Two Stage Hybrid Procedure For Stanford A Aortic Dissection
Anna G. Everding, Benigno Ferreira, Dr., Carlos A. Jimenez, Dr., Aureliano Gutierrez, Dr., Hector R. Diaz, Dr..
Instituto Cardiovascular de Minima Invasion, Zapopan, Mexico.
BACKGROUND- Stanford A aortic dissection has a mortality of up to 50% within the first 48 hours. The mortality of the conventional technique (5-20%), excludes approximately half of the patients due to their age or comorbidities. Hybrid procedures offer maximum benefit with lower surgical risk, especially for high-risk patients. METHODS- 50-year-old male with uncontrolled HTN and severe chest pain. CT shows aortic dissection Standford A, above coronary ostiums to inguinal arteries, aortic valve respected. First surgical-stage: deep hypothermic circulatory arrest (DHCA) and anterograde selective brain protection. Right axillary cannulation and 7fr sheath in the left common carotid and cannulation of the left femoral arteria with a purse-string knot and tourniquet for retrograde perfusion to abdominal structures. Aortic arch debranching and graft placement # 28 anastomosis. After femoral decannulation, we left femoral purse-string for second-stage. Second-stage (24 hours later): descending aortic endoprosthesis placed through previous left-femoral incision. RESULTS- First Stage: XCT: 102 min. CPBT: 77 min. ICU stayed: 4 days. Hospital discharged at day 7 Postop. No complications. CONCLUSIONS- Although the gold standard for extensive aortic dissection remains the Elephant Trunk technique, technological advances and their increasing experience open up poorly documented novel alternatives, which in selected patients decreases surgical risk and gives good reproducible results.
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