Resternotomy Plus Left Thoracotomy Surgery after Previous Acute Type A Aortic Dissection Repair

Uchino, Gaku; Yoshida, Takeshi; Kakii, Bunpachi; Furui, Masato

doi:10.1055/s-0037-1607442

Cited by 1 publication

(3 citation statements)

References 22 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…We previously reported redo arch-descending aorta replacement using mid-sternotomy plus left thoracotomy. 12 Although the outcomes were quite good, some key demerits were noted, such as longer operation time and longer postoperative hospital stay due to the invasiveness of the procedure. To solve these problems, we devised a strategy of additional TEVAR and distal neo-neck formation.…”

Section: Discussionmentioning

confidence: 97%

“…In such cases, open surgery, which includes arch-descending aorta replacement by mid-sternotomy with left thoracotomy or extensive descending and thoracoabdominal replacement by left thoracotomy, is often performed, and various methods have been devised. [12][13][14][15][18][19][20] These procedures offer good success rates but are highly invasive. We previously reported redo arch-descending aorta replacement using mid-sternotomy plus left thoracotomy.…”

Section: Discussionmentioning

confidence: 99%

“…2,3,[8][9][10][11] When only open surgery is performed for chronic dissection, extensive aortic replacement is usually required, making the procedure very invasive. 2,[12][13][14][15] Therefore, we have developed a new method for closing the false lumen after TEVAR and named it as distal neo-neck with true aortic aneurysm and including patients with postoperative aneurysm of type A dissection, at the Matsubara Tokushukai Hospital. However, among these, 5 patients (mean age, 57 [13]; range: 43-77 years) with chronic dissection in the arch and descending aorta required additional treatment (Tables 1 and 2).…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Distal Neo-Neck Formation for Chronic Type B Dissection: False Lumen Closure After TEVAR

Furui

Sakaguchi

Kakii

et al. 2018

Vasc Endovascular Surg

Self Cite

View full text Add to dashboard Cite

Objectives: Patients with chronic aortic dissection often require repeat interventions due to enlargement of the pressurized false lumen or disseminated intravascular coagulation even after additional thoracic endovascular aortic repair (TEVAR) to occlude the entry tear. Residual false lumen flow can persist even after performing the candy-plug technique or branched stentgraft placement in some cases. We have devised a new method for false lumen closure. Methods: From December 2010 to May 2017, 5 patients (mean age: 57 [13] years, range: 43-77 years) with chronic dissection at the aortic arch and descending aorta, who underwent initial TEVAR, required additional treatment. Using an open surgical approach, the endograft was fixed with an outer felt under cardiopulmonary bypass after the endograft with stent was expanded by fenestration. The false lumen was closed using this procedure, and the aortotomy was repaired by direct closure in 2 cases and by graft replacement in 3 cases. Results: No major operative complications occurred, such as respiratory failure or paraplegia. Postoperative enhanced computed tomography (CT) images showed that the false lumen flow disappeared in all cases. All patients were discharged under normal conditions. They were all followed up and their CT did not indicate any complications for a mean of 33.6 (20.3) months. Conclusions: Our combined procedure was effective and provided a higher success rate compared with endovascular therapy alone. This staged treatment approach, using a combination of TEVAR and false lumen closure, is less invasive compared with open surgery alone and may represent a valid treatment option for chronic type B dissection. Keywords chronic dissection, false lumen closure, open surgery, thoracic endovascular aortic repair formation. This study reports 5 cases treated by distal neo-neck formation after TEVAR.

show abstract

Section: Discussionmentioning

confidence: 97%