Yong-Liang Zhong1, Rui-Dong Qi1, Wei-Guo Ma1, Yi-Peng Ge1, Zhi-Yu Qiao1, Cheng-Nan Li1, Jun-Ming Zhu1, Li-Zhong Sun1. 1. Department of Cardiovascular Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing Aortic Disease Center, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing Engineering Research Center of Vascular Prostheses, Beijing 100029, China.
Abstract
BACKGROUND: Several methods of arch vessel reconstruction, such as en bloc (island) and branched graft techniques, have been proposed to treat aortic arch pathologies during total arch replacement (TAR). We seek to review our experience with modified en bloc technique and left subclavian (LSCA)-left carotid artery (LCCA) transposition in TAR and frozen elephant trunk (FET) procedure for chronic type A aortic dissection (CTAAD). METHODS: From September 2010 to September 2016, 35 consecutive patients with CTAAD underwent modified en bloc arch reconstruction with LSCA-LCCA transposition during TAR and FET procedure. Computed tomographic angiography (CTA) was performed during follow-up. RESULTS: In-hospital mortality was 5.7% (2/35). No neurological deficit or spinal cord injury occurred. Re-exploration for bleeding and continuous renal replacement therapy were required in 2 patients each (5.7%). Follow-up was complete in 100% for a mean duration of 4.1±1.8 years (range, 0.5-6.7 years). One patient experienced a transient stroke and thoracoabdominal aortic replacement was performed in 1. There were 2 late non-cardiac deaths. Survival was 87.9% (95% CI, 70.7-95.3%) at 6 years. At 6 years, the incidence was 3% for reoperation, 12% for late death, and 85% of patients were alive without reoperation. The anastomosis between the LSCA and LCCA was patent in 100%. CONCLUSIONS: Acceptable early and mid-term outcomes were achieved for patients with chronic type A dissection using en bloc technique with LSCA-LCCA transposition during TAR and FET procedure. This technique may be an alternative approach to chronic type A dissection in selected patients.
BACKGROUND: Several methods of arch vessel reconstruction, such as en bloc (island) and branched graft techniques, have been proposed to treat aortic arch pathologies during total arch replacement (TAR). We seek to review our experience with modified en bloc technique and left subclavian (LSCA)-left carotid artery (LCCA) transposition in TAR and frozen elephant trunk (FET) procedure for chronic type A aortic dissection (CTAAD). METHODS: From September 2010 to September 2016, 35 consecutive patients with CTAAD underwent modified en bloc arch reconstruction with LSCA-LCCA transposition during TAR and FET procedure. Computed tomographic angiography (CTA) was performed during follow-up. RESULTS: In-hospital mortality was 5.7% (2/35). No neurological deficit or spinal cord injury occurred. Re-exploration for bleeding and continuous renal replacement therapy were required in 2 patients each (5.7%). Follow-up was complete in 100% for a mean duration of 4.1±1.8 years (range, 0.5-6.7 years). One patient experienced a transient stroke and thoracoabdominal aortic replacement was performed in 1. There were 2 late non-cardiac deaths. Survival was 87.9% (95% CI, 70.7-95.3%) at 6 years. At 6 years, the incidence was 3% for reoperation, 12% for late death, and 85% of patients were alive without reoperation. The anastomosis between the LSCA and LCCA was patent in 100%. CONCLUSIONS: Acceptable early and mid-term outcomes were achieved for patients with chronic type A dissection using en bloc technique with LSCA-LCCA transposition during TAR and FET procedure. This technique may be an alternative approach to chronic type A dissection in selected patients.
Entities:
Keywords:
Chronic type A aortic dissection (CTAAD); frozen elephant trunk (FET); island technique; left subclavian artery transposition; total arch replacement (TAR)
Authors: Sven Peterss; Ahmed M Mansour; Julia A Ross; Irena Vaitkeviciute; Paris Charilaou; Julia Dumfarth; Hai Fang; Bulat A Ziganshin; John A Rizzo; Adebowale J Adeniran; John A Elefteriades Journal: J Am Coll Cardiol Date: 2016-09-06 Impact factor: 24.094
Authors: Bartosz Rylski; Rita K Milewski; Joseph E Bavaria; Emanuela Branchetti; Prashanth Vallabhajosyula; Wilson Y Szeto; Nimesh D Desai Journal: Ann Thorac Surg Date: 2014-11-06 Impact factor: 4.330
Authors: Konstantinos G Moulakakis; Spyridon N Mylonas; Fotis Markatis; Thomas Kotsis; John Kakisis; Christos D Liapis Journal: Ann Cardiothorac Surg Date: 2013-05