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Background Type Ia endoleaks are not uncommon complications that occur after thoracic endovascular aortic repair (TEVAR). Because aortic arch vessels prevent extension of the landing zone, it is very difficult to manipulate a type Ia endoleak using an extension cuff or stent-graft, especially when the aortic arch is involved. Here, we retrospectively review our experience of surgical treatment of type Ia endoleak after TEVAR using a stented elephant trunk procedure. Methods From July 2010 to August 2016, we treated 17 patients diagnosed with a type Ia endoleak following TEVAR using stented elephant trunk procedure. The mean age of our patients was 52 ± 8 years. The mean interval between TEVAR and the open surgical repair was 38 ± 43 months. Results All cases of type Ia endoleak (100%) were repaired successfully. There were no in-hospital deaths. One case required reintubation and continuous renal replacement therapy due to renal failure; this patient recovered smoothly before discharge. One other patient suffered a stroke and renal failure and did not fully recover following discharge, or follow-up. During follow-up, there were 3 deaths. Conclusions Acceptable results were obtained using a stented elephant trunk procedure in patients with a type Ia endoleak after TEVAR. This technique allowed us to repair the proximal aortic arch lesions, surgically correct the type Ia endoleak, and promote false lumen thrombosis in the distal aorta. Implantation of a stented elephant trunk, with or without a concomitant aortic arch procedure, is an alternative approach for this type of lesion. [ABSTRACT FROM AUTHOR]

To compare early and mid-term outcomes between David reimplantation and the Bentall procedure with simultaneous total arch replacement (TAR) and stented elephant trunk (SET) implantation in acute type A aortic dissection (ATAAD). From January 2012 to June 2018, 148 patients underwent aortic root replacement combined with TAR and SET for ATAAD. Patients were evaluated retrospectively and categorized into David reimplantation (n = 55) and Bentall procedure (n = 93) groups. Propensity-matched analysis was performed to compare in-hospital and follow-up adverse events between the 2 groups. In-hospital mortality and the incidence of major perioperative complications were comparable between the 2 groups (all P >.05). No significant difference in mean cardiopulmonary bypass time and circulatory arrest time was found between the 2 groups, although mean crossclamp time was longer in the David group (P =.02). During a follow-up period of 2.6 (interquartile range, 1.5-4.3) years, the Bentall group experienced rates of paravalvular leakage and prosthetic valve endocarditis of 2.3% and 2.3%, respectively, whereas the David group experienced rates of infective endocarditis and recurrent moderate aortic regurgitation of 1.9% and 1.9%, respectively. The overall survival was 82.9% for the David group and 89.2% for the Bentall group (P =.63), whereas the incidence of major cardiovascular-related events was 21.3% and 17.3% (P =.30) 5 years postoperatively. For Chinese patients undergoing ATAAD, David reimplantation provided similar outcomes compared with the Bentall procedure, with simultaneous TAR and SET. David reimplantation is an appealing option for patients who suffer root ectasia or extensive sinus damage albeit normal leaflets. From January 2012 to June 2018, 148 patients underwent aortic root replacement combined with TAR and SET for ATAAD. Patients were evaluated retrospectively and categorized into David reimplantation (n = 55) and Bentall procedure (n = 93) groups. After being propensity matched, 36 patients in each group were identified with similar baseline characteristics. During follow-up, the overall survival (82.9% in the David group vs 89.2% in the Bentall group, P =.63) and freedom from valve-event (96.3% in the David group vs 94.5% in the Bentall group, P =.34) were similar between the 2 groups. The results were similar between 2 matched groups as well. [Display omitted] [ABSTRACT FROM AUTHOR]