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OBJECTIVE: Standard management for treatment of acute type A aortic dissection is open surgical repair. This technique is known to be associated with high mortality and morbidity rates, especially in octogenerians and patients with severe comorbidities.
METHODS: Two male patients, both diagnosed with an acute type A aortic dissection (Debakey II) and pericardiac tamponade, were treated with an endovascular stent graft through transapical access. Both patients were not considered candidates for open surgical repair: the first, 83 years old, due to his poor general condition, and the second, due to his comorbidities such as COPD (Gold IV), chronic renal failure, peripheral artery disease, and disabling ankylosing spondylitis. Transapical access through a mini-thoracotomy was used to decompress the pericardiac tamopnade and to place the endograft securely into the true lumen of the ascending aorta under repeated angiographies. Rapid ventricular pacing was used to reduce cardiac output during endograft-deployment.
RESULTS: Both patients were transferred to ICU postoperatively and were hemodynamically stable through the entire treatment period. Following stentgraft placement false lumen perfusion occluded and the entry tear was securely covered in both cases. Both patients survived. There were no malperfusion syndromes or cerebrovascular events. Postoperative CT scans showed the stentgraft in ideal position with no signs of persistent false lumen perfusion. Both patients could be discharged to rehab facilities 10 and 13 days respectively, after intervention.
CONCLUSIONS: Stent graft placement for limited dissection of the ascending aorta (Debakey II) is feasible in patients unfit for open treatment with promising short term results. This novel treatment option may play a gaining role in the future. However, long term follow-up is requested to demonstrate durable results.