Search

Background: This study aimed to elucidate the methodology and assess the efficacy of the aortic arch inclusion technique using an artificial blood vessel in managing acute type A aortic dissection (ATAAD)., Methods: We conducted a retrospective review of 18 patients (11 males and 7 females, average age: 56.2 ± 8.6 years) diagnosed with ATAAD who underwent total aortic arch replacement (TAAR) using an artificial vascular "inclusion" between June 2020 and October 2022. During the operation, deep hypothermic circulatory arrest (DHCA) and selective antegrade cerebral perfusion (ACP) of the right axillary artery were employed for brain protection. The 'inclusion' total aortic arch replacement and stented elephant trunk (SET) surgery were performed., Results: Four patients underwent the Bentall procedure during the study, with one additional patient requiring coronary artery bypass grafting (CABG) due to significant involvement of the right coronary orifice. Three patients died during postoperative hospitalization. Other notable complications included two cases of postoperative renal failure necessitating continuous renal replacement therapy (CRRT), one case of postoperative double lower limb paraplegia, and one case of cerebral infarction resulting in unilateral impairment of the left upper limb. Eleven patients underwent computed tomography angiography (CTA) examinations of the aorta three months to one-year post-operation. The CTA results revealed thrombosis in the false lumen surrounding the aortic arch stent in seven patients and complete thrombosis of the false lumen around the descending aortic stent in eight patients. One patient had partial thrombosis of the false lumen around the descending aortic stent, and another patient's false lumen in the thoracic and abdominal aorta completely resolved after one year of follow-up., Conclusions: Incorporating vascular graft in aortic arch replacement simplifies the procedure and yields promising short-term outcomes. It achieves the aim of total arch replacement using a four-branch prosthetic graft. However, extensive sampling and thorough, prolonged follow-up observations are essential to fully evaluate the long-term results., (© 2024. The Author(s).)

Objectives: 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)., Methods: 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., Results: 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., Conclusions: 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., (Copyright © 2019 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.)

The analysis of the gained experience in treatment of patients with pathology of the arch and descending portion of the aorta is suggestive that the 'frozen elephant trunk' technique is an effective and safe method. In this connection, there is an increasing need for universal hybrid devices characterized by ease of use and durability in various aortic pathologies. Discussed in the article is the state of the art of the technology of treatment of patient with aortic arch pathology by means of hybrid grafts, followed by comparative analysis of currently used vascular hybrid prostheses, and although none of the hybrid grafts available worldwide is either universal or ideal, the grafts for the 'frozen elephant trunk' procedure continue to be improved, which will inevitably lead to wide implementation of this technique.

Background: Open stented elephant trunk (SET) or SET with left subclavian artery (LSCA) to left common carotid artery (LCCA) bypass is proven to a potentially alternative treatment for complicated Stanford type B aortic dissection (TBAD). In the current study, we reported our experience with ten consecutive TBAD patients who underwent open SET., Methods: Patients with complicated TBAD underwent open SET from May 2016 to November 2018 in our institution were included. Patients' clinical data were obtained from the electronic medical record system, and long-term clinical outcomes were collected by telephone interviews or outpatient interviews., Results: A total of ten patients with nine males and one female were included, and the average age was 47.3 (31-65) years. Increased D-dimer and fibrinogen degradation products were observed in all patients at admission, and two patients had renal insufficiency. The average postoperative mechanical ventilation time, length of stay in intensive care unit, and postoperative hospital length of stay were 46.9 (6.7-151.2) hours, 7.7 (4-17) days, and 15.7 (10-26) days. No postoperative death occurred. Acute kidney injury and other complications were observed, and they were recovered well when discharge. In long-term follow-up, computed tomography angiography indicated that aortas were completely well remodeled, and blood supply of the brachiocephalic trunks was normal without anastomotic complications. All patients lived well., Conclusion: SET or SET with subclavian artery correction shows satisfactory clinical outcomes, and it could be considered as an alternative treatment. Well-designed, large-scale studies with long-term follow-up are still needed.