Surgery for acute type A dissection with the tear in the descending aorta using a stented elephant trunk procedure.

Abstract

BACKGROUND Surgical management of acute type A dissection with the tear in the descending aorta is challenging because of the technical difficulty in managing proximal and distal aortic lesions through a median sternotomy or lateral thoracotomy using a single-stage procedure. METHODS Thirty-three patients with acute type A dissection with the tear in the descending aorta underwent total arch replacement combined with stented elephant trunk implantation through a median sternotomy from April 2003 to June 2007. Preoperative complications included acute cardiac tamponade (n = 1), acute left heart failure (n = 1), acute myocardial infarction (n = 1), cerebral ischemia (n = 1), acute renal failure (n = 2), chronic renal dysfunction (n = 2), and acute mesenteric ischemia (n = 1) and lower extremity ischemia (n = 3). The residual false lumen was evaluated using postoperative computed tomography. RESULTS Death at 30 days was 6.06% (2 of 33 patients). One patient with preoperative mesenteric ischemia died of postoperative multiple-organ failure. One patient with preoperative acute renal failure ceased treatment after three reoperations owing to uncontrollable bleeding. Left lower-extremity paraparesis occurred in 1 patient, and transient neurologic dysfunction occurred in 1 patient. Severe complications were not observed at a mean follow-up of 25 +/- 11 months. Thrombus obliteration of the false lumen was observed at the distal end of the stented graft in 29 patients (96.7%) and at the diaphragmatic level in 20 patients (66.7%) during follow-up. CONCLUSIONS Encouraging outcomes favor this technique in patients with acute type A dissection with the tear in the descending aorta. Simultaneous repair of proximal aortic lesions and thrombosis of the false lumen in the descending aorta could be obtained.

DOI: 10.1016/j.athoracsur.2009.01.042

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@article{Sun2009SurgeryFA, title={Surgery for acute type A dissection with the tear in the descending aorta using a stented elephant trunk procedure.}, author={Lizhong Sun and Ruidong Qi and Qian Ci Chang and Junming Zhu and Yongmin Liu and Chuntao Yu and Haitao Zhang and Bin Lv and Jun Zheng and Liangxin Tian and Jinguo Lu}, journal={The Annals of thoracic surgery}, year={2009}, volume={87 4}, pages={1177-80} }