Total aortic arch reconstruction with open placement of triple-branched stent graft for Stanford type A aortic dissection
10.3760/cma.j.issn.1001-4497.2011.06.005
- VernacularTitle:升主动脉替换联合三分支支架血管术中置入治疗急性A型主动脉夹层
- Author:
Liangwan CHEN
;
Lin LU
;
Xiaofu DAI
;
Zhaowei YANG
;
Guican ZHANG
;
Hua CAO
;
Guofeng YANG
;
Yi DONG
- Publication Type:Journal Article
- Keywords:
Aneurysm,dissecting;
Blood vessel prosthesis;
Stents;
Aorta,thoracic
- From:
Chinese Journal of Thoracic and Cardiovascular Surgery
2011;27(6):334-337
- CountryChina
- Language:Chinese
-
Abstract:
Objective To report the primary experience of open placement of triple-branched stent graft for acute Stanford type A aortic dissection. Methods Between June 2008 and September 2009, 20 well-selected patients with acute Stanford type A aortic dissection underwent open placement of triple-branched stent graft for total arch reconstruction. When core cooling to a 20℃ nasophageal temperature, perfusion to the lower body was discontinued and the ascending aorta was transected at the base of the innominate artery. Through a transverse incision, the triple-branched stent graft was inserted into the true lumen of the arch and descending aorta, and each side arm of the stent graft was positioned one by one into the arch branches.The transected stump of the ascending aorta was reconstructed by inner proximal stent-free dacron tube of the main graft and outer teflon felt, and subsequently continuous anastomosis to the 1-branched dacron tube graft was made. Results Open placement of triple-branched stent graft was technically successful in all patients. The mean cardiopulmonary bypass time, aortic cross-clamp time and lower body arrest time were (163.2 ±19.2) min, (89.4 ±10.0) min and (32. 7 ±6. 6)min, respectively. Transient postoperative neurological dysfunction was observed in 1 patient and acute renal failure in 1 patient. All patients were discharged from the hospital. Their computed tomographic scans at 3 months postoperatively showed that all stent grafts were fully opened without distortion. In the vascular stent implantation site the dissected false lumen was eliminated. The false lumen of the descending aorta distal to the stent graft was closed with thrombus in 16 cases. Conclusion Open placement of triple-branched stent graft is a new effective technique for total arch reconstruction in acute type A aortic dissection. Patients have the indications of the extensive primary repair of the thoracic aorta without primary intimal tears in the arch may be the best candidates for this new technique. The size of the stent graft, the distances between two neighboring side arm grafts and the prevention of the intimal trauma during the placement are crucial for successful open placement of triple-branched stent graft.
