International Society For Minimally Invasive Cardiothoracic Surgery

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Open Repair Following Failed Tevar Of An Acute Type A Aortic Dissection
Grayson H. Wheatley, III, MD1, Corbin Muetterties, MD2.
1TriStar Centennial Medical Center, Nashville, TN, USA, 2UCLA Medical Center, Los Angeles, CA, USA.

OBJECTIVE: Successful endovascular repair of acute Type A aortic dissections have been reported in a number of case reports. Limited information is available regarding the feasability of performing an open surgical conversion following unsuccessful endovascular repair of the ascending aorta. We demonstrate our technique for surgical explantation of an ascending aortic stent-graft in the setting of an expanding false lumen resulting from incomplete endovascular repair of a Type A aortic dissection.
METHODS: An 80 year-old female who presented with an acute type A aortic dissection was initially treated with an endovascular aortic stent-graft. Three months later, she developed an asymptomatic, expanding false lumen of the ascending aorta and required elective open surgical conversion. Patient consent for filming the surgical procedure was obtained, as was institutional IRB approval.
RESULTS: An 80-year-old female presented with an acute, focal Type A aortic dissection with isolated intramural hematoma of the ascending aorta. She was successfully treated with an ascending aortic stent-graft delivered via a right axillary approach. She recovered fully and a routine 3 month surveillance computed tomography scan demonstrated an expanding 6.5cm ascending aorta with antegrade flow into the false lumen. Although she was asymptomatic, she underwent elective surgical conversion where the ascending aortic stent was removed and a standard aortic root replacement with a bio-Bentall and hemi-arch repair was performed using standard central cannulation techniques. She recovered uneventfully.
CONCLUSIONS: Optimal patient selection for endovascular repair of Type A aortic dissections depends on several clinical and anatomic factors. Regardless, open surgical conversions will be necessary to treat patients that fail an endovascular approach. We demonstrate that patients treated with an ascending aortic stent can be successfully converted and that open surgical repair remains a viable option.


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