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Ito H, Bessho S, Shomura Y, Kato N, Kanemitsu S, Mizumoto T, Hirano K, Maze Y, Tokui T, Takao M. Long-term results of the frozen elephant trunk technique in primary chronic type B aortic dissection. Gen Thorac Cardiovasc Surg 2024:10.1007/s11748-024-02043-9. [PMID: 38822182 DOI: 10.1007/s11748-024-02043-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Accepted: 05/18/2024] [Indexed: 06/02/2024]
Abstract
OBJECTIVES The aim of this study is to analyze long-term results of the total aortic arch replacement with the frozen elephant trunk technique for primary chronic type B aortic dissection. METHODS Among 322 patients who had the frozen elephant trunk technique, 43 (13.4%) patients (median age, 64.0 years) with primary chronic type B aortic dissection were analyzed. The patients underwent surgery at a median of 27.0 months after the onset of aortic dissection. The false lumen was patent in 30 (69.8%) patients preoperatively. RESULTS Two patients suffered paraplegia and another died of cerebral infarction. Complete thrombosis of the peri-stent false lumen was achieved in 36 (83.7%) patients. Overall survival, freedom from aortic events, and freedom from aortic reintervention were 83.5%, 37.2%, and 42.2% at 5 years, respectively. Survival rates of the patients with or without aortic events were 75.0% and 95.8% at 5 years (Log-rank, p = 0.22). Late aortic events occurred in 19 (44.2%) patients including distal stent graft-induced new entry, type Ib endoleak, and false lumen dilation. The ratio of the stent graft diameter to the preoperative short axis diameter of the true lumen (hazard ratio, 1.90; 95% confidence interval, 1.01-3.59), and the maximal diameter of a postdissection aneurysm (1.07; 1.01-1.12) were the significant multivariate risk predictors of late aortic events. CONCLUSIONS Late aortic events occurr fairly frequently, and new strategies need to be explored to enhance the effectiveness of this procedure in the future.
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Affiliation(s)
- Hisato Ito
- Department of Thoracic and Cardiovascular Surgery, Mie University Hospital, 2-174, Edobashi, Tsu, Mie, 514-8507, Japan.
| | - Saki Bessho
- Department of Thoracic and Cardiovascular Surgery, Mie University Hospital, 2-174, Edobashi, Tsu, Mie, 514-8507, Japan
| | - Yu Shomura
- Department of Thoracic and Cardiovascular Surgery, Mie University Hospital, 2-174, Edobashi, Tsu, Mie, 514-8507, Japan
| | - Noriyuki Kato
- Department of Radiology, Mie University Hospital, Tsu, Mie, Japan
| | - Shinji Kanemitsu
- Department of Cardiothoracic Surgery, Anjo Kosei Hospital, Anjo, Aichi, Japan
| | - Toru Mizumoto
- Department of Cardiothoracic Surgery, Anjo Kosei Hospital, Anjo, Aichi, Japan
| | - Koji Hirano
- Department of Thoracic and Cardiovascular Surgery, Ise Red Cross Hospital, Ise, Mie, Japan
| | - Yasumi Maze
- Department of Thoracic and Cardiovascular Surgery, Ise Red Cross Hospital, Ise, Mie, Japan
| | - Toshiya Tokui
- Department of Thoracic and Cardiovascular Surgery, Ise Red Cross Hospital, Ise, Mie, Japan
| | - Motoshi Takao
- Department of Thoracic and Cardiovascular Surgery, Mie University Hospital, 2-174, Edobashi, Tsu, Mie, 514-8507, Japan
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Charchyan ER, Breshenkov DG, Belov YV. [Hybrid aortic repair in patients with type III aortic dissection and concomitant proximal aortic lesion]. Khirurgiia (Mosk) 2020:28-37. [PMID: 33029999 DOI: 10.17116/hirurgia202009128] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To report our own experience of hybrid treatment using FET technique in patients with type A aortic dissection and concomitant lesion of aortic arch and ascending aorta. MATERIAL AND METHODS There were 90 (28,3%) FET procedures for the period from January 2010 to August 2019. Type B aortic dissection was diagnosed in 19 (45,2%) patients. Type B aortic dissection combined with aortic arch aneurysm occurred in 11 (58%) cases, ascending aorta aneurysm - 15 (79%) cases. Patients underwent total arch and ascending aorta replacement via median sternotomy (upper partial J-shaped sternotomy in 3 cases). Valve-sparing interventions were performed in 58% of cases (aortic root repair - 6 (32%) patients, David procedure - 5 (26%) cases). Intraoperative features, early postoperative morbidity and in-hospital mortality were retrospectively analyzed. In long-term period, distal aortic remodeling, survival rate and incidence of redo interventions were evaluated. RESULTS Mean CPB time was 166±27 min, aortic cross-clamping time - 93±23 min, duration of circulatory arrest - 43±11 min. Neurological complications and paraplegia were absent. In-hospital mortality was absent. Reversible acute renal failure without need for hemodialysis developed in 2 cases (11%). Two patients underwent repeated intervention (TEVAR) due to dSINE and negative aortic remodeling. Annual survival rate was 100%. Freedom from redo aortic surgery was 89,5%. CONCLUSION FET surgery is an adequate alternative treatment for type B aortic dissection combined with lesion of aortic arch and ascending aorta. This approach ensures a one-stage repair in patients with contraindications to TEVAR. Unlike thoracotomy, FET procedure is valuable for simultaneous correction of cardiac and proximal aortic lesion, stabilizing the distal segments of dissected aorta. This is obvious advantage of this technique.
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Affiliation(s)
- E R Charchyan
- Petrovsky National Research Centre of Surgery, Moscow, Russia
| | - D G Breshenkov
- Petrovsky National Research Centre of Surgery, Moscow, Russia
| | - Yu V Belov
- Petrovsky National Research Centre of Surgery, Moscow, Russia
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Kanaoka Y, Ohki T, Maeda K, Shukuzawa K, Baba T, Tezuka M, Omori M, Hara M, Takizawa R, Tachihara H. Outcomes of Chimney Thoracic Endovascular Aortic Repair for an Aortic Arch Aneurysm. Ann Vasc Surg 2020; 66:212-219. [DOI: 10.1016/j.avsg.2018.12.087] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 11/23/2018] [Accepted: 12/20/2018] [Indexed: 10/27/2022]
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Settepani F, Cappai A, Basciu A, Barbone A, Citterio E, Ornaghi D, Tarelli G. Hybrid Versus Conventional Treatment of Acute Type A Aortic Dissection. J Card Surg 2015. [DOI: 10.1111/jocs.12598] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Fabrizio Settepani
- Department of Cardiac Surgery; Humanitas Clinical and Research Center; Rozzano, Milano Italy
| | - Antioco Cappai
- Department of Cardiac Surgery; Humanitas Clinical and Research Center; Rozzano, Milano Italy
| | - Alessio Basciu
- Department of Cardiac Surgery; Humanitas Clinical and Research Center; Rozzano, Milano Italy
| | - Alessandro Barbone
- Department of Cardiac Surgery; Humanitas Clinical and Research Center; Rozzano, Milano Italy
| | - Enrico Citterio
- Department of Cardiac Surgery; Humanitas Clinical and Research Center; Rozzano, Milano Italy
| | - Diego Ornaghi
- Department of Cardiac Surgery; Humanitas Clinical and Research Center; Rozzano, Milano Italy
| | - Giuseppe Tarelli
- Department of Cardiac Surgery; Humanitas Clinical and Research Center; Rozzano, Milano Italy
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Katayama K, Uchida N, Katayama A, Takahashi S, Takasaki T, Kurosaki T, Imai K, Sueda T. Multiple factors predict the risk of spinal cord injury after the frozen elephant trunk technique for extended thoracic aortic disease. Eur J Cardiothorac Surg 2014; 47:616-20. [DOI: 10.1093/ejcts/ezu243] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Weiss G, Tsagakis K, Jakob H, Di Bartolomeo R, Pacini D, Barberio G, Mascaro J, Mestres CA, Sioris T, Grabenwoger M. The frozen elephant trunk technique for the treatment of complicated type B aortic dissection with involvement of the aortic arch: multicentre early experience†. Eur J Cardiothorac Surg 2014; 47:106-14; discussion 114. [DOI: 10.1093/ejcts/ezu067] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Transaortic stent grafting of a Kommerell diverticulum arising from a right-sided aortic arch. Ann Vasc Surg 2013; 28:1037.e15-9. [PMID: 24333523 DOI: 10.1016/j.avsg.2013.08.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2013] [Revised: 07/13/2013] [Accepted: 08/13/2013] [Indexed: 11/21/2022]
Abstract
In this article, we report the case of a 68-year-old woman who presented with shortness of breath. Respiratory function tests showed a slightly obstructive physiology. Computed tomography (CT) results revealed an aberrant left subclavian artery and a Kommerell diverticulum arising from a right-sided aortic arch that was compressing the trachea and the surrounding tissues. A median sternotomy was performed with the patient under circulatory arrest with moderate hypothermia, and a transaortic stent graft was inserted to exclude the Kommerell diverticulum. The aberrant left subclavian artery was ligated and an axillo-axillar bypass was constructed. Postoperative CT showed complete exclusion of the Kommerell diverticulum without an endoleak. The patient's breathing difficulty was resolved, and she was discharged uneventfully. This procedure should be considered as an alternative strategy for exclusion of Kommerell diverticulum.
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Holubec T, Raupach J, Dominik J, Vojácek J. "Elephant trunk" and endovascular stentgrafting--a hybrid approach to the treatment of extensive thoracic aortic aneurysm. ACTA MEDICA (HRADEC KRÁLOVÉ) 2013; 56:80-2. [PMID: 24069662 DOI: 10.14712/18059694.2014.28] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
A hybrid approach to elephant trunk technique for treatment of thoracic aortic aneurysms combines a conventional surgical and endovascular therapy. Compared to surgery alone, there is a presumption that mortality and morbidity is reduced. We present a case report of a 42-year-old man with a giant aneurysm of the entire thoracic aorta, significant aortic and tricuspid regurgitation and ventricular septum defect. The patient underwent multiple consecutive operations and interventions having, among others, finally replaced the entire thoracic aorta with the use of the hybrid elephant trunk technique.
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Affiliation(s)
- Tomás Holubec
- Department of Cardiac Surgery, Charles University in Prague, Faculty of Medicine and University Hospital, Hradec Králové, Czech Republic.
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Uchida N. Open stent grafting for complex diseases of the thoracic aorta: clinical utility. Gen Thorac Cardiovasc Surg 2012; 61:118-26. [PMID: 23054614 PMCID: PMC3589658 DOI: 10.1007/s11748-012-0151-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2012] [Indexed: 11/02/2022]
Abstract
Open stent grafting is an alternative treatment for extensive thoracic aortic replacement. However, this procedure is associated with a high incidence of spinal cord injury, which has limited its application. Multiple factors have been suggested to explain the risk of spinal cord injury, including deep delivery of the stent graft, history of operation of the downstream aorta, and postoperative low blood pressure. Cerebrospinal fluid drainage or a hybrid operation in combination with trans-femoral thoracic stent grafting is useful for preventing spinal cord injury. Open stent grafting remains an alternative treatment for atherosclerotic aneurysms with dilatation of the ascending aorta. Open stent grafting for acute aortic dissection is effective for remodeling of the false lumen. The graft diameter for aortic dissection should be 90 % of the total diameter of the aorta, and the distal landing zone should be limited to the T7 vertebral level to prevent new intimal tears or spinal cord injury. Open stent grafting seems a feasible bailout strategy for the treatment of retrograde aortic dissection after TEVAR for type B aortic dissection. Newly designed devices for open stent grafts include the Matsui-Kitamura stent graft or branched open stent graft, which is produced in Japan. The effectiveness of open stent grafting in the treatment of Marfan syndrome remains unclear. A commercially available device for open stent grafting would be desired in Japan. In conclusion, an open stent graft remains an alternative treatment for complex thoracic aortic pathologies.
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Affiliation(s)
- Naomichi Uchida
- Division of Surgery, Graduate School of Biomedical Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-Ku, Hiroshima, 734-8551, Japan.
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Shimamura J, Kubota H, Endo H, Tsuchiya H, Kawashima N, Sudo K. Three-dimensional replica of a life-sized model of aortic arch aneurysm for preoperative assessments. Ann Thorac Surg 2012; 93:1699-702. [PMID: 22541200 DOI: 10.1016/j.athoracsur.2012.01.072] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2011] [Revised: 01/19/2012] [Accepted: 01/23/2012] [Indexed: 11/15/2022]
Abstract
PURPOSE In the treatment of extended distal aortic arch aneurysms with open stent grafting, detailed preoperative minute evaluation is essential to determine the optimal operative strategy and reduce the incidence of complications. We describe a three-dimensional replica of a life-sized aortic arch aneurysm model for aiding preoperative assessments. DESCRIPTION Life-sized replicas of an aortic arch aneurysm were made for 4 patients who underwent total aortic arch replacement with open stent-grafting. These replicas were used to determine the curve of the CLATE, a newly developed open stent delivery system (Senko Medical Instrument Mfg, Co, Ltd, Tokyo, Japan), and the depth of the open stent grafting. The replica and the CLATE system were also used to obtain informed consent from the patients. EVALUATION Surgeons could simulate the operative procedure precisely. Insertion of the graft was smooth in all patients. Use of the replica made it easier for the patients to understand the form and site of the aneurysm, as well as the operative procedure. CONCLUSIONS The combination of the three-dimensional replica and the CLATE system may be useful for both surgeons and patients in the treatment of extended distal aortic arch aneurysms.
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Affiliation(s)
- Junichi Shimamura
- Department of Cardiovascular Surgery, Kyorin University School of Medicine, Tokyo, Japan.
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Uchida N, Katayama A, Tamura K, Miwa S, Masatsugu K, Sueda T. New Approach for Extended Thoracic Aortic Repair: Anterolateral Thoracotomy with Partial Sternotomy. Ann Thorac Cardiovasc Surg 2012; 18:395-9. [DOI: 10.5761/atcs.nm.11.01744] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Uchida N, Katayama A, Tamura K, Sutoh M, Murao N, Kuraoka M. Early entry closure for acute type B aortic dissection by open stent grafting. Gen Thorac Cardiovasc Surg 2011; 59:329-34. [PMID: 21547626 DOI: 10.1007/s11748-010-0749-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2010] [Accepted: 11/24/2010] [Indexed: 11/29/2022]
Abstract
PURPOSE We describe the long-term efficacy of early entry closure for acute type B aortic dissection by open stent grafting based on long-term results and changes in the false lumen on enhanced computed tomography (CT). METHODS We performed open stent grafting for acute type B aortic dissection in 28 28 patients between 1998 a 2008. They included 14 patients with complicated type B aortic dissection (11 patients with limb and/or visceral ischemia and 4 patients with impending rupture). Uncomplicated type B aortic dissection was present in 14 patients, including 4 patients with an ulcer-like projection and 10 patients who had stable dissection with a patent false lumen. RESULTS Two patients who had the ischemic type died within 30 days. Postoperative complications occurred in two patients, including one case of paraplegia and one of mediastinitis. Two more deaths occurred during a median follow-up period of 45 months (range 6-114 months), with one related to open stent-graft infection and one due to pneumonia. The overall survival rate 5 years after open stent grafting was 77%. According to follow-up by CT, the false lumen was completely thrombosed and obliterated in all 26 patients with stent grafts. CONCLUSION Early entry closure for both complicated and uncomplicated acute type B aortic dissection with an open stent graft has an acceptable early outcome and provides a high aortic remodeling rate.
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Affiliation(s)
- Naomichi Uchida
- Division of Cardiovascular Surgery, Hiroshima Asa General Hospital, 2-1-1 Kabe-minami, Asa-kita-ku, Hiroshima 731-0293, Japan.
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Chen X, Huang F, Xu M, Wang L, Jiang Y, Xiao L, Chen X, Qiu Z. The stented elephant trunk procedure combined total arch replacement for Debakey I aortic dissection: operative result and follow-up. Interact Cardiovasc Thorac Surg 2010; 11:594-8. [PMID: 20716557 DOI: 10.1510/icvts.2010.238212] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Xin Chen
- Department of Thoracic and Cardiovascular Surgery, Nanjing Cardiovascular Disease Research Institute, Nanjing First Hospital Affiliated to Nanjing Medical University, 68 Changle Road, Nanjing 210006, China.
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Long-term results of the frozen elephant trunk technique for extended aortic arch disease. Eur J Cardiothorac Surg 2010; 37:1338-45. [PMID: 20303777 DOI: 10.1016/j.ejcts.2010.01.007] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2009] [Revised: 12/28/2009] [Accepted: 01/05/2010] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES This study describes the long-term safety and effectiveness of extended aortic arch replacement with the frozen elephant trunk technique from our 12 years of experience. METHODS Between September 1997 and September 2008, 156 patients (mean age 67.9 years) with different pathologies from the aortic arch to the extended descending aorta in 100 dissections (acute A/acute B/chronic B=66/26/8) and 56 thoracic arteriosclerotic aneurysms (TAAs) had the frozen elephant technique performed upon them. During moderate hypothermic circulation with selective cerebral perfusion, the stent graft was inserted through the transected proximal aortic arch with trans-oesophageal echo guidance. RESULTS Six patients (3.2%) (acute A/acute B/chronic B/TAA=3/2/0/1) died in hospital. Postoperative morbidity induced four (2.6%) strokes (acute A/acute B/chronic B/TAA=2/0/0/2) and three (2.0%) spinal injuries (paraplegia in two and transient paraparesis in one) (acute A/acute B/chronic B/TAA=0/0/1/2). In the long-term follow-up (mean 63.3 + or - 39.2 months, maximum 144 months) 16 patients died. The survival rate was 99.3%, 86.5% and 74.9% at 1, 5 and 10 years, respectively. An additional operation was performed in 15 (9.4%) (ascending aorta/aortic root/descending aorta/abdominal aorta=1/2/5/7) including three stent-graft-related events (2.1%), and the additional repair proved successful. A follow-up computed tomography (CT) image was available for 96.0% (143/149) of patients who survived longer than 12 months. The size of false lumen or aneurysm increased in four patients, was unchanged in 20 patients (14.0%), shrank in 66 (46.2%) and was completely obliterated in 55 (37.1%). CONCLUSIONS The frozen elephant technique could be an attractive treatment for extended aortic arch disease to the extended descending aorta for acute aortic dissection as well as arteriosclerotic aneurysm.
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Long-term results of the frozen elephant trunk technique for the extensive arteriosclerotic aneurysm. J Thorac Cardiovasc Surg 2009; 139:913-7. [PMID: 19909997 DOI: 10.1016/j.jtcvs.2009.08.018] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2008] [Revised: 05/09/2009] [Accepted: 08/10/2009] [Indexed: 11/24/2022]
Abstract
OBJECTIVES The objective of this report is to elucidate the feasibility of the frozen elephant trunk technique as a one-stage operation for extensive arteriosclerotic aneurysms and to investigate the long-term durability and efficacy of this procedure from our 11 years of experience. METHODS The subjects were 58 consecutive patients who electively received the frozen elephant trunk technique for arteriosclerotic aneurysms involving the aortic arch and the descending aorta between September 1997 and September 2008. Concomitant procedures included 15 coronary artery bypass grafts, 2 aortic valve replacements, 1 aortic root replacement, and 3 maze procedures. The stent graft was delivered to the seventh thoracic vertebra level (Th7) in 22, Th8 in 26, Th9 in 8, and Th10 in 2 patients. Cerebrospinal fluid drainage was administered preoperatively in 10 (17.2%) patients. RESULTS Operative mortality within 30 days was 0 of 58. There was 1 in-hospital death. Perioperative morbidity included strokes and spinal cord injury in 2 (3.4%) patients each. During the mean follow-up period of 54.2 +/- 36.9 months, there were 9 (15.5%) late deaths, and 7 (12.1%) patients required additional intervention. The 8-year survival was 65.5%, the overall 8-year aortic event free survival was 72.8%, and the 8-year event free survival on the site of the stent graft was 94.8%. A follow-up computed tomographic image was available for 86.2% (50/58) of patients who survived longer than 6 months. The size of the aneurysm increased in 1 (2.0%) patient, was not changed in 6 (12.0%) patients, shrank in 34 (68.0%) patients, and was obliterated in 9 (18.0%) patients. CONCLUSIONS The frozen elephant trunk for extensive aortic aneurysms had long-term durability and efficacy and might become the alternative treatment for extended aortic replacement.
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Uchida N, Shibamura H, Katayama A, Shimada N, Sutoh M, Ishihara H. Operative Strategy for Acute Type A Aortic Dissection: Ascending Aortic or Hemiarch Versus Total Arch Replacement With Frozen Elephant Trunk. Ann Thorac Surg 2009; 87:773-7. [DOI: 10.1016/j.athoracsur.2008.11.061] [Citation(s) in RCA: 131] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2008] [Revised: 11/20/2008] [Accepted: 11/21/2008] [Indexed: 11/16/2022]
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Yamada K, Mochizuki T, Tsubota H, Funamoto M. Early and midterm outcomes of open stent-graft treatment for distal aortic arch aneurysm. Gen Thorac Cardiovasc Surg 2008; 56:490-7. [DOI: 10.1007/s11748-008-0289-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2007] [Accepted: 06/16/2008] [Indexed: 11/30/2022]
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Fully supported open stent grafting applied with a Matsui-Kitamura (MK) stent in treatment of distal arch aneurysm. Gen Thorac Cardiovasc Surg 2008; 56:209-14. [DOI: 10.1007/s11748-007-0223-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2007] [Accepted: 12/25/2007] [Indexed: 11/26/2022]
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Uchida N, Ishihara H, Shibamura H, Kyo Y, Ozawa M. Midterm results of extensive primary repair of the thoracic aorta by means of total arch replacement with open stent graft placement for an acute type A aortic dissection. J Thorac Cardiovasc Surg 2006; 131:862-7. [PMID: 16580445 DOI: 10.1016/j.jtcvs.2005.08.061] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2005] [Revised: 08/24/2005] [Accepted: 08/30/2005] [Indexed: 11/22/2022]
Abstract
OBJECTIVES We sought to describe the midterm results of extensive primary repair of the thoracic aorta by means of the modified elephant trunk technique with a stent graft for acute type A aortic dissection, particularly the changes of the false lumen shown by enhanced computed tomographic scanning. METHODS The subjects were 35 consecutive patients who received arch replacement with open stent grafting for type A acute aortic dissection between December 1997 and April 2002. The mean follow-up period was 55 months (range, 30-83 months). Computed tomographic scanning was performed at 1, 3, 12, and 36 months postoperatively to detect thrombosis and obliteration of the false lumen after its exclusion by the stent graft. The diameter of the aorta was measured at 3 levels: the distal edge of the stent graft, the diaphragm, and the origin of the superior mesenteric artery. RESULTS Two patients died in the initial operation, but no patients required additional surgical treatment of the thoracic aorta. The mean diameter of the stent grafts was 26.2 mm, and the mean length was 8.9 cm. Thrombus formation in the false lumen was recognized at the distal edge of the graft in all patients, at the diaphragmatic level in 26 patients, and at the superior mesenteric artery level in 15 patients. Obliteration of the false lumen was recognized at the distal edge of the graft in all patients, at the diaphragmatic level in 20 patients, and at the superior mesenteric artery level in 15 patients. The aorta distal to the stent graft showed minimal changes. CONCLUSIONS In patients with acute type A aortic dissections, it is possible to perform extensive primary repair of the thoracic aorta with relative safety by using a synthetic graft with a self-expanding stent, and this method might reduce the necessity of further operations not only for the distal descending aorta but also for the thoracoabdominal aorta.
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Affiliation(s)
- Naomichi Uchida
- Division of Cardiovascular Surgery, Hiroshima-city Asa General Hospital, Hiroshima, Japan.
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Flores J, Kunihara T, Shiiya N, Yoshimoto K, Matsuzaki K, Yasuda K. Extensive deployment of the stented elephant trunk is associated with an increased risk of spinal cord injury. J Thorac Cardiovasc Surg 2006; 131:336-42. [PMID: 16434262 DOI: 10.1016/j.jtcvs.2005.09.050] [Citation(s) in RCA: 140] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2005] [Revised: 09/02/2005] [Accepted: 09/15/2005] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Thoracic aortic aneurysm repair with the stented elephant trunk technique seems to be associated with an increased risk of spinal cord injury. We investigated whether severe atherosclerosis of the distal landing zone or extensive deployment of the stented elephant trunk is associated with increased risk of spinal cord injury. METHODS Twenty-five patients underwent thoracic aortic aneurysm repair with the stented elephant trunk technique. The study population included 19 men and had a mean age of 73 +/- 7 years. All patients underwent a median sternotomy with cardiopulmonary bypass and selective cerebral perfusion. The elephant trunk was fixed with a Z-stent distal to the aneurysm during hypothermic circulatory arrest. Thirteen patients underwent concomitant total aortic arch replacement. RESULTS Six (24%) patients had spinal cord injury. The presence of severe atherosclerosis at the distal landing zone demonstrated a tendency to increase the incidence of spinal cord injury (36% vs 9%, P = .1218). More distal deployment of the stented elephant trunk was significantly associated with increased risk of spinal cord injury (T8.0 +/- 0.6 vs T6.5 +/- 1.1, P = .0043). Univariate logistic regression analysis identified a history of abdominal aortic aneurysm repair (P = .0296) and the vertebral level of the distal landing zone (P = .0249) as significant independent risk factors for spinal cord injury, and only the latter was significant in multivariate analysis (P = .0396). The combination of a distal landing zone of T7 or greater and a history of abdominal aortic aneurysm repair was the strongest predictor for spinal cord injury (71% vs 6%, P = .0047). CONCLUSIONS Spinal cord injury after stented elephant trunk deployment might be related to occlusion of the excessive intercostal arteries or thromboembolism. Patients with a history of abdominal aortic aneurysm repair who require extensive deployment of the stented elephant trunk seem to be at a higher risk for spinal cord injury.
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Affiliation(s)
- Jorge Flores
- Department of Cardiovascular Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, Japan
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Chavan A, Karck M, Hagl C, Winterhalter M, Baus S, Galanski M, Haverich A. Hybrid endograft for one-step treatment of multisegment disease of the thoracic aorta. J Vasc Interv Radiol 2005; 16:823-9. [PMID: 15947046 DOI: 10.1097/01.rvi.0000159205.00299.97] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
PURPOSE At present, a two-step surgical approach is necessary to treat patients with coexistent pathologic conditions involving the proximal and descending thoracic aorta. A hybrid endograft is described here that enables such treatment during a single operation. MATERIALS AND METHODS The Chavan-Haverich endograft consists of a Dacron vascular prosthesis with stainless-steel stents affixed at its distal end. After approval by the institutional review board, the endograft was prospectively implanted in 22 patients with multisegment thoracic aortic disease (13 men, nine women; median age, 64 years). Eleven patients had type A dissections (one acute, 10 chronic), four had a chronic type B dissection, and seven had atherosclerotic aneurysms of the ascending aorta or aortic arch as well as of the descending aorta. Of these patients, 11 additionally required aortic valve replacement or coronary artery bypass grafting. Via median sternotomy, the aortic arch was opened in circulatory arrest. After antegrade deployment of the stent-containing portion in the descending aorta, the proximal non-stent-containing endograft was used to reconstruct the aortic arch. Median follow-up was 14 months. RESULTS Endograft implantation was successful in all but one patient. Complications included neurologic deficits that were transient in one case and lasting in two, two cases of vocal cord paralysis, and one death. In all patients with atherosclerotic aneurysms who received the endograft (six of seven), aneurysm thrombosis was noted at follow-up. In aortic dissections, partial or complete false-lumen thrombosis to the level of the stents occurred in all patients. None of the patients showed a progressive widening of the descending aorta. CONCLUSION The Chavan-Haverich endograft enables one-step treatment of multisegment pathologic conditions affecting the thoracic aorta that otherwise would require two or more operations.
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Affiliation(s)
- Ajay Chavan
- Department of Radiology, Hannover Medical School, Hannover, Germany.
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Shibata T, Hirai H, Fukui T, Aoyama T, Suehiro S. Assembly and Deployment of a Branched Arch Stent Graft Using the Transaortic Approach. Ann Thorac Surg 2005; 79:1790-2. [PMID: 15854989 DOI: 10.1016/j.athoracsur.2003.12.055] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/29/2003] [Indexed: 11/28/2022]
Abstract
Transaortic stent grafting is an alternative method for treating distal arch aneurysms. Total arch grafts are too bulky to be inserted into a sheath catheter during usual stent grafting methods. An assembling method that uses a chain stitch enables the deployment of any type of stent graft into the distal aorta without the need for a sheath catheter. We describe how to safely assemble and use a branched arch stent graft. We consider this method to be beneficial in selected cases involving extensive distal arch aneurysms or in patients with highly calcified aortas.
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Affiliation(s)
- Toshihiko Shibata
- Department of Cardiovascular Surgery, Osaka City University Medical School, Abeno, Osaka, Japan.
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Czermak BV, Fraedrich G, Perkmann R, Mallouhi A, Steingruber IE, Waldenberger P, Neuhauser B, Jung T, Jaschke WR. Endovascular repair of thoracic aortic disease: What we have learned. Curr Probl Diagn Radiol 2004; 33:269-82. [PMID: 15549052 DOI: 10.1067/j.cpradiol.2004.08.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Benedikt V Czermak
- Department of Radiology, Kurt Amplatz Center, University Hospital of Innsbruck, Austria.
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Pocar M, Fundarò P, Donatelli F. Simplified thoracic aortic aneurysm repair. Ann Thorac Surg 2004; 77:2199-200. [PMID: 15172303 DOI: 10.1016/s0003-4975(03)01252-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/06/2003] [Indexed: 11/27/2022]
Abstract
Descending thoracic and thoracoabdominal aortic operations still represent a challenge for the cardiovascular surgeon. In recent years, endovascular stent grafting has become a popular alternative to a conventional operation in selected patients, but is not always readily available or is technically contraindicated; also, long-term results are unknown. We describe a simplified surgical technique to secure a standard vascular prosthesis by performing a modified "elephant trunk" operation and discuss potential indications for its application.
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Affiliation(s)
- Marco Pocar
- Cattedra e Divisione di Cardiochirurgia, Università degli Studi di Milano e IRCCS Ospedale Maggiore, Milan, Italy.
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Sueda T, Orihashi K, Okada K, Sugawara Y, Imai K, Kochi K. Fate of aneurysms of the distal arch and proximal descending thoracic aorta after transaortic endovascular Stent-Grafting. Ann Thorac Surg 2003; 76:84-9; discussion 89. [PMID: 12842518 DOI: 10.1016/s0003-4975(03)00266-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND The purpose of this study was to evaluate the midterm results of transaortic stent-grafting for distal aortic arch aneurysms or proximal descending aortic aneurysms and the feasibility of this method for thoracic aortic aneurysm repair. METHODS Twenty-three patients with true distal aortic arch aneurysms or proximal descending thoracic aortic aneurysms were repaired with the stent-graft introduced through the incision on the proximal arch aorta. Follow-up computed tomography was performed every 6 months in 21 surviving patients. The maximum dimension of the excluded aneurysmal space and the maximum aneurysmal diameter were measured and evaluated to determine whether the aneurysmal space decreased or disappeared after this alternative procedure. RESULTS There was 1 hospital death (4.3%) due to cerebral embolism. Another patient died of pneumonia 1 year after surgery. Twenty-one patients (91%) survived during the follow-up period, but 1 patient (4.3%) suffered from paraplegia. The follow-up period ranged from 12 to 62 months (average, 34.3 +/- 15.2). There were no instances of aneurysmal rupture during the follow-up period. Postoperative serial computed tomography scans showed disappearance or significant shrinkage of the excluded aneurysmal space in 20 of 21 patients (95%), except for the one patient with endoluminal leakage. CONCLUSIONS Transaortic endovascular stent-grafting was an effective alternative approach to treating distal aortic arch aneurysms or proximal descending aortic aneurysms. The excluded aneurysm disappeared or shrunk after successful placement of the stent-graft.
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Affiliation(s)
- Taijiro Sueda
- Department of Cardiovascular Surgery, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan.
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Sunder-Plassmann L, Scharrer-Pamler R, Liewald F, Kapfer X, Görich J, Orend KH. Endovascular exclusion of thoracic aortic aneurysms: mid-term results of elective treatment and in contained rupture. J Card Surg 2003; 18:367-74. [PMID: 12869185 DOI: 10.1046/j.1540-8191.2003.02077.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE The purpose is to present results of endovascular exclusion (stent-graft treatment) of aneurysms of the descending thoracic aorta both in elective cases and in emergencies. METHODS Indications for stent-graft treatment were dependent on multislice angio-CT evaluation revealing a proximal neck of at least 10 mm between the left common carotid artery and the onset of aneurysm. All stent grafts were inserted in the operating room; 43 transfemoral, 2 transiliac. The stent grafts used were Corvita, Stenford, Vanguard, AneuRx, Talent, and Excluder. Deployment was achieved under fluoroscopic control, endoleaks were checked for with D S A on the operating table and postoperatively by angio-CT. Long-term follow-up consisted of evaluation with angio-CT after 6 and 12 months, and from there on once a year and with plain chest X-rays. Follow-up was achieved in all patients. RESULTS Mean follow-up is 21 months (1-66); 30-day mortality is 3/45, no permanent neurologic deficit. Thirty patients were treated electively, 15 with contained rupture. Left subclavian artery overstenting proved to be necessary in 12 patients for proper proximal sealing of the aneurysm, type I endoleaks were observed in 10 patients, one early conversion, 7 proximal extension cuffs, one sealed spontaneously, one still at risk. Among patients where LSA had been overstented only one wanted a transposition, all others did well without left-hand ischemia or subclavian steal syndrome. CONCLUSION Endovascular treatment is less invasive and has reasonable mortality and morbidity but is limited to well-defined morphologies. Mid-term results are promising but it has to be observed whether these will translate into long-term durability.
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Affiliation(s)
- L Sunder-Plassmann
- Department of Thoracic and Vascular Surgery, University of Ulm, Ulm, Germany
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Beaver TM, Martin TD. Reply. Ann Thorac Surg 2002. [DOI: 10.1016/s0003-4975(02)03939-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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