Surgery for acute type A dissection using total arch replacement combined with stented elephant trunk implantation: Preservation of autologous brachiocephalic vessels

Abstract

This technique simplified hemostasis and anastomosis, reduced the size of the residual aortic wall, and preserved the autologous brachiocephalic vessels, yielding satisfactory surgical results. This technique is an alternative approach for suitable patients with acute type A dissection. However, outcomes are preliminary, and long-term follow up is required.

Frozen elephant trunk with modified en bloc arch reconstruction and left subclavian transposition for chronic type A dissection

“…At 6 years, the incidence was 3% for reoperation, 12% for late death, and 85% of patients were alive without reoperation. The rate of false lumen thrombosis was comparable to previous FET series (2,4,12). Persistent anastomotic leak of the aortic arch was rarely observed (3.4%), which we think could be avoided by improving the suturing technique.…”

“…In our modification, the "island" (residual aortic arch aortic wall containing only the IA and the LCCA origins) was trimmed into a very small piece, and all the native arch vessels were preserved via LSCA-LCCA transposition during TAR. The selection criteria of this technique in total arch repair for patients with type A dissection include: (I) the IA, LCCA and distal LSCA (at most 1 cm distal to its origin) are not involved by dissection, aneurysm; (II) the "island" is free from atherosclerotic and aneurysmal lesions; (III) adequacy of the circle of Willis (12).…”

“…After deployment of FET, the stent-free sewing edge (3 cm long Dacron graft) of the FET was straightened and trimmed to fit within native aortic wall containing the origins of the IA and LCCA. Next, the trimmed sewing edge was sutured to the native aortic wall near the origins of the IA and LCCA, as described in detail previously (12). Thus, the residual aortic arch wall and sewing edge formed a circular opening.…”

“…During the rewarming phase, the LSCA was clamped and transected 5-10 mm distal to its origin. The proximal stump of the LSCA was sewed with a running suture, and the distal end of the LSCA was anastomosed to the LCCA in an end-to-side fashion, as described previously (12,13). For patients with an ILVA, ILVA-LCCA transposition was performed in a similar way.…”

Mechanisms of aortic dissection smooth muscle cell phenotype switch

“…Thoracic aortic dissection (TAD) is a life-threating medical emergency with very high mortality. 1,2 Some connective tissue diseases can result in TAD, but only approximately 10% of TAD can be attributed to connective tissue diseases, and the pathogenesis of the others is still unclear. 3 It is known that the abnormity of aortic media is the pathogenetic base of TAD.…”