Modified frozen elephant trunk for acute type A aortic dissection: a comparative study with standard repair technique
| Autor: | Prerana Banerjee, Martin Siegemund, Oliver Reuthebuch, Jens Fassl, Peter Matt, Florian Rueter, Friedrich Eckstein, Martin Grapow, Ulrich Schurr |
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| Rok vydání: | 2016 |
| Předmět: |
Pulmonary and Respiratory Medicine
Male Reoperation medicine.medical_specialty Elephant trunks medicine.medical_treatment Aorta Thoracic Dissection (medical) 030204 cardiovascular system & hematology 03 medical and health sciences Blood Vessel Prosthesis Implantation 0302 clinical medicine Hypothermia Induced medicine.artery Ascending aorta medicine Humans Cerebral perfusion pressure Stroke Aged Retrospective Studies Aortic dissection Paraplegia Aortic Aneurysm Thoracic business.industry Stent General Medicine Middle Aged equipment and supplies medicine.disease Surgery Blood Vessel Prosthesis Aortic Dissection Treatment Outcome 030228 respiratory system Descending aorta Acute Disease Female Stents Cardiology and Cardiovascular Medicine business |
| Zdroj: | European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery. 51(4) |
| ISSN: | 1873-734X |
| Popis: | Objectives We hypothesized that antegrade open stent graft implantation in the descending aorta during acute type A aortic dissection surgery is safe and improves patient outcome compared with the standard repair technique. Methods Hundred and forty-one consecutive patients underwent surgery for acute type A aortic dissection at our institution from 2010 to 2016. Of those, 104 patients underwent ascending aorta and hemiarch repair under hypothermic circulatory arrest with antegrade cerebral perfusion (standard group). Since 2013, 37 patients have undergone the standard procedure combined with antegrade stent implantation in the descending aorta (stented group). A matched analysis using the logistic EuroSCORE (37 patients per group) was done. All data were collected prospectively. Results The mean logistic EuroSCORE was 29 in both groups, P = 1. Cardiopulmonary bypass time was 150 ± 57 (standard) vs 157 ± 48 (stented) min, P = 0.6; aortic clamping 99 ± 47 (standard) vs 100 ± 36 (stented) min, P = 1. Stented patients had longer circulatory arrest times with antegrade cerebral perfusion, 23 ± 7 vs 15 ± 7 min, P < 0.001. Stroke occurred in 24.3% (standard) vs 8.1% (stented), P = 0.1; paraplegia developed in 2.7% (standard) vs 0% (stented), P = 1. Abdominal intervention due to suspected visceral ischaemia was needed in 18.9% (standard) vs 5.4% (stented), P = 0.2. 30-day mortality was 13.5% (standard) vs 0% (stented), P = 0.05. Survival at 6-month was 100% and 86.5% in patients with implanted stents and standard repair, respectively, P = 0.02. Conclusions Antegrade, open stent graft implantation into the descending aorta during acute type A aortic dissection repair is safe and is associated with improved outcomes at 6 months postoperatively compared to the standard repair technique. |
| Databáze: | OpenAIRE |
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