The Journal of Thoracic and Cardiovascular Surgery
Volume 138, Issue 6 , Pages 1358-1362 , December 2009

Surgery for acute type A dissection using total arch replacement combined with stented elephant trunk implantation: Experience with 107 patients

  • Li-Zhong Sun, MD

      Affiliations

    • Department of Cardiovascular Surgery, Cardiovascular Institute and Fuwai Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
    • Corresponding Author InformationAddress for reprints: Li-Zhong Sun, MD, Department of Cardiovascular Surgery, Cardiovascular Institute and Fuwai Hospital, 167 Beilishi Road, Beijing, 100037, China.
    • ,
  • Rui-Dong Qi, MD

      Affiliations

    • Department of Cardiovascular Surgery, Tianjin Cardiovascular Institute and Tianjin Chest Hospital, Tianjin, China
    • ,
  • Qian Chang, MD

      Affiliations

    • Department of Cardiovascular Surgery, Cardiovascular Institute and Fuwai Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
    • ,
  • Jun-Ming Zhu, MD

      Affiliations

    • Department of Cardiovascular Surgery, Cardiovascular Institute and Fuwai Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
    • ,
  • Yong-Min Liu, MD

      Affiliations

    • Department of Cardiovascular Surgery, Cardiovascular Institute and Fuwai Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
    • ,
  • Cun-Tao Yu, MD

      Affiliations

    • Department of Cardiovascular Surgery, Cardiovascular Institute and Fuwai Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
    • ,
  • Bin Lv, MD

      Affiliations

    • Department of Radiology, Cardiovascular Institute and Fuwai Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
    • ,
  • Jun Zheng, MD

      Affiliations

    • Department of Cardiovascular Surgery, Cardiovascular Institute and Fuwai Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
    • ,
  • Liang-Xin Tian, MD

      Affiliations

    • Department of Cardiovascular Surgery, Cardiovascular Institute and Fuwai Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
    • ,
  • Jin-Guo Lu, MD

      Affiliations

    • Department of Radiology, Cardiovascular Institute and Fuwai Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China

Received 19 December 2008 ,Revised 31 March 2009 ,Accepted 17 April 2009.

References 

  1. Trimarchi S, Nienaber CA, Rampoldi V, Myrmel T, Suzuki T, Mehta RH, et al. Contemporary results of surgery in acute type A aortic dissection: The International Registry of Acute Aortic Dissection experience. J Thorac Cardiovasc Surg. 2005;129:112–122
  2. Kazui T, Washiyama N, Muhammad BA, Terada H, Yamashita K, Takinami M, et al. Extended total arch replacement for acute type a aortic dissection: experience with seventy patients. J Thorac Cardiovasc Surg. 2000;119:558–565
  3. Ohtsubo S, Itoh T, Takarabe K, Rikitake K, Furukawa K, Suda H, et al. Surgical results of hemiarch replacement for acute type A dissection. Ann Thorac Surg. 2002;74:S1853–S1856discussion S1857-63
  4. Westaby S, Saito S, Katsumata T. Acute type A dissection: conservative methods provide consistently low mortality. Ann Thorac Surg. 2002;73:707–713
  5. Crawford ES, Kirklin JW, Naftel DC, Svensson LG, Coselli JS, Safi HJ. Surgery for acute dissection of ascending aorta. Should the arch be included?. J Thorac Cardiovasc Surg. 1992;104:46–59
  6. Sun LZ, Qi RD, Chang Q, Zhu JM, Liu YM, Yu CT, et al. Surgery for Marfan patients with acute type A dissection using a stented elephant trunk procedure. Ann Thorac Surg. 2008;86:1821–1826
  7. Liu ZG, Sun LZ, Chang Q, Zhu JM, Dong C, Yu CT, et al. Should the “elephant trunk” be skeletonized? Total arch replacement combined with stented elephant trunk implantation for Stanford type A aortic dissection. J Thorac Cardiovasc Surg. 2006;131:107–113
  8. David TE, Armstrong S, Ivanov J, Barnard S. Surgery for acute type A aortic dissection. Ann Thorac Surg. 1999;67:1999–2001discussion 2014-9
  9. Sabik JF, Lytle BW, Blackstone EH, McCarthy PM, Loop FD, Cosgrove DM. Long-term effectiveness of operations for ascending aortic dissections. J Thorac Cardiovasc Surg. 2000;119:946–962
  10. Heinemann M, Laas J, Jurmann M, Karck M, Borst HG. Surgery extended into the aortic arch in acute type A dissection. Indications, techniques, and results. Circulation. 1991;84(5 Suppl):III25–III30
  11. 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;5:27–32
  12. Hirotani T, Kameda T, Kumamoto T, Shirota S. Results of a total aortic arch replacement for an acute aortic arch dissection. J Thorac Cardiovasc Surg. 2000;120:686–691
  13. Massimo CG, Presenti LF, Marranci P, Favi PP, Poma AG, Ponzalli M, et al. Extended and total aortic resection in the surgical treatment of acute type A aortic dissection: experience with 54 patients. Ann Thorac Surg. 1988;46:420–424
  14. Ando M, Nakajima N, Adachi S, Nakaya M, Kawashima Y. Simultaneous graft replacement of the ascending aorta and total aortic arch for type A aortic dissection. Ann Thorac Surg. 1994;57:669–676
  15. Ochiai Y, Imoto Y, Sakamoto M, Ueno Y, Sano T, Baba H, et al. Long-term effectiveness of total arch replacement for type A aortic dissection. Ann Thorac Surg. 2005;80:1297–1302
  16. Mori Y, Hirose H, Takagi H, Umeda Y, Fukumoto Y, Shimabukuro K, et al. Aortic arch repair for Stanford type A aortic dissection with distal anastomosis to the proximal level of the distal aortic arch. J Thorac Cardiovasc Surg. 2003;126:415–419
  17. Ando M, Takamoto S, Okita Y, Morota T, Matsukawa R, Kitamura S. Elephant trunk procedure for surgical treatment of aortic dissection. Ann Thorac Surg. 1998;66:82–87
  18. Crawford ES, Coselli JS, Svensson LG, Safi HJ, Hess KR. Diffuse aneurysmal disease (chronic aortic dissection, Marfan, and mega aorta syndromes) and multiple aneurysm. Treatment by subtotal and total aortic replacement emphasizing the elephant trunk operation. Ann Surg. 1990;211:521–537
  19. Fann JI, Sarris GE, Mitchell RS, Shumway NE, Stinson EB, Oyer PE, et al. Treatment of patients with aortic dissection presenting with peripheral vascular complications. Ann Surg. 1990;212:705–713
  20. 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;131:336–342
  21. Kawanishi Y, Okada K, Nakagiri K, Kitagawa A, Tanaka H, Matsumori M, et al. Three cases of newly developed paraplegia after repairing type A acute aortic dissection. Ann Thorac Surg. 2007;84:1738–1740

PII: S0022-5223(09)00592-3

doi: 10.1016/j.jtcvs.2009.04.017

The Journal of Thoracic and Cardiovascular Surgery
Volume 138, Issue 6 , Pages 1358-1362 , December 2009

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