Total Aortic Arch Reconstruction with Triple-branched Aortic Arch Stent Graft Placement in Elderly Patients with Stanford Type A Aortic Dissection_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

 HENGXiang-yang , WANGPing-fan , LIANGZhi-qiang , ZHURu-jun , HEFa-ming , ZHANGLi

Department of Cardiovascular Surgery, Chest Hospital of Henan Province, Zhengzhou 450008, P. R. China;

Corresponding author：

HENGXiang-yang, Email: 1075508535@qq.com

Keywords：

Stanford type A aortic dissection; Triple-branched aortic arch stent graft; Elderly patient; Surgery

DOI：

10.7507/1007-4848.20140212

Video：

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Objective To summarize clinical experience of total aortic arch reconstruction with triple-branched stent graft placement in elderly patients with Stanford type A aortic dissection (SAAD). Methods From December 2008 to December 2012, 46 elderly SAAD patients underwent total aortic arch reconstruction with triple-branched stent graft placement under deep hypothermic circulatory arrest and selective cerebral perfusion (SCP)in Department of Cardiova-scular Surgery, Henan Provincial Chest Hospital. There were 37 male and 9 female patients with their age of 65-75 (68.2±5.0)years. There were 6 patients undergoing modified David procedure, 1 patient undergoing Bentall procedure, 2 patients undergoing Wheat procedure, and 37 patients undergoing ascending aortic replacement. Results There was no in-hos-pital death. Cardiopulmonary bypass time was 135-183 (131.1±10.5)minutes, aortic cross-clamping time was 81-100 (61.5±18.3)minutes, and SCP time was 19-28 (24.4±5.6)minutes. Postoperative complications included low cardiac output syndrome in 3 patients, acute renal failure in 2 patients, pleural effusion in 5 patients, lung infection in 2 patients, and sternal dehiscence in 1 patient, who were all cured after treatment. All the patients were followed up for 3 to 12 months without complication related to the stent graft. Conclusion Total aortic arch reconstruction with triple-branched stent graft placement is an easy surgical procedure for SAAD with a high successful rate and low morbidity, and especially suitable for elderly patients who can't bear traditional operation.

Citation： HENGXiang-yang, WANGPing-fan, LIANGZhi-qiang, ZHURu-jun, HEFa-ming, ZHANGLi. Total Aortic Arch Reconstruction with Triple-branched Aortic Arch Stent Graft Placement in Elderly Patients with Stanford Type A Aortic Dissection. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2014, 21(6): 736-739. doi: 10.7507/1007-4848.20140212 Copy

1.	Hata M, Sezai A, Niino T, et al. Should emergency surgical interven-tion be performed for an octogenarian with type A acute aortic dissection? J Thorac Cardiovasc Surg, 2008, 135(5):1042-1046.
2.	Suzuki S, Masuda M. An update on surgery for acute type A aortic dissection:aortic root repair, endovascular stent graft, and genetic research. Surg Today, 2009, 39(4):281-289.
3.	王平凡, 李潮, 陈良万, 等.新型三分支主动脉弓覆膜支架治疗Ⅰ型主动脉夹层的研究.医药论坛杂志, 2009, 30(21):1-5.
4.	陈良万, 卢琳, 戴小幅, 等.升主动脉替换联合三分支支架血管术中置人治疗急性A型主动脉夹层.中华胸心血管外科杂志, 2011, 27(6):334-337.
5.	华菲, 沈振亚, 余云生, 等.主动脉弓三分支覆膜支架在Stanford A型急性主动脉夹层外科治疗中的应用.中华外科杂志, 2011, 49(8):720-723.
6.	Easo J, Weigang E, Hölzl PP, et al. Influence of operative strategy for the aortic arch in DeBakey typeⅠ aortic dissection-analysis of the German Registry for Acute Aortic Dissection type (GERAADA). Ann Cardiothorac Surg, 2013, 2(2):175-180.
7.	Tsai TT, Trimarchi S, Nienaber CA. Acute aortic dissection:pers-pectives from the International Registry of Acute Aortic Dissection(IRAD). Eur J Vasc Endovasc Surg, 2009, 37(2):149-159.
8.	Svensson LG, Crawford ES. Aortic dissection and aortic aneurysm surgery:clinical observations, experimental investigations, and statis-tical analyses. Part Ⅰ. Curr Probl Surg, 1992, 29(11):817-911.
9.	Hsu YC, Lin CC. Paraparesis as the major initial presentation of aortic dissection:report of four cases. Acta Neurol Taiwan, 2004, 13(4):192-197.
10.	Kleinfeldt T, Rehders TC, Raab U, et al. Paraplegia after acute thor-acic pain. Internist(Berl), 2006, 47(1):76-79.
11.	庄晓荣, 林晓芳, 郑维红, 等.急性无痛性主动脉夹层导致的截瘫.脑与神经疾病杂志, 2006, 14(5):357-359.
12.	Eren E, Toker ME, Tuncer A, et al. Surgical management of coronary malperfusion due to type a aortic dissection. J Card Surg, 2007, 22(1):2-6.
13.	Su YJ, Chang WH, Chang KS, et al. Aortic dissection in the elderly. J Emerg Med, 2008, 35(2):135-138.
14.	Kawahito K, Adachi H, Murata S, et al. Coronary malperfusion due to type A aortic dissection:mechanism and surgical management. Ann Thorac Surg, 2003, 76(5):1471-1476.
15.	孙立忠, 刘志刚, 常谦, 等.主动脉弓替换加支架"象鼻"手术治疗Stanford A型主动脉夹层.中华外科杂志, 2004, 42(13):812-816.
16.	于存涛, 孙立忠, 常谦, 等.人工四分支血管在主动脉外科的应用.中华外科杂志, 2005, 43(18):1181-1183.
17.	唐滔, 申康军, 唐浩, 等.新型三分支型主动脉弓腔内覆膜支架在DeBakey Ⅰ型主动脉夹层中的应用.中南大学学报(医学版), 2012, 37(7):706-710.
18.	张力, 王平凡, 梁志强, 等.三分支型主动脉弓覆膜支架在治疗DeBaKey Ⅰ型主动脉夹层中的临床应用.中国实用医刊, 2012, 39(13):5-6.
19.	申运华, 严中亚, 章庆春, 等.三分支覆膜支架重建主动脉弓部手术治疗Stanford A型主动脉夹层的疗效.中华心血管病杂志, 2012, 40(8):676-680.
20.	李琦, 吴景全, 黄兴涛.主动脉弓分支变异螺旋CT三维成像解剖学研究.中国临床解剖学杂志, 2008, 26(1):52-55.
21.	田红燕, 刘亚, 刘亚民.主动脉弓分支的数字减影血管造影解剖学变异及其意义.解剖学杂志, 2009, 32(1):99-102.

1. Hata M, Sezai A, Niino T, et al. Should emergency surgical interven-tion be performed for an octogenarian with type A acute aortic dissection? J Thorac Cardiovasc Surg, 2008, 135(5):1042-1046.
2. Suzuki S, Masuda M. An update on surgery for acute type A aortic dissection:aortic root repair, endovascular stent graft, and genetic research. Surg Today, 2009, 39(4):281-289.
3. 王平凡, 李潮, 陈良万, 等.新型三分支主动脉弓覆膜支架治疗Ⅰ型主动脉夹层的研究.医药论坛杂志, 2009, 30(21):1-5.
4. 陈良万, 卢琳, 戴小幅, 等.升主动脉替换联合三分支支架血管术中置人治疗急性A型主动脉夹层.中华胸心血管外科杂志, 2011, 27(6):334-337.
5. 华菲, 沈振亚, 余云生, 等.主动脉弓三分支覆膜支架在Stanford A型急性主动脉夹层外科治疗中的应用.中华外科杂志, 2011, 49(8):720-723.
6. Easo J, Weigang E, Hölzl PP, et al. Influence of operative strategy for the aortic arch in DeBakey typeⅠ aortic dissection-analysis of the German Registry for Acute Aortic Dissection type (GERAADA). Ann Cardiothorac Surg, 2013, 2(2):175-180.
7. Tsai TT, Trimarchi S, Nienaber CA. Acute aortic dissection:pers-pectives from the International Registry of Acute Aortic Dissection(IRAD). Eur J Vasc Endovasc Surg, 2009, 37(2):149-159.
8. Svensson LG, Crawford ES. Aortic dissection and aortic aneurysm surgery:clinical observations, experimental investigations, and statis-tical analyses. Part Ⅰ. Curr Probl Surg, 1992, 29(11):817-911.
9. Hsu YC, Lin CC. Paraparesis as the major initial presentation of aortic dissection:report of four cases. Acta Neurol Taiwan, 2004, 13(4):192-197.
10. Kleinfeldt T, Rehders TC, Raab U, et al. Paraplegia after acute thor-acic pain. Internist(Berl), 2006, 47(1):76-79.
11. 庄晓荣, 林晓芳, 郑维红, 等.急性无痛性主动脉夹层导致的截瘫.脑与神经疾病杂志, 2006, 14(5):357-359.
12. Eren E, Toker ME, Tuncer A, et al. Surgical management of coronary malperfusion due to type a aortic dissection. J Card Surg, 2007, 22(1):2-6.
13. Su YJ, Chang WH, Chang KS, et al. Aortic dissection in the elderly. J Emerg Med, 2008, 35(2):135-138.
14. Kawahito K, Adachi H, Murata S, et al. Coronary malperfusion due to type A aortic dissection:mechanism and surgical management. Ann Thorac Surg, 2003, 76(5):1471-1476.
15. 孙立忠, 刘志刚, 常谦, 等.主动脉弓替换加支架"象鼻"手术治疗Stanford A型主动脉夹层.中华外科杂志, 2004, 42(13):812-816.
16. 于存涛, 孙立忠, 常谦, 等.人工四分支血管在主动脉外科的应用.中华外科杂志, 2005, 43(18):1181-1183.
17. 唐滔, 申康军, 唐浩, 等.新型三分支型主动脉弓腔内覆膜支架在DeBakey Ⅰ型主动脉夹层中的应用.中南大学学报(医学版), 2012, 37(7):706-710.
18. 张力, 王平凡, 梁志强, 等.三分支型主动脉弓覆膜支架在治疗DeBaKey Ⅰ型主动脉夹层中的临床应用.中国实用医刊, 2012, 39(13):5-6.
19. 申运华, 严中亚, 章庆春, 等.三分支覆膜支架重建主动脉弓部手术治疗Stanford A型主动脉夹层的疗效.中华心血管病杂志, 2012, 40(8):676-680.
20. 李琦, 吴景全, 黄兴涛.主动脉弓分支变异螺旋CT三维成像解剖学研究.中国临床解剖学杂志, 2008, 26(1):52-55.
21. 田红燕, 刘亚, 刘亚民.主动脉弓分支的数字减影血管造影解剖学变异及其意义.解剖学杂志, 2009, 32(1):99-102.

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Total Aortic Arch Reconstruction with Triple-branched Aortic Arch Stent Graft Placement in Elderly Patients with Stanford Type A Aortic Dissection

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