Open Surgery for the Treatment of Complex Acute Stanford Type B Aortic Dissection: An Open Stented Elephant Trunk Procedure_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

CHENGLi-jian , LIUWei , QIAOZhi-yu , CHENLei , LICheng-nan , HUHai-ou , GEYi-peng ,  ZHUJun-ming

Department of Cardiovascular Surgery, Beijing Anzhen Hospital of Capital Medical University, Beijing Aortic Disease Center, Beijing 100029, P. R. China;

Corresponding author：

ZHUJun-ming, Email: anzhenjzm@163.com

Keywords：

Stented elephant trunk procedure; Stanford type B aortic dissection; Cardiac surgery

DOI：

10.7507/1007-4848.20150004

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To summarize clinical experience and surgical indications of open stented elephant trunk (sET) procedure for the treatment of complex acute Stanford type B aortic dissection (AD). Methods From February 2009 to April 2013, 25 patients with complex acute Stanford type B AD underwent open sET procedure in Beijing Anzhen Hospital. There were 22 male and 3 female patients with their age of 46.92±9.12 years (range, 30 to 66 years). There were 16 patients with hypertension and 3 patients with preoperative acute renal failure. All the patients received sET implantation via an aortic arch incision under deep hypothermic circulatory arrest. Concomitant procedures included extra-anatomic bypass grafting in 11 patients, Bentall procedure in 1 patient, aortic valve replacement in 3 patients, and ascending aorta plasty in 3 patients. Computed tomography angiography (CTA) was performed before discharge and during follow-up for all the patients. Results Operation time was 4-7 (5.5±0.7) hours, cardiopulmonary bypass time was 93-206 (137.64±30.02) minutes, aortic cross-clamping time was 28-109 (57.96±21.05) minutes, and selective cerebral perfusion time was 15-76 (26.76±11.88) minutes. There was no in-hospital death. Postoperatively, there were 2 patients with pulmonary complications, 2 patients with type I endoleak, 1 patient with acute renal failure, 1 patient with temporary neurological disorder, 1 patient with sudden ventricular fibrillation, and 1 patient with delayed wound healing. Mean follow-up time was 6-54 (25.76±16.15) months, and 2 patients were lost during follow-up. The follow-up rate was 92%.There was no late death during follow-up. Conclusions Open sET procedure is a reliable and efficacious therapeutic strategy for patients with complex acute Stanford type B AD. Surgical indications include complex Stanford type B AD without enough landing zone, type B AD with ascending aortic disease, aortic root disease, valvular heart disease, coronary artery disease and congenital heart defects, and type B AD caused by genetic connective tissue disorder.

Citation： CHENGLi-jian, LIUWei, QIAOZhi-yu, CHENLei, LICheng-nan, HUHai-ou, GEYi-peng, ZHUJun-ming. Open Surgery for the Treatment of Complex Acute Stanford Type B Aortic Dissection: An Open Stented Elephant Trunk Procedure. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2015, 22(1): 15-18. doi: 10.7507/1007-4848.20150004 Copy

1.	Daily PO, Trueblood HW, Stinson EB, et al. Management of acute aortic dissections. Ann Thorac Surg, 1970, 10(3):237-247.
2.	Toda K, Taniguchi K, Masai T, et al. Arch aneurysm repair with long elephant trunk:a 10-year experience in 111 patients. Ann Thorac Surg, 2009, 88(1):16-22.
3.	孙立忠, 刘宁宁, 常谦, 等. 主动脉夹层的细化分型及其应用. 中华外科杂志, 2005, 43(18):1171-1176.
4.	程力剑, 孙立忠, 朱俊明, 等. 63 例全胸腹主动脉置换术患者中期结果分析. 中国胸心血管外科临床杂志, 2009, 16(5):339-343.
5.	Zhu J, Cheng L, Liu Y, et al. One-stage repair for stanford type B aortic dissection concomitant with cardiac diseases:open stented elephant trunk technique combined with cardiac operation. Thorac Cardiovasc Surg, 2012, 60(1):11-16.
6.	Svensson LG, Kouchoukos NT, Miller DC, et al. Expert consensus document on the treatment of descending thoracic aortic disease using endovascular stent-grafts. Ann Thorac Surg, 2008, 85(1 Suppl):S1-S41.
7.	Wheat MJ, Palmer RF, Bartley TD, et al. Treatment of dissectiong aneurysms of the aorta without surgery. J Thorac Cardiovasc Surg,1965, 50:364-373.
8.	Coady MA, Rizzo JA, Goldstein LJ, et al. Natural history, pathogenesis, and etiology of thoracic aortic aneurysms and dissections. Cardiol Clin, 1999, 17(4):615-635.
9.	戈小虎, 方青波, 管圣, 等. Stanford B 型主动脉夹层的腔内治疗(附134 例报告). 中国微创外科杂志, 2012, 12(9):774-776.
10.	Hanna JM, Andersen ND, Ganapathi AM, et al. Five-year results for endovascular repair of acute complicated type B aortic dissection. J Vasc Surg, 2014, 59(1):96-106.
11.	Ma H, Yang H, Xu W, et al. Endovascular repair with the chimney technique for Stanford type B aortic dissection involving right-sided arch with mirror image branching. J Endovasc Ther, 2013, 20(3):283-288.
12.	Bunger CM, Kische S, Liebold A, et al. Hybrid aortic arch repair for complicated type B aortic dissection. J Vasc Surg, 2013, 58(6):1490-1496.
13.	Hiratzka LF, Bakris GL, Beckman JA, et al. 2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM guidelines for the diagnosis and management of patients with Thoracic Aortic Disease:a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, American Association for Thoracic Surgery, American College of Radiology, American Stroke Association, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of Thoracic Surgeons, and Society for Vascular Medicine. Circulation, 2010, 121(13):e266-e369.
14.	程力剑, 郑军, 孙立忠. 象鼻手术的应用与发展. 中华胸心血管外科杂志, 2012, 28(1):49-53.
15.	谷天祥, 于洋, 师恩祎, 等. "改良"次全弓置换加支架象鼻手术治疗Stanford A型主动脉夹层. 中国胸心血管外科临床杂志, 2012, 19(1):4-7.
16.	刘宸铖, 郭应强, 蒙炜, 等. 全主动脉弓置换加支架象鼻手术治疗A型主动脉夹层. 中国胸心血管外科临床杂志, 2009, 16(2):148-149.

1. Daily PO, Trueblood HW, Stinson EB, et al. Management of acute aortic dissections. Ann Thorac Surg, 1970, 10(3):237-247.
2. Toda K, Taniguchi K, Masai T, et al. Arch aneurysm repair with long elephant trunk:a 10-year experience in 111 patients. Ann Thorac Surg, 2009, 88(1):16-22.
3. 孙立忠, 刘宁宁, 常谦, 等. 主动脉夹层的细化分型及其应用. 中华外科杂志, 2005, 43(18):1171-1176.
4. 程力剑, 孙立忠, 朱俊明, 等. 63 例全胸腹主动脉置换术患者中期结果分析. 中国胸心血管外科临床杂志, 2009, 16(5):339-343.
5. Zhu J, Cheng L, Liu Y, et al. One-stage repair for stanford type B aortic dissection concomitant with cardiac diseases:open stented elephant trunk technique combined with cardiac operation. Thorac Cardiovasc Surg, 2012, 60(1):11-16.
6. Svensson LG, Kouchoukos NT, Miller DC, et al. Expert consensus document on the treatment of descending thoracic aortic disease using endovascular stent-grafts. Ann Thorac Surg, 2008, 85(1 Suppl):S1-S41.
7. Wheat MJ, Palmer RF, Bartley TD, et al. Treatment of dissectiong aneurysms of the aorta without surgery. J Thorac Cardiovasc Surg,1965, 50:364-373.
8. Coady MA, Rizzo JA, Goldstein LJ, et al. Natural history, pathogenesis, and etiology of thoracic aortic aneurysms and dissections. Cardiol Clin, 1999, 17(4):615-635.
9. 戈小虎, 方青波, 管圣, 等. Stanford B 型主动脉夹层的腔内治疗(附134 例报告). 中国微创外科杂志, 2012, 12(9):774-776.
10. Hanna JM, Andersen ND, Ganapathi AM, et al. Five-year results for endovascular repair of acute complicated type B aortic dissection. J Vasc Surg, 2014, 59(1):96-106.
11. Ma H, Yang H, Xu W, et al. Endovascular repair with the chimney technique for Stanford type B aortic dissection involving right-sided arch with mirror image branching. J Endovasc Ther, 2013, 20(3):283-288.
12. Bunger CM, Kische S, Liebold A, et al. Hybrid aortic arch repair for complicated type B aortic dissection. J Vasc Surg, 2013, 58(6):1490-1496.
13. Hiratzka LF, Bakris GL, Beckman JA, et al. 2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM guidelines for the diagnosis and management of patients with Thoracic Aortic Disease:a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, American Association for Thoracic Surgery, American College of Radiology, American Stroke Association, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of Thoracic Surgeons, and Society for Vascular Medicine. Circulation, 2010, 121(13):e266-e369.
14. 程力剑, 郑军, 孙立忠. 象鼻手术的应用与发展. 中华胸心血管外科杂志, 2012, 28(1):49-53.
15. 谷天祥, 于洋, 师恩祎, 等. "改良"次全弓置换加支架象鼻手术治疗Stanford A型主动脉夹层. 中国胸心血管外科临床杂志, 2012, 19(1):4-7.
16. 刘宸铖, 郭应强, 蒙炜, 等. 全主动脉弓置换加支架象鼻手术治疗A型主动脉夹层. 中国胸心血管外科临床杂志, 2009, 16(2):148-149.

Previous Article
Autophagy and Its Research Progress in Gastric Cancer
Next Article
Clinical Research on Natural Course of Severe Acute Pancreatitis

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Open Surgery for the Treatment of Complex Acute Stanford Type B Aortic Dissection: An Open Stented Elephant Trunk Procedure

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content