Fenestrated Stent For Arch Repair For Acute Stanford Type A Aortic Dissection - A Conservative Solution For Complex Condition
Jun Pan, Qing Zhou, Hailong Cao, Fudong Fan, Yunxing Xue, Dongjin Wang
Nanjing Drum Tower Hospital, Nanjing, China
Background: The best surgical strategy for acute Stanford type A aortic dissection (aTAAD) involving the arch is controversial. We have used a novel method that antegrade implanting a previously fenestrated stent for arch repair, which have revealed acceptable results. Methods: From December 2014 to December 2016, 81 aTAAD patients (52 male, 29 female) underwent ascending aorta replacement and fenestrated stent graft implantation. The fenestrated stent graft was implanted into the true lumen of aortic arch during the hypothermia circulation arrest period. The proximal descending aorta with the fenestration opening at the ostia of three head vessels in the arch. The proximal end of the stent graft was anastomosed to the distal end of the Dacron tube graft that replaced the proximal ascending aorta. All patients had contrast enhanced computed tomography angiography before discharge and during follow up. Results: The cardiopulmonary bypass time was 213 ± 49 minutes, aortic cross-clamp time was 133 ± 39 minutes, and selective cerebral perfusion and lower body arrest time was 27 ± 8 minutes. There were 5 in-hospital deaths due to circulation failure, multiple organ dysfunction and pulmonary infection (with the mortality of 6.2%). 5 patients died during follow-up period, the main causes of follow-up mortality were cerebral events and aortic rupture. The surviving patients had contrast enhanced CT scans in the 3rd, 6th, and 12th months. The morbidity of complication of endoleak from supraarch vessels was 5.6% (4/71), but all 4 patients were under follow-up without intervention because no dilation were discovered. The flow up CT revealed increasing false lumen thrombosis. Conclusion: In patients with aTADD, the previously fenestrated stent graft results in excellent aortic remodeling of the aortic arch and descending aorta without increasing morbidity and mortality. The risk of endoleak is maybe the underlying complication. But it will be a conservative solution for arch repair in aTAAD, especially concomitant with severe conditions.
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