Multicenter early experience with extended aortic repair in acute aortic dissection: Is simultaneous descending stent grafting justified?

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

doi:10.1016/j.jtcvs.2010.07.066

Cited by 95 publications

(56 citation statements)

References 24 publications

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“…The reported sizing techniques are: size of the true lumen as measured by intraoperative sizing with a ball sizer (12,25), 10-15% larger than the proximal aorta measured by preoperative computed tomography (CT) (9), size only of the true lumen, obtained by preoperative CT (20), size of total lumen diameter obtained by preoperative CT (24), or intraoperative angiogram (22). Sizing of the endograft for the hybrid approach is crucial because the endograft needs to be large enough to open up the collapsed true lumen and avoid type I endoleak.…”

Section: Sizing Techniquementioning

confidence: 99%

Descending endografts for type A dissections: con

Tanaka¹,

Sandhu²,

Estrera³

2016

Ann. Cardiothorac. Surg.

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An important goal of surgical repair of type A aortic dissection is to resect the intimal tear. Studies on the fate of residual dissection after acute type A aortic dissection repair in the past decade have driven surgeons to seek procedures to avoid distal reoperation. Aggressive surgical approach with total arch replacement in acute type A dissection has demonstrated lower incidence of distal reoperation and slower aortic growth rate compared to less aggressive ascending/hemiarch repair. Recently, successful results of thoracic endovascular aortic repair (TEVAR) in type B aortic dissection have encouraged surgeons to further attack acute type A aortic dissection with hybrid approach: antegrade endografting in the descending thoracic true lumen as an adjunct to hemiarch or total arch repair. However, is the hybrid approach with simultaneous descending endografting justified in all the acute type A aortic dissection cases? The outcomes of the hybrid approach reported by the several groups have demonstrated 80-100% of false lumen thrombus formation in the proximal descending aorta (stented segment); however, the complete obliteration of the false lumen is only 17-50%. The incidence of distal reoperation/reintervention after hybrid approach is as high as 14% and an adjunctive procedure is often performed. Moreover, there are concerns about additional risks associated with the hybrid procedures, such as spinal cord injury (SCI), stent graft induced new entry and stroke. The data on this new approach are still very limited. Hence, further study is warranted to prove its safety and durability.

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Section: Sizing Techniquementioning

confidence: 99%

Descending endografts for type A dissections: con

Tanaka¹,

Sandhu²,

Estrera³

2016

Ann. Cardiothorac. Surg.

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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: 83%

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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“…Although commonly associated with a poor post-operative prognosis, recovery has been reported when rapid brain reperfusion is achieved (29,30) especially if the time between symptom onset and arrival at the operating theatre is less than 5 hours (31).…”

Section: Malperfusionmentioning

confidence: 99%

Differential aspects of the disease and treatment of Thoracic Acute Aortic Dissection (TAAD)—the European experience

Pepper

2016

Ann. Cardiothorac. Surg.

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Multicenter early experience with extended aortic repair in acute aortic dissection: Is simultaneous descending stent grafting justified?

Abstract: Extended thoracic aortic repair of acute aortic dissection with a hybrid stent graft is feasible at acceptable early mortality and promotes false lumen thrombosis around the stent graft and below.

Cited by 95 publications

References 24 publications

Descending endografts for type A dissections: con

Descending endografts for type A dissections: con

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?

Differential aspects of the disease and treatment of Thoracic Acute Aortic Dissection (TAAD)—the European experience

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