Surgery for acute type A dissection using total arch replacement combined with stented elephant trunk implantation: Experience with 107 patients

Abstract

Low morbidity and mortality were achieved using total arch replacement combined with stented elephant trunk implantation. These encouraging surgical results and postoperative outcomes favor this more aggressive procedure for acute type A dissection.

Total Arch versus Hemiarch Replacement for Type A Acute Aortic Dissection: A Single-Center Experience

“…In an effort to maximize the resection of entry tears and to decrease the incidence of residual patent false lumina, several groups [4][5][6][7]11,12 have advocated a more aggressive approach to aortic arch repair: routine replacement of the total aortic arch regardless of the site of the entry tear, although distal manipulation has been associated with an increased operative mortality rate.…”

“…Because the residual dissection flap in the aortic arch and descending aorta carries risks of progressive aortic dilation and rupture and the need for secondary intervention, several groups have suggested immediate extensive surgery that involves the aortic arch, although concomitant distal aortic manipulation has been associated with an increased risk of morbidity and death. [4][5][6][7][8][9][10][11][12][13] In this situation, 2 different surgical strategies have been proposed: total arch replacement or hemiarch replacement (a more conservative repair limited to the ascending aorta and proximal arch). 4,[9][10][11][12] We evaluated the early and intermediate outcomes of aortic arch surgery in patients with type A AAD, investigating the effect, upon postoperative results, of aortic arch extension.…”

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

“…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).…”

“…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].…”

“…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].…”