Treatment of Stanford Type A Aortic Dissection with “Modified” Ascending Aorta and Hemiarch Replacement Combined with Stent-graft Elephant Trunk Technique_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

GU Tianxiang , YU Yang , SHI Enyi

（Department of Cardiac Surgery， First Affiliated Hospital of China Medical University，Shenyang 110001， P. R. China;;
Email： cmugtx@sina. com）;

Corresponding author：

Keywords：

Aortic dissection; Stanford A type; Hemiarch; Modified

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Abstract： Objective To summarize and evaluate the clinical effect of “modified” ascending aorta and hemiarch replacement combined with stent-graft elephant trunk technique, a new surgical approach for patients with Stanford type A aortic dissection. Methods Between December 2009 and January 2011, the “modified” ascending aorta and hemiarch replacement combined with stent-graft elephant trunk technique was performed to a total of 47 patients suffering from Stanford type A aortic dissection in the First Affiliated Hospital of China Medical University. There were 35 male patients and 12 female patients. Their mean age was（57.9±16.0）years （ranging from 29 to 86 years）. Preoperative computedtomography angiography（CTA） imaging was analyzed using three-dimensional （3D） reconstruction to clarify their diagnosis.All these patients underwent their procedures under cardiopulmonary bypass（CPB）, hypothermic circulatory arrestand right axilary artery cannulation for selected cerebral perfusion. The treatment of proximal end to heart included： ascending aorta replacement in 29 patients, Bentall procedure in 11 patients, Wheat procedure in 4 patients, and David procedure in 3 patients. Five patients underwent concomitant coronary artery bypass grafting. Results Their average CPB time was （136±32） min, average aortic cross-clamp time was （97±28） min, and average selected cerebral perfusion and
lower body arrest time was （27±11） min. The in-hospital mortality was （4.25% , 2/47）. Postoperatively, two patients had transient neurological disorder, 1 patient had irreversible paraplegia, and 4 patients underwent reoperations for bleeding. All the 45 surviving patients underwent 3D CTA before discharge and 6 months after operation. The stented elephanttrunk-elastic metal stent were all well exhibited in the true lumen of the descending aorta, and the true lumens distal to the stent graft were also significantly enlarged compared with their preoperative diameters（P ＜ 0.05）. All the patients were followed up from 1 to 13 months. There was no aneurysm rupture and no reoperation related to residual dissected aorta was
carried out during follow-up. Conclusions “Modified” ascending aorta and hemiarch replacement combined with stentgraftelephant trunk technique is a safe and effective approach to treat patients with Stanford type A aortic dissection without involvement of 3 vessels of the arch. The main advantage of this approach is to simplify the surgical procedure, shorten the procedure time and CPB time, and reduce morbidity with a satisfying short-term result.

Citation： GU Tianxiang,YU Yang,SHI Enyi,et al .. Treatment of Stanford Type A Aortic Dissection with “Modified” Ascending Aorta and Hemiarch Replacement Combined with Stent-graft Elephant Trunk Technique. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2012, 19(1): 4-7. doi: Copy

1.	Mészáros I, Mórocz J, Szlávi J, et al. Epidemiology and clinicopathology of aortic dissection. Chest, 2000, 117（5）：1271-1278.
2.	廖明芳, 景在平. 胸主动脉夹层病因研究进展. 中华普通外科杂志, 2005, 20（9）：606-608.
3.	DeBakey ME, McCollum CH, Crawford ES, et al. Dissection and dissecting aneurysms of the aorta： twenty-year follow-up of five hundred twenty-seven patients treated surgically.Surgey, 1982, 92（6）：1118-1134.
4.	孙立忠, 刘志刚, 常谦, 等．主动脉弓替换加支架“象鼻”手术治疗Stanford A型主动脉夹层．中华外科杂志, 2004, 42（13）：812-816．.
5.	赵鑫, 常谦, 朱俊明, 等. 术后CT评价支架象鼻手术治疗慢性Ⅰ型主动脉夹层的降主动脉重塑效果.中华医学杂志, 2010,90（12）：830-833.
6.	David TE, Armstrong S, lvanov J, et al．Surgery for acute type A aortic dissection．Ann Thorac Surg, 1999, 67（6）：1999-2001.
7.	DeBakey ME, Cooley DA, Creech O Jr．Surgical treatment of aneurysms and occlusive disease of the aorta．Postgrad Med, 1954, 15（2）：120-127．.
8.	Bernard Y, Zimmermann H, Chocron S, et al. False lumen patency as a predictor of late outcome in aortic dissection. Am J Cardiol， 2001, 87（12）：1378-1382.
9.	Svensson LG, Crawford ES, Hess KR, et al. Dissection of the aorta and dissecting aortic aneurysms lmproving early and long-term surgical results. Circulation, 1990, 82（5 Suppl IV）：IV24-38.
10.	Rizzo RJ, Aranki SF, Aklog L, et al. Rapid noninvasive diagnosis and surgical repair of acute ascending aortic dissection.lmproved survival with less angiography. J Thorac Cardiovasc Surg, 1994, 108（3）：567-575.
11.	Lytle BW, Mahfood SS, Cosgrove DM, et al. Replacement of the ascending aorta：Early and late results. J Thorac Cardiovasc Surg, 1990, 99（4）：651-658.
12.	Sun LZ, Qi RD, Chang Q, et al. Surgery for acute type A dissection using total arch replacement combined with stented elephant trunk implantation experience with 107 patients. J Thorac Cardiovasc Surg, 2009, 138（6）：1358-1362.
13.	Bakaeen FG, Chu D, Huh J, et al. Outcomes of circulatory arrest procedures for the treatment of thoracic aortic disease at a veterans facility. Am J Surg, 2010, 200（5）：581-584.
14.	Heinemann M, Laas J, Jurmann M, et al. Surgery extended into theaortic arch in acute type A dissection. Indications, techniques, and results. Circulation, 1991, 84（5 Suppl）：III 25-30.
15.	Kirklin JW, Kouchoukos NT. When and how to include arch repair in patients with acute dissections involving the ascending aorta. Semin Thorac Cardiovasc Surg, 1993, 5（1）：27-32.
16.	Hirotani T, Kameda T, Kumamoto T, et al. Results of a total aorticarch replacement for an acute aortic arch dissection. J Thorac Cardiovasc Surg, 2000, 120（4）：686-691.

1. 　Mészáros I, Mórocz J, Szlávi J, et al. Epidemiology and clinicopathology of aortic dissection. Chest, 2000, 117（5）：1271-1278.
2. 　廖明芳, 景在平. 胸主动脉夹层病因研究进展. 中华普通外科杂志, 2005, 20（9）：606-608.
3. 　DeBakey ME, McCollum CH, Crawford ES, et al. Dissection and dissecting aneurysms of the aorta： twenty-year follow-up of five hundred twenty-seven patients treated surgically.Surgey, 1982, 92（6）：1118-1134.
4. 　孙立忠, 刘志刚, 常谦, 等．主动脉弓替换加支架“象鼻”手术治疗Stanford A型主动脉夹层．中华外科杂志, 2004, 42（13）：812-816．.
5. 　赵鑫, 常谦, 朱俊明, 等. 术后CT评价支架象鼻手术治疗慢性Ⅰ型主动脉夹层的降主动脉重塑效果.中华医学杂志, 2010,90（12）：830-833.
6. 　David TE, Armstrong S, lvanov J, et al．Surgery for acute type A aortic dissection．Ann Thorac Surg, 1999, 67（6）：1999-2001.
7. 　DeBakey ME, Cooley DA, Creech O Jr．Surgical treatment of aneurysms and occlusive disease of the aorta．Postgrad Med, 1954, 15（2）：120-127．.
8. 　Bernard Y, Zimmermann H, Chocron S, et al. False lumen patency as a predictor of late outcome in aortic dissection. Am J Cardiol， 2001, 87（12）：1378-1382.
9. 　Svensson LG, Crawford ES, Hess KR, et al. Dissection of the aorta and dissecting aortic aneurysms lmproving early and long-term surgical results. Circulation, 1990, 82（5 Suppl IV）：IV24-38.
10. 　Rizzo RJ, Aranki SF, Aklog L, et al. Rapid noninvasive diagnosis and surgical repair of acute ascending aortic dissection.lmproved survival with less angiography. J Thorac Cardiovasc Surg, 1994, 108（3）：567-575.
11. 　Lytle BW, Mahfood SS, Cosgrove DM, et al. Replacement of the ascending aorta：Early and late results. J Thorac Cardiovasc Surg, 1990, 99（4）：651-658.
12. 　Sun LZ, Qi RD, Chang Q, et al. Surgery for acute type A dissection using total arch replacement combined with stented elephant trunk implantation experience with 107 patients. J Thorac Cardiovasc Surg, 2009, 138（6）：1358-1362.
13. 　Bakaeen FG, Chu D, Huh J, et al. Outcomes of circulatory arrest procedures for the treatment of thoracic aortic disease at a veterans facility. Am J Surg, 2010, 200（5）：581-584.
14. 　Heinemann M, Laas J, Jurmann M, et al. Surgery extended into theaortic arch in acute type A dissection. Indications, techniques, and results. Circulation, 1991, 84（5 Suppl）：III 25-30.
15. 　Kirklin JW, Kouchoukos NT. When and how to include arch repair in patients with acute dissections involving the ascending aorta. Semin Thorac Cardiovasc Surg, 1993, 5（1）：27-32.
16. 　Hirotani T, Kameda T, Kumamoto T, et al. Results of a total aorticarch replacement for an acute aortic arch dissection. J Thorac Cardiovasc Surg, 2000, 120（4）：686-691.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Treatment of Stanford Type A Aortic Dissection with “Modified” Ascending Aorta and Hemiarch Replacement Combined with Stent-graft Elephant Trunk Technique

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