International Society For Minimally Invasive Cardiothoracic Surgery

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Early Outcome Of The Treatment Of Complicated Stanford B Dissection With Surgeon-modified Endografts
Minxin Wei, Zanxin Wang, Rong Ren, Junmin Wen, Weixin Chen.
Shenzhen Sun Yat-sun Cardiovascular Hospital, Shenzhen, China.

Background: Surgeon-modified fenestrated endovascular aortic repair (sm-fEVAR) is a good option to patients with acute Stanford B dissection, especially in the emergent cases. This technique has increased rapidly in this decade. The present research was to evaluate the early results of sm-fEVAR in complicated Stanford B dissection. Methods: Fifteen consecutive patients who underwent sm-fEVAR were retrospectively reviewed. The modality of sm-fEVAR technique was assessed, peri -operative clinical data were recorded. Diameters of total aortic, true and false lumen were measured at different anatomic locations: the left subclavia artery, the carina and the celiac artery. True lumen index (true lumen/total aortic diameter, goal=1) was calculated to evaluate the impact of reintervention on remodeling of the descending aorta. Results: The median patient age was 44 years old (range, 34 -78years), and 14 of the 15 patients were male. Indications were complicated Stanford B dissection with inadequate proximal landing zone. There were no death, stroke or spinal cord injury happened. All the cases were deployed Medtronic Valiant stent. Mean operatiion time was 109 43 minutes. Mean duration of hospital stay was 7 3 days (range, 3-10 days). During follow up, no postoperative complications occurred, all target vessels remained patent and no fenestration-related endoleak. False lumen was absorbed at left subclavia artery level, carina level in all patients. True lumen index increased significantly at the level of celiac artery (P < 0.05).Conclusions: Surgeon-modified fenestrated endograft could be a good alternative for patients with complicated Stanford B dissection with unfavorable proximal landing zones, when patients are in urgent condition.


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