OBJECTIVE: Chronic type B dissection though optimal is still considered to be a controversial procedure, even in the advent of stent grafts. Recently, we used a novel surgical technique involving left axillary perfusion to analyze the results of our surgical strategy and compare them with those reported in the literature. MATERIALS AND METHODS: Between August 2004 and July 2009, 39 patients underwent graft replacement for chronic type B aortic dissection. The left axillary artery was used for perfusion inflow. Perfusion was maintained at approximately 23˚C during open proximal anastomosis. The graft was anastomosed to the distal true lumen whenever possible. RESULTS: Open proximal anastomosis was performed in 22 patients (56%). In 24 cases (62%), grafts were anastomosed to the true lumen of the peripheral aorta. The early overall mortality rate was 3% (1 patient). Permanent cerebral infarction occurred in 2 patients (5%); and paraparesis, in 1 patient (3%). The Kaplan-Meier survival estimates were 91% at 2 years and 88% at 5 years. CONCLUSION: Our surgical strategy is associated with excellent short-term and midterm outcomes. Although further investigation is needed, this strategy may be useful for patients with chronic type B dissection.
OBJECTIVE: Chronic type B dissection though optimal is still considered to be a controversial procedure, even in the advent of stent grafts. Recently, we used a novel surgical technique involving left axillary perfusion to analyze the results of our surgical strategy and compare them with those reported in the literature. MATERIALS AND METHODS: Between August 2004 and July 2009, 39 patients underwent graft replacement for chronic type B aortic dissection. The left axillary artery was used for perfusion inflow. Perfusion was maintained at approximately 23˚C during open proximal anastomosis. The graft was anastomosed to the distal true lumen whenever possible. RESULTS: Open proximal anastomosis was performed in 22 patients (56%). In 24 cases (62%), grafts were anastomosed to the true lumen of the peripheral aorta. The early overall mortality rate was 3% (1 patient). Permanent cerebral infarction occurred in 2 patients (5%); and paraparesis, in 1 patient (3%). The Kaplan-Meier survival estimates were 91% at 2 years and 88% at 5 years. CONCLUSION: Our surgical strategy is associated with excellent short-term and midterm outcomes. Although further investigation is needed, this strategy may be useful for patients with chronic type B dissection.
Authors: Himanshu J Patel; Michael S Shillingford; Scott Mihalik; Mary C Proctor; G Michael Deeb Journal: Ann Thorac Surg Date: 2006-07 Impact factor: 4.330
Authors: Ali Khoynezhad; Carlos E Donayre; Bassam O Omari; George E Kopchok; Irwin Walot; Rodney A White Journal: J Thorac Cardiovasc Surg Date: 2009-09 Impact factor: 5.209
Authors: Y Kawashima; R Shirakura; S Nakano; H Matsuda; K Taniguchi; M Kaneko; A T Kawaguchi; K Kadoba; R Matsuwaka Journal: Surgery Date: 1993-01 Impact factor: 3.982