Hybrid Aortic Arch Debranching With Staged Endovascular Completion in DeBakey Type I Aortic Dissection
| Autor: | Rocco A. Pennetta, Antonio M. Cricco, Luigi Specchia, Gerardo Di Matteo, Giampiero Esposito, Antonino G.M. Marullo, Fausto Castriota, Samuele Bichi |
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| Rok vydání: | 2010 |
| Předmět: |
Male
Pulmonary and Respiratory Medicine Aortic arch medicine.medical_specialty Dissection (medical) Prosthesis Design Aortic aneurysm Imaging Three-Dimensional Aneurysm Blood vessel prosthesis medicine.artery Ascending aorta medicine Humans Thoracic aorta Hospital Mortality cardiovascular diseases Retrospective Studies Aortic dissection Aortic Aneurysm Thoracic business.industry Dissection Endovascular Procedures Middle Aged medicine.disease Blood Vessel Prosthesis Surgery Aortic Dissection Treatment Outcome surgical procedures operative Italy cardiovascular system Female Radiology Tomography X-Ray Computed Cardiology and Cardiovascular Medicine business Follow-Up Studies |
| Zdroj: | The Annals of Thoracic Surgery. 90:1847-1853 |
| ISSN: | 0003-4975 |
| DOI: | 10.1016/j.athoracsur.2010.07.077 |
| Popis: | Background We assess midterm results of a hybrid approach to DeBakey type I aortic dissection using a new multibranched Dacron graft to create, by relocation of the inflow openings to the arch vessels toward the aortic root, a new aortic arch for an easier and safer second-staged endovascular stent grafting of the distal thoracic aorta. Methods From March 2006 to July 2008 24 patients with DeBakey type I aortic dissection underwent ascending aorta and aortic arch replacement with debranching of epiaortic vessels using a new prosthesis to create an optimal landing zone for possible subsequent endovascular stent grafting of the distal thoracic aorta. Fifteen patients, who postoperatively presented a residual patent distal false lumen, underwent a successful second-stage endovascular stent-graft implantation. Results One patient died after the surgical stage while there was no death after the endovascular stage with hospital mortality of 4.2%. Follow-up confirmed complete thrombosis of the residual distal false lumen in 95.6% and partial thrombosis in 4.4% of patients with no evidence of endoleaks in the cases that required the endovascular procedure. Overall actuarial survival at 28 months is 92.1% ± 7.9% with 100% freedom from reoperation. Conclusions Hybrid treatment of DeBakey type I aortic dissection with aortic arch debranching, using a new multibranched prosthesis (Lupiae Graft; Vascutek Terumo Inc, Scotland, United Kingdom) is confirmed to facilitate the subsequent endovascular completion. Midterm results in terms of survival and distal false lumen thrombosis are satisfactory. Further study of this operation is warranted to confirm the effectiveness and the durability of this approach. |
| Databáze: | OpenAIRE |
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