoperation or an intervention on the thoracic and/or abdominal aorta. Moreover, no noticeable progression of the chronic dissection in the downstream aorta was documented in any patient. CONCLUSIONS:The results after conventional aortic arch repair with distal resection of the dissection membrane and, if necessary, with replacement of the progressively dilated chronic dissected thoracic aorta can offer excellent results in experienced hands and, therefore, this technique may be considered as a preferable option for surgical treatment of chronic aortic dissection with involvement of the aortic arch and the visceral arteries originating from different lumens.

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“…One-stage open repair is conventional but serves as a definitive procedure for this complicated subset of patients. Kouchoukos et al 2 described 68 recent cases of one-stage open repair using bilateral thoracotomy with successful results. The hospital mortality rate was only 2.9%, and permanent paraplegia occurred in only 1.5% of total cases.…”

Section: Discussionmentioning

confidence: 99%

Extra-anatomic bypass with open-plugging stent graft for extensive dissected aortic aneurysm

Saito

Kowatari

Minakawa

et al. 2015

Journal of Vascular Surgery Cases

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Treatment for an extensively dissected aortic aneurysm is a surgical challenge. Open surgery using a left thoracotomy is promising but can be dangerous in patients with pulmonary comorbidity. We treated a 63-year-old man with chronic type B aortic dissection with aneurysmal change and ascending aortic dilation. The thoracoabdominal aorta was also dissected, dilated, and tapered; thus, a simple hybrid strategy was not possible, even with open fenestration. We performed ascending aortic replacement with reconstruction of the cervical vessels and extra-anatomic bypass from the ascending to descending aorta, with aneurysmal isolation. A stent graft was inserted at the true lumen of the residual aneurysm to reduce endopressure. Total thrombosis and reduction in size of the aneurysm was achieved, and the patient recovered well, without complications. (J Vasc Surg Cases 2015;1:32-5.) Surgical repair of extensive dissected aortic aneurysm is challenging. Patients are often complicated by postoperative pulmonary complications. Avoiding graft replacement through a left thoracotomy is preferable in patients with pulmonary comorbidity. Extra-anatomic bypass with aneurysm isolation, first described by Carpentier et al, 1 can be performed through a median sternotomy, with or without an upper laparotomy. However, this technique is rarely used currently because backflow from intercostal arteries and mediastinal branches is uncontrollable and the longterm result is unwarranted.We here present a case of a patient with obstructive pulmonary disease and an extensively dissected aortic aneurysm who was successfully treated by extra-anatomic bypass. The aneurysm was isolated, and a stent graft was inserted into the true lumen of the aneurysm to reduce type II endoleak from intercostal arteries. Patient consent to the publication was obtained. CASE REPORTA 63-year-old man was emergently admitted to our hospital with sudden onset of chest pain. His medical history included type B aortic dissection 12 years before the admission, emphysema from cigarette smoking, mild renal dysfunction, and alcoholic liver dysfunction. He was obese (body mass index, 31.9 kg/m 2 ). Shock was not present.A contrast-enhanced computed tomography (CT) scan on admission revealed a dissected aortic aneurysm from the aortic arch to the bilateral common iliac arteries. The maximum diameter of the descending aorta was 68 mm, and the aorta around the origin of the celiac artery was tapered (diameter range, 38-46 mm ; Fig 1, A). The ascending aorta was also dilated (maximum diameter, 51 mm). There was mediastinal hematoma with no extravasation, indicating contained rupture.Because the patient had no symptoms after administration of antihypertensive therapy, no progressive anemia, and had stable circulatory condition, we opted for intentionally delayed surgery. A simple extensive graft replacement via left thoracotomy was contraindicated due to the risk of postoperative pulmonary morbidity. A two-stage hybrid procedure, including the open fenestration technique was...

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Clinical outcomes and fate of the distal aorta following 1-stage repair of extensive chronic thoracic aortic dissection

Cited by 14 publications

References 23 publications

One-stage replacement of the aorta from arch to thoracoabdominal region

One-stage replacement of the aorta from arch to thoracoabdominal region

Open aortic arch surgery in chronic dissection with visceral arteries originating from different lumens

Extra-anatomic bypass with open-plugging stent graft for extensive dissected aortic aneurysm

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