Frozen elephant trunk technique and partial remodeling for acute type A aortic dissection
| Autor: | Miwa Sutoh, Masatsugu Kuraoka, Naomichi Uchida, Hiroshi Ishihara, Kentaro Tamura, Akira Katayama |
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| Rok vydání: | 2011 |
| Předmět: |
Male
Reoperation Pulmonary and Respiratory Medicine Aortic arch medicine.medical_specialty Elephant trunks medicine.medical_treatment Blood Vessel Prosthesis Implantation Aneurysm medicine.artery medicine Humans Thoracic aorta Aged Retrospective Studies Aortic dissection Aorta business.industry Stent General Medicine Middle Aged Prognosis medicine.disease Aortic Aneurysm Surgery Aortic Dissection Treatment Outcome Descending aorta Acute Disease Female Stents Radiology Cardiology and Cardiovascular Medicine business Follow-Up Studies |
| Zdroj: | European Journal of Cardio-Thoracic Surgery. |
| ISSN: | 1010-7940 |
| DOI: | 10.1016/j.ejcts.2011.02.074 |
| Popis: | Objective: The aimed to describe the frozen elephant trunk (FET) technique and partial remodeling (PR) for acute type A aortic dissection (ATAAD), considering the long-term prognosis on the basis of our 13 years of experience. Methods: There were 80 consecutive patients (mean age: 66.4 years) with an FET and PR technique for ATAAD between September 1997 and February 2010. We indicated a PR for all 80 patients without dilatation of the sinuses and a FET for 20 patients with a distal entry in the descending aorta, 14 patients with a dilatation more than 4 cm on the distal arch and 46 patients with a narrow true lumen younger than 70 years with a narrow true lumen. During moderate hypothermic circulation with selective cerebral perfusion and distal perfusion from the femoral artery, a stent graft (mean diameter: 27.7 mm, mean length: 9.9 mm, mean distal depth: thoracic vertebra (Th) 6.0th) was inserted through the transected proximal aortic arch. The plication of the sinotubular junction (N = 42) or partial remodeling for right and/or non-coronary cusp (N = 38) was performed after total arch replacement with a fourbranched prosthesis. Results: Four patients died in hospital. Early morbidity included two (2.5%) strokes but no spinal cord injury. In long-term follow-up (mean 94.6 months), five patients died of non-aortic events and two re-operations (Bentall and stent grafting to the descending aorta) were required. No patients had patent false lumen on the stent graft and residual aortic regurgitation, according to late follow-up computed tomography (CT) and echogram. The 10-year survival was 75% and the overall 10-year re-operation free rate on the thoracic aorta was 95%. Conclusion: FETand modified PR techniques could be effective for improving the long-term outcome on the distal and proximal aorta in an ATAAD. Crown Copyright # 2011 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved. |
| Databáze: | OpenAIRE |
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