Total Arch Replacement with Proximal Lengthening Grafted Stent and Modified Inno-minate Artery Cannula for Stanford A Aortic Dissection_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

YUYang ,  GUTian-xiang , SHIEn-yi , WANGChun , YULei , YUPeng , LIUBo

Department of Cardiac Surgery, The First Affiliated Hospital of China Medical University, Shenyang 110001, P. R. China;

Corresponding author：

GUTian-xiang, Email: cmugtx@sina.com

Keywords：

Aortic dissection; Innominate artery; Cannulation; Simplified technique

DOI：

10.7507/1007-4848.20160112

Video：

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Objective To evaluate the short-term result of proximal lengthening grafted stent and modified innominate artery cannula for Stanford A aortic dissection. Method We retrospectively analyzed the clinical data of 21 patients with Stanford A aortic dissection in our hospital between December 2012 and January 2015. There were 16 males and 5 females at a mean age of 57 years. All 21 patients underwent total arch replacement with proximal lengthening grafted stent and modified innominate artery cannula invented by our center. Result The mean operation time of 21 patients was 187.0±31.1 minutes, the mean cardiopulmonary bypass time was 116.0±32.0 minutes, the mean aortic block time was 87.0±23.0 minutes, the mean selective cerebral perfusion (SCP) time was 23.0±3.9 minutes, the mean breathing machanical ventilation time was 19.0±6.0 hours, and the mean intensive care unit stay time was 3.0±0.9 days. All patients had a good recovery after surgery. There was no death or severe complications. Conclusion The technique of total arch replacement with proximal lengthening grafted stent and modified innominate artery cannula for Stanford A aortic dissection is effective, easy, and safe. The short-term result is satisfying.

Citation： YUYang, GUTian-xiang, SHIEn-yi, WANGChun, YULei, YUPeng, LIUBo. Total Arch Replacement with Proximal Lengthening Grafted Stent and Modified Inno-minate Artery Cannula for Stanford A Aortic Dissection. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2016, 23(5): 476-479. doi: 10.7507/1007-4848.20160112 Copy

1.	Banbury MK, Cosgrove DM 3rd. Arterial cannulation of the inno-minate artery. Ann Thorac Surg, 2000, 69:957.
2.	Ji S, Yang J, Chen C. Brain protection by using innominate artery cannulation during aortic arch surgery. Chin J Thorac Cardiovasc Surg, 2006, 22:424-425.
3.	Shi E, Gu T, Yu L, et al. Repair of Stanford type A aortic dissection with ascending aorta and hemiarch replacement combined with stent-graft elephant trunk technique by using innominate cannula-tion. J Thorac Cardiovasc Surg, 2011, 142:1458-1463.
4.	Koray AK, Dogan S. Carotid artery cannulation in aortic surgery. J Thorac Cardiovasc Surg, 2007, 133:1392.
5.	Kru GT, Conzelmann LO, Bonser RS, et al. Acute aortic dissection type A. Br J Surg, 2012, 99(10):1331-1344.
6.	Ourania P, Faisal G. Bakaeen MD, et al. Innominate artery cannu-lation:An alternative to femoral or axillary cannulation for arterial inflow in proximal aortic surgery. J Thorac Cardiovasc Surg, 2013, 145:S191-196.
7.	Yvon R, Baribeau M, Benjamin M, et al. Arterial inflow via an axil-lary artery graft for the severely atheromatous aorta. Ann Thorac Surg, 1998, 66:33-37.
8.	Sabik JF, Lytle BW, McCarthy PM, et al. Axillary artery:an alterna-tive site of arterial cannulation for patients with extensive aortic and peripheral vascular disease. J Thorac Cardiovasc Surg, 1995, 109:885-890.
9.	Lars G, Svensson M, Eugene H, et al. Does the arterial cannulation site for circulatory arrest influence stroke risk? Ann Thorac Surg, 2004, 78:1274-1284.
10.	Joseph F, Sabik M, Hassan N, et al. Cannulation of the axillary artery with a side graft reduces morbidity. Ann Thorac Surg, 2004, 77:1315-1320.
11.	Fang JH, Qiang W, Chang WR, et al. Cannulation of the innominate artery with a side graft in arch surgery. Ann Thorac Surg, 2010, 89:800-803.
12.	Bradley G, Leshnower M, Richard J, et al. Moderate hypothermia and unilateral selective antegrade cerebral perfusion:A contempo-rary cerebral protection strategy for aortic arch surgery. Ann Thorac Surg, 2010, 90:547-554.
13.	Ji BY, Liu JP, Chang Q, et al. Benefits and risks with using cannula-tion at the innominate artery with a side graft during arch surgery. Ann Thorac Surg, 2011, 91:1649-1650.
14.	Kazumasa O, Taijiro S, Kenji O, et al. Detection and monitoring of complications associated with femoral or axillary arterial cannula-tion for surgical repair of aortic dissection. J Cardiothorac Vasc Anesth, 2006, 20:20-25.
15.	Miralem P, Jens S, Matthias B, et al. Cannulation of the right axillary artery for surgery of acute type A aortic dissection. Eur J Cardio-thorac Surg, 2003, 24:231-235.
16.	Augoustides J, Andritsos M. Innovations in aortic disease:The ascending aorta and aortic arch. J Cardiothorac Vasc Anesth, 2010, 24:198-207.
17.	Shetty R, Voisine P, Mathieu P, et al. Recannulation of the right axillary artery for complex aortic surgeries. Tex Heart Inst J, 2005, 32:194-197.
18.	Kru GT, Conzelmann LO, Bonser RS, et al. Acute aortic dissection type A. Br J Surg, 2012, 99(10):1331-1344.
19.	Sun LZ, Qi RD, Zhu JM, et al. Repair of acute type A dissection:Our experiences and results. Ann Thorac Surg, 2011, 91:1147-1152.
20.	Sun LZ, Qi RD, Chang Q, et al. Surgery for acute type A dissection using total arch replacement combined with stented elephant trunk implantation:Experience with 107 patients. J Thorac Cardiovasc Surg, 2009, 138:1358-1362.
21.	Westaby S, Saito S, Katsumata T. Acute type A dissection:conserva-tive methods provide consistently low mortality. Ann Thorac Surg, 2002, 73:707-713.
22.	Kazui T, Washiyama N, Bashar AH, et al. Surgical outcome of acute type A aortic dissection:analysis of risk factors. Ann Thorac Surg, 2002, 74:75-81.

1. Banbury MK, Cosgrove DM 3rd. Arterial cannulation of the inno-minate artery. Ann Thorac Surg, 2000, 69:957.
2. Ji S, Yang J, Chen C. Brain protection by using innominate artery cannulation during aortic arch surgery. Chin J Thorac Cardiovasc Surg, 2006, 22:424-425.
3. Shi E, Gu T, Yu L, et al. Repair of Stanford type A aortic dissection with ascending aorta and hemiarch replacement combined with stent-graft elephant trunk technique by using innominate cannula-tion. J Thorac Cardiovasc Surg, 2011, 142:1458-1463.
4. Koray AK, Dogan S. Carotid artery cannulation in aortic surgery. J Thorac Cardiovasc Surg, 2007, 133:1392.
5. Kru GT, Conzelmann LO, Bonser RS, et al. Acute aortic dissection type A. Br J Surg, 2012, 99(10):1331-1344.
6. Ourania P, Faisal G. Bakaeen MD, et al. Innominate artery cannu-lation:An alternative to femoral or axillary cannulation for arterial inflow in proximal aortic surgery. J Thorac Cardiovasc Surg, 2013, 145:S191-196.
7. Yvon R, Baribeau M, Benjamin M, et al. Arterial inflow via an axil-lary artery graft for the severely atheromatous aorta. Ann Thorac Surg, 1998, 66:33-37.
8. Sabik JF, Lytle BW, McCarthy PM, et al. Axillary artery:an alterna-tive site of arterial cannulation for patients with extensive aortic and peripheral vascular disease. J Thorac Cardiovasc Surg, 1995, 109:885-890.
9. Lars G, Svensson M, Eugene H, et al. Does the arterial cannulation site for circulatory arrest influence stroke risk? Ann Thorac Surg, 2004, 78:1274-1284.
10. Joseph F, Sabik M, Hassan N, et al. Cannulation of the axillary artery with a side graft reduces morbidity. Ann Thorac Surg, 2004, 77:1315-1320.
11. Fang JH, Qiang W, Chang WR, et al. Cannulation of the innominate artery with a side graft in arch surgery. Ann Thorac Surg, 2010, 89:800-803.
12. Bradley G, Leshnower M, Richard J, et al. Moderate hypothermia and unilateral selective antegrade cerebral perfusion:A contempo-rary cerebral protection strategy for aortic arch surgery. Ann Thorac Surg, 2010, 90:547-554.
13. Ji BY, Liu JP, Chang Q, et al. Benefits and risks with using cannula-tion at the innominate artery with a side graft during arch surgery. Ann Thorac Surg, 2011, 91:1649-1650.
14. Kazumasa O, Taijiro S, Kenji O, et al. Detection and monitoring of complications associated with femoral or axillary arterial cannula-tion for surgical repair of aortic dissection. J Cardiothorac Vasc Anesth, 2006, 20:20-25.
15. Miralem P, Jens S, Matthias B, et al. Cannulation of the right axillary artery for surgery of acute type A aortic dissection. Eur J Cardio-thorac Surg, 2003, 24:231-235.
16. Augoustides J, Andritsos M. Innovations in aortic disease:The ascending aorta and aortic arch. J Cardiothorac Vasc Anesth, 2010, 24:198-207.
17. Shetty R, Voisine P, Mathieu P, et al. Recannulation of the right axillary artery for complex aortic surgeries. Tex Heart Inst J, 2005, 32:194-197.
18. Kru GT, Conzelmann LO, Bonser RS, et al. Acute aortic dissection type A. Br J Surg, 2012, 99(10):1331-1344.
19. Sun LZ, Qi RD, Zhu JM, et al. Repair of acute type A dissection:Our experiences and results. Ann Thorac Surg, 2011, 91:1147-1152.
20. Sun LZ, Qi RD, Chang Q, et al. Surgery for acute type A dissection using total arch replacement combined with stented elephant trunk implantation:Experience with 107 patients. J Thorac Cardiovasc Surg, 2009, 138:1358-1362.
21. Westaby S, Saito S, Katsumata T. Acute type A dissection:conserva-tive methods provide consistently low mortality. Ann Thorac Surg, 2002, 73:707-713.
22. Kazui T, Washiyama N, Bashar AH, et al. Surgical outcome of acute type A aortic dissection:analysis of risk factors. Ann Thorac Surg, 2002, 74:75-81.

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Total Arch Replacement with Proximal Lengthening Grafted Stent and Modified Inno-minate Artery Cannula for Stanford A Aortic Dissection

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