Surgery for Acute Type A Dissection With the Tear in the Descending Aorta Using a Stented Elephant Trunk Procedure

Sun, Li‐Zhong; Qi, Rui-Dong; Chang, Qian; Zhu, Jun; Liu, Yongmin; Yu, Chun-tao; Hai-tao, Zhang; Lv, Bin; Zheng, Jun; Tian, Lu; Lu, Jin-Guo

doi:10.1016/j.athoracsur.2009.01.042

Cited by 60 publications

(57 citation statements)

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“…Sun's procedure encompasses several technical details in terms of cannulation, cardiopulmonary bypass, cerebral protection, and surgical skills [12][13][14][15][16]. It is performed via a median sternotomy under total cardiopulmonary bypass (CPB) and selective cerebral perfusion (SCP) with cannulation of the right axillary artery (RAA).…”

Section: Surgical Techniquesmentioning

confidence: 99%

“…As our team has gained vast experience since its introduction, the indications of Sun's procedure have evolved considerably [12][13][14][15][16][17][19][20][21][22][23][24]. This, in part, may be ascribed to an algorithm dictating the surgical strategies based on our subcategorization of the Stanford system that divides type A dissections into subtypes according to the aortic root diameter, degree of aortic insufficiency, competency of the sinotubular junction, and the dissection process in the arch and beyond [17].…”

Section: Operative Indicationsmentioning

confidence: 99%

“…In 2002, the senior author (L.Z.S. ), then the chief of Aortic Surgery in Fu Wai Hospital, designed a new stented graft and proposed a modified technique of total arch replacement using a four-branched graft with implantation of this stented elephant trunk as a treatment for type A aortic dissection [12], which has produced satisfactory early and long-term results [13][14][15][16][17]. Owing to its ingenious design, widespread usage, and excellent outcomes, this technique was named after Dr. Sun by domestic and international colleagues in 2008, hence the term "Sun's procedure," i.e., total arch replacement using a tetrafurcate graft with stented elephant trunk implantation [18].…”

Section: Introductionmentioning

confidence: 99%

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Dr. Sun's Procedure for Type A Aortic Dissection: Total Arch Replacement Using Tetrafurcate Graft With Stented Elephant Trunk Implantation

Zheng

Liu

et al. 2013

aorta

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Sun's procedure is a modified elephant trunk technique that integrates the advantages of open surgical and endovascular repairs as a treatment of type A aortic dissection. It is named after Dr. Li-Zhong Sun and refers to total arch replacement using a four-branched graft with implantation of a special stented endovascular graft. Since its introduction, it has produced excellent early and late clinical outcomes. We present a video of this procedure and make an overview regarding the technical aspects, surgical indications, and clinical outcomes of Sun's procedure.

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Section: Surgical Techniquesmentioning

confidence: 99%

Section: Operative Indicationsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Dr. Sun's Procedure for Type A Aortic Dissection: Total Arch Replacement Using Tetrafurcate Graft With Stented Elephant Trunk Implantation

Zheng

Liu

et al. 2013

aorta

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“…However, this treatment approach is associated with a high mortality rate and numerous complications. 4 TEVAR with implantation of an aortic stent graft to cover the primary tear is considered as a less invasive and more effective alternative in the management of aortic lesions. In our experience, TEVAR is indicated when the aortic dissection is complicated with rupture, branch-organ malperfusion, persistent pain, or hypertension managed with regular medication.…”

Section: Benefits Of the Chimney Techniquementioning

confidence: 99%

Endovascular Aortic Repair Combined with Chimney Technique in the Treatment of Stanford Type B Aortic Dissection Involving Aortic Arch

Liu

Shu

et al. 2015

Annals of Vascular Surgery

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“…The majority of entry tears in patients undergoing surgery for acute type A aortic dissection are located in the proximal thoracic aorta and can therefore be addressed by surgical resection during repair [7]. Nevertheless, a certain percentage, being potentially underreported in the literature, do have their primary entry at a more distal site, such as the descending aorta with retrograde propagation of the dissecting membrane into the proximal thoracic aorta [8].This mechanism has also been confirmed in experimental studies [9]. In patients after surgery for acute type B aortic dissection, spontaneous closure of the primary entry tear is rare [10].…”

Section: Commentmentioning

confidence: 99%

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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Surgery for Acute Type A Dissection With the Tear in the Descending Aorta Using a Stented Elephant Trunk Procedure

Cited by 60 publications

References 8 publications

Dr. Sun's Procedure for Type A Aortic Dissection: Total Arch Replacement Using Tetrafurcate Graft With Stented Elephant Trunk Implantation

Dr. Sun's Procedure for Type A Aortic Dissection: Total Arch Replacement Using Tetrafurcate Graft With Stented Elephant Trunk Implantation

Endovascular Aortic Repair Combined with Chimney Technique in the Treatment of Stanford Type B Aortic Dissection Involving Aortic Arch

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?

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