Optimization of Aortic Arch Replacement With a One-Stage Approach

Kouchoukos, Nicholas T.; Mauney, Michael C.; Masetti, Paolo; Castner, Catherine F.

doi:10.1016/j.athoracsur.2006.10.095

Cited by 72 publications

(38 citation statements)

References 12 publications

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“…Our early results were comparable to those in other reports regarding mortality [5,10,11]. A major concern with this left posterolateral thoracotomy is the complication of intraoperative endobronchial hemorrhage under a fully heparinized condition.…”

Section: Discussionsupporting

confidence: 80%

“…Median sternotomy is the gold standard to access the aortic arch; however, exposure to the distal descending aorta is limited even if additional left anterolateral thoracotomy is applied. Kouchoukos et al [5] reported the clam-shell approach as an excellent procedure for one-stage extended aortic arch replacement. We entirely agree that the clam-shell approach is highly useful if aortic root replacement is required.…”

Section: Discussionmentioning

confidence: 99%

“…Residual dissection from the aortic arch down to the descending or thoracoabdominal aorta after ascending aortic replacement for acute type A dissection is often encountered, which requires an extended replacement of the aortic arch. Kouchoukos et al reported excellent results of a one-stage operation for extended thoracic aneurysms through a clam-shell incision using the arch-first technique [5]. Left posterolateral thoracotomy is another beneficial option to access the ascending, arch and entire descending aorta, which allows for performance of even a thoracoabdominal procedure by entering the retroperitoneal space.…”

Section: Introductionmentioning

confidence: 99%

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Extended replacement of aortic arch aneurysms through left posterolateral thoracotomy

Okada

Tanaka

Munakata

et al. 2009

European Journal of Cardio-Thoracic Surgery

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Objective: To present our experience of total aortic arch replacement through a left posterolateral thoracotomy. Methods: Sixteen patients (13 males; mean age 62.1 AE 11.3 years) with extended thoracic aortic aneurysms, including those in the thoracoabdominal aorta, underwent replacement through a left posterolateral thoracotomy. The pathology of the diseased aorta was non-dissecting aneurysm due to aortitis in 1 patient and aortic dissection in 15 patients (acute type A: 1, chronic type A: 12, chronic type B: 2). In a prior operation, the patient with aortitis had undergone the Bentall procedure with endovascular stenting of the brachiocephalic artery, and among the other 15 patients, one previously had endovascular stenting for the aortic arch and 12 had hemi-arch replacement for acute type A dissection. Extension of arch replacement was the aortic arch and descending aorta in eight patients, the ascending arch and descending aorta in five patients and the descending arch, and thoracoabdominal aorta in three patients. Additional retroperitoneal dissection was required for the repair of a thoracoabdominal aortic aneurysm. Results: One patient died of traumatic cerebral hemorrhage on day 145 (hospital mortality 6.3%). Average duration of ventilation support was 19.4 AE 17.0 h and length of ICU stay was 3.6 AE 1.6 days. Actuarial survival at 2 years after the operations was 67.7%. However, no aortic-related mortality was observed during follow-up. Conclusions: Early results of extended aortic arch replacement through a left posterolateral thoracotomy were satisfactory in selected patients. #

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Section: Discussionsupporting

confidence: 80%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Extended replacement of aortic arch aneurysms through left posterolateral thoracotomy

Okada

Tanaka

Munakata

et al. 2009

European Journal of Cardio-Thoracic Surgery

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“…In order to improve the outcomes, few methods of single-stage repair have been proposed. Most of them are performed through a clamshell incision [15][16][17]. The surgical invasiveness of the bilateral anterior thoracotomy is not innocuous and it is potentially associated with a high incidence of pulmonary complications.…”

Section: Discussionmentioning

confidence: 99%

Treatment of complex disease of the thoracic aorta: the frozen elephant trunk technique with the E-vita open prosthesis☆

Bartolomeo

Marco

Armaro

et al. 2009

European Journal of Cardio-Thoracic Surgery

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The frozen elephant trunk technique with the new E-vita open prosthesis combines surgical and interventional technologies and represents a feasible and efficient option in the treatment of complex aortic pathologies. Strict monitoring of the patient has to be carried out in order to detect possible evolution of the aortic lesion, which can require prompt treatment. However, long-term follow-up is required.

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“…The supraaortic vessels may be anastomosed end-to-end to side branches of the graft or as a patch. [6][7][8][9][10][11][12][13] Unfortunately, some delivery systems are quite cumbersome and deployment of the stented portion of the graft might be imprecise, therefore causing a far more distal landing than intended.…”

Section: Introductionmentioning

confidence: 99%

Long-term results of simplified frozen elephant trunk technique in complicated acute type A aortic dissection: A case–control study

et al. 2016

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Aim: To describe the long-term experience of a simplified frozen elephant trunk technique (sFETT) used in complicated acute type A aortic dissection (AAAD) treatment. Methods and results: Between January 2001 and December 2012, 34 patients (mean age 59.9 AE 11.0 years) with complicated AAAD (DeBakey I) underwent an emergency surgery including sFETT. sFETT consisted in gluing the dissected aortic arch wall layers with gelatine-resorcinol adhesive and video-assisted antegrade open arch aortic stent-graft deployment in the arch or proximal descending aorta. In addition to sFETT, the aortic root was addressed with standard techniques. A 30-day mortality was 14.7% (five patients) due to bleeding (1), multiple organ failure (2), and colon ischemia (2). Postoperative morbidity included neurological (2), renal (1) and cardio-pulmonary complications (4), as well as wound infection (1). Mean follow-up was 74.4 AE 45.0 months. Actual survival rates were 73.5% at 1 year, 70.2% at 5 years, and 58.5% at 13 years of follow-up. Six patients died during long-term follow-up from heart failure (1) and unknown reasons (5). Five patients required reoperation for aortic arch (3) or aorto-iliac (2) progression of aneurysm during the mid-and long-term follow-up. The remaining patients showed favorable evolution of the dissected aorta with false lumen occlusion in most cases and stable aortic diameters. Conclusions: In AAAD patients, sFETT as used in our series is an easy and safe technique to repair the aortic arch. Long-term results after sFETT showed false lumen occlusion and stable aortic diameter in up to 13 years of follow-up.

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Optimization of Aortic Arch Replacement With a One-Stage Approach

Cited by 72 publications

References 12 publications

Extended replacement of aortic arch aneurysms through left posterolateral thoracotomy

Extended replacement of aortic arch aneurysms through left posterolateral thoracotomy

Treatment of complex disease of the thoracic aorta: the frozen elephant trunk technique with the E-vita open prosthesis☆

Long-term results of simplified frozen elephant trunk technique in complicated acute type A aortic dissection: A case–control study

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