Wrapping of the Ascending Aorta in Acute Type A Retrograde Aortic Dissection

Ramadan, Ramzi; Azmoun, Alexandre; Al‐Attar, Nawwar; Nottin, R

doi:10.1016/j.athoracsur.2011.03.110

Cited by 9 publications

(6 citation statements)

References 4 publications

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“…Recently, there is increasing interest in this wrapping technique in patients with type A dissections, either as a standalone procedure or in combination with stent-grafts. 14 Gao et al 15 described for the first time mesh wrapping in combination with a sandwich graft for acute type A dissection, with excellent intermediate-term results.…”

Section: Discussionmentioning

confidence: 99%

Endovascular Hybrid Repair of True Ascending Aortic Aneurysms Using Double Graft Wrapping to Prepare a Landing Zone for Ascending Aortic Stent-Graft Placement: A Cohort Study

et al. 2019

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Purpose: To describe a hybrid procedure that avoids cardiopulmonary bypass to treat patients with true ascending aortic aneurysms without a suitable proximal landing zone for endovascular repair. Material and Methods: Thirteen consecutive patients (mean age 75.9±6.5 years; 8 women) with true ascending aortic aneurysms were treated with the endovascular hybrid repair of true aortic aneurysms (EHTA) approach, which consists of a conventional sternotomy with double wrapping of the ascending aorta followed by staged stent-graft placement. Via sternotomy, a polypropylene mesh trimmed to downsize the aneurysm is placed around the dilated ascending aorta and sutured to the adventitia. A similarly trimmed polytetrafluoroethylene graft is placed loosely around the first wrap to avoid adhesions and secure the proximal landing zone. There is no need for cardiopulmonary bypass. A few days later, a standard thoracic stent-graft is deployed via either a transaxillary or transfemoral access; chimney or bypass grafts are used as needed to revascularize the supra-aortic vessels. Results: The ascending aortic diameter was reduced from a mean 5.7 cm (range 4.8–6.5) to 3.9 cm (range 3.2–4.3) after wrapping. The mean interval between surgery and stent-graft placement was 5 days. In this interval, 2 patients with significant reduction in the diameter of the ascending aorta elected to forego placement of a stent-graft. Of the 11 patients who underwent the full hybrid EHTA procedure, the ascending aortic stent-graft was combined with a chimney graft in the innominate artery in 4 cases. In 1 patient, a supra-aortic debranching procedure using a bifurcated Dacron graft to the innominate and left common carotid arteries was performed after wrapping with the polypropylene mesh. There was no mortality or neurological complication. A sternal wound infection required a prolonged hospital stay. At a mean follow-up of 13.8 months (range 3–24), there has been no death, type I endoleak, or sign of aneurysm enlargement on imaging. Conclusion: This technique permits complete endovascular exclusion of an ascending aortic aneurysm in a less invasive approach than standard open repair. Although this is only a small cohort of patients without long-term follow-up, it seems that this hybrid procedure is associated with low morbidity and mortality. It offers a beating-heart approach to treat true ascending aortic aneurysms in selected high-risk patients.

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Section: Discussionmentioning

confidence: 99%

Endovascular Hybrid Repair of True Ascending Aortic Aneurysms Using Double Graft Wrapping to Prepare a Landing Zone for Ascending Aortic Stent-Graft Placement: A Cohort Study

et al. 2019

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“…For type A dissection, the aorta proximal to the branches is not normal, and an ancillary procedure may be needed to reduce the diameter of the ascending aorta to better conform to the aortic stent-graft. Wrapping of the ascending aorta in TAAD treatment is not commonly used, 3 but the concept of reinforcing the landing zone for an aortic stent-graft is sound. In general, the aortic wall of the ascending aorta will maintain its mechanical characteristics when the post-dissection diameter is ≤40 mm.…”

Section: Discussionmentioning

confidence: 99%

“…Wrapping of the ascending aorta in TAAD treatment is not commonly used, 3 but the concept of reinforcing the landing zone for an aortic stent-graft is sound. In general, the aortic wall of the ascending aorta will maintain its mechanical characteristics when the post-dissection diameter is ≤40 mm.…”

Section: Discussionmentioning

confidence: 99%

Sandwich Technique for Endovascular Repair of Acute Type A Aortic Dissection

et al. 2017

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Overview: To describe a new endovascular procedure for acute type A aortic dissection (TAAD) repair. Methods: Between 2013 and 2016, 12 patients (average age 54±9.6 years; 10 men) with acute TAAD (mean EURO score 11.4%±3.2%, range 5-17) and unfit for surgery underwent thoracic endovascular aortic repair (TEVAR) with 2 periscope grafts to preserve blood supply to supra-aortic branches plus bypass grafting as needed. If the ascending aorta was dilated to >40 mm, sternotomy was performed to wrap the ascending aorta and reduce its diameter to accommodate the aortic stentgrafts. Results: All patients were successfully treated. Seven patients required bypass grafting, and most of the patients had periscope grafts to the innominate/right common carotid artery and left common carotid artery; only 3 patients had the left subclavian artery preserved. All patients exhibited good hemodynamics and normal pressures after the procedure. The mean procedure time and blood loss were 4.5±1.0 hours and 217±111.5 mL, respectively. Two patients treated emergently died shortly after surgery from multiorgan failure. The average follow-up duration was 17±14.5 months (range 2-42) in the 10 survivors. The remaining patients recovered and none experienced stent-graft thrombosis, stroke, or peripheral artery embolism during follow-up. Conclusion: A procedure that combines sandwich/periscope grafting with TEVAR, wrapping of the aorta, and supra-arch bypass grafting can be used to treat patients with acute TAAD.

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“…Off-pump aortic wrapping of the aorta in SAAD aims at avoiding intrapericardial aortic rupture and the complications of extensive aortic arch replacement in elderly or high-risk patients [3]. We performed this technique in 18 patients: In 14 patients the intimal flap reapplied itself spontaneously in the reinforced ascending aorta, whereas in 4 patients, the false lumen was still circulating after the wrapping, with a threat to the aortic root.…”

Section: Commentmentioning

confidence: 99%

Ascending Aorta Stenting After Off-Pump Aortic Wrapping in Stanford A Retrograde Aortic Dissection

Verscheure

Ramadan

Azmoun

et al. 2017

The Annals of Thoracic Surgery

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We report 4 cases of off-pump ascending aorta wrapping combined with ascending aorta stenting in retrograde Stanford A acute aortic dissection (SAAD). Since 2008, 18 patients have undergone wrapping of the ascending aorta at our institution. Four patients had a persistent circulating false lumen in the ascending aorta after wrapping, with a threat to the aortic root. We chose an endovascular approach with ascending aorta stenting. Follow-up computed tomography showed a reapplication of the intimal flap in the reinforced aorta. Ascending aorta stenting after aortic wrapping for retrograde SAAD is a safe and efficient technique to prevent proximal progression of the dissection.

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Wrapping of the Ascending Aorta in Acute Type A Retrograde Aortic Dissection

Cited by 9 publications

References 4 publications

Endovascular Hybrid Repair of True Ascending Aortic Aneurysms Using Double Graft Wrapping to Prepare a Landing Zone for Ascending Aortic Stent-Graft Placement: A Cohort Study

Endovascular Hybrid Repair of True Ascending Aortic Aneurysms Using Double Graft Wrapping to Prepare a Landing Zone for Ascending Aortic Stent-Graft Placement: A Cohort Study

Sandwich Technique for Endovascular Repair of Acute Type A Aortic Dissection

Ascending Aorta Stenting After Off-Pump Aortic Wrapping in Stanford A Retrograde Aortic Dissection

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