Surgical Repair of Stanford Type A Aortic Dissection Involving an Aberrant Right Subc-lavian Artery_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

ZHONGYong-liang ,  ZHUJun-ming , QIRui-dong , GEYi-peng , CHENLei , LIUWei , LICheng-nan , ZHENGJun , LIUYong-min , SUNLi-zhong

Department of Cardiovascular Surgery, Beijing Anzhen Hospital of Capital Medical University, Beijing Aortic Disease Center, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing 100029, P. R. China;

Corresponding author：

ZHUJun-ming, Email: anzhenzjm@163.com

Keywords：

Stanford type A aortic dissection; Aberrant right subclavian artery; Sun's procedure

DOI：

10.7507/1007-4848.20160248

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Objective To summarize our experience and clinical effect of surgical treatment of Stanford type A aortic dissection (TAAD) involving an aberrant right subclavian artery (ARSA). Methods From March 2009 to January 2016, 14 patients with TAAD involving an ARSA (acute TAAD, n=10; chronic TAAD, n=4) underwent operation under hypothermic cardiopulmonary bypass combined with selective antegrade cerebral perfusion in our center. There were 11 male and 3 female patients with a mean age of 46.07±8.45 years. A total of 13 patients (13/14, 92.86%) underwent stented elephant trunk procedure combined with total arch replacement (Sun's procedure). The remaining patient (1/14, 7.14%) underwent partial aortic arch replacement combined with Bentall procedure without ARSA revascularization. Results The average operation time, cardiopulmonary bypass time, aortic cross-clamping time and selective cerebral perfusion time was 7.89±1.80 h, 208.43±28.84 min, 117.64±23.30 min, and 30.50±10.15 min, respectively. No operation-related deaths occurred. However, two (14.29%) patients died on postoperative 5 d, 7 d, respectively in hospital. One patient required repeat thoracotomy for bleeding, one suffered temporary renal dysfunction and one renal failure (this patient had renal failure before surgery). The mean follow-up was 28.42±22.52 months with a follow-up rate of 100.00% (12/12). One patient died of heart failure and renal failure at 64 months after operation. The others were free from any aortic complications during follow-up. Conclusions TAAD involving an ARSA should be clearly diagnosed before surgery, and treated by the optimal arterial cannulation and cerebral perfusion during operation. Repair of aortic dissection with Sun's procedure and revascularization of the ARSA can obtain satisfactory clinical outcomes in patients with TAAD involving an ARSA.

Citation： ZHONGYong-liang, ZHUJun-ming, QIRui-dong, GEYi-peng, CHENLei, LIUWei, LICheng-nan, ZHENGJun, LIUYong-min, SUNLi-zhong. Surgical Repair of Stanford Type A Aortic Dissection Involving an Aberrant Right Subc-lavian Artery. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2016, 23(11): 1055-1060. doi: 10.7507/1007-4848.20160248 Copy

1.	Chaoui R, Rake A, Heling KS. Aortic arch with four vessels: aberrant right subclavian artery. Ultrasound Obstet Gynecol, 2008, 31(1): 115-117.
2.	Freed K, Low VH. The aberrant subclavian artery. AJR Am J Roent-genol, 1997, 168(2): 481-484.
3.	Kikuchi K, Makuuchi H, Oono M, et al. Surgery for aortic dissection involving an aberrant right subclavian artery. Jpn J Thorac Cardio-vasc Surg, 2005, 53(12): 632-634.
4.	Nasir A, Jadoon M, Ellis P K, et al. Kommerell's diverticulum, risk factor for aortic dissection. J Card Surg, 2009, 24(4): 463.
5.	Jalaie H, Grommes J, Sailer A, et al. Treatment of symptomatic aberrant subclavian arteries. Eur J Vasc Endovasc Surg, 2014, 48(5): 521-526.
6.	Furukawa H, Takemura T, Ohno H, et al. Stanford type A acute aortic dissection involving an aberrant right subclavian artery--a successful operative case. Nihon Kyobu Geka Gakkai Zasshi, 1995, 43(4): 533-537.
7.	Misumi T, Kudo M, Ito T, et al. Acute aortic dissection involving an aberrant right subclavian artery. Jpn J Thorac Cardiovasc Surg, 2002, 50(3): 119-121.
8.	Battaloglu B, Secici S, Colak C, et al. Aberrant right subclavian artery and axillary artery cannulation in type a aortic dissection repair. Ann Thorac Surg, 2013, 96(1): e1-e2.
9.	Kitamura H, Kimura A, Fukaya S, et al. Emergent total arch replace-ment for acute type A aortic dissection with aberrant right subclavian artery in a systemic lupus erythematosus patient. Gen Thorac Cardi-ovasc Surg, 2016, 64(1): 25-27.
10.	Maxwell BG, Harrington KB, Beygui RE, et al. Congenital anomalies of the aortic arch in acute type-a aortic dissection: implications for monitoring, perfusion strategy, and surgical repair. J Cardiothorac Vasc Anesth, 2014, 28(3): 467-472.
11.	Tanaka K, Tanaka K, Natsume K, et al. Successful surgical exclusion of rapidly expanding kommerell diverticulum following a total arch replacement for an acute type a aortic dissection. Ann Vasc Dis, 2014, 7(3): 339-342.
12.	Li C, Shi J, Shi Y, et al. Unusual association of type A aortic disse-ction and aberrant right subclavian artery in Marfan syndrome. Int J Cardiol, 2014, 175(1): e14-e15.
13.	Tanaka Y, Kitamura T, Horai T, et al. Two-stage operation for Stan-ford type A acute aortic dissection originating from Kommerell's diverticulum. Interact Cardiovasc Thorac Surg, 2016, 22(5): 695-697.
14.	Ren C, Sun L, Huang L, et al. Hybrid procedure for acute stanford type a aortic dissection with aberrant right subclavian artery. J Card Surg, 2015, 30(3): 274-275.
15.	Guo C, Zhu K, Xu D, et al. Open triple-branched stent graft applied to patient of acute type A aortic dissection with aberrant right subclavian artery. J Cardiothorac Surg, 2013, 8: 85.
16.	Sun L, Qi R, Zhu J, et al. Total arch replacement combined with stented elephant trunk implantation: a new "standard" therapy for type a dissection involving repair of the aortic arch? Circulation, 2011, 123(9): 971-978.
17.	Ma WG, Zhu JM, Zheng J, et al. Sun's procedure for complex aortic arch repair: total arch replacement using a tetrafurcate graft with stented elephant trunk implantation. Ann Cardiothorac Surg, 2013, 2(5): 642-648.
18.	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.
19.	Zhu JM, Qi RD, Chen L, et al. Surgery for acute type A dissection using total arch replacement combined with stented elephant trunk implantation: Preservation of autologous brachiocephalic vessels. J Thorac Cardiovasc Surg, 2015, 150(1): 101-105.
20.	Davies M, Guest PJ. Developmental abnormalities of the great vessels of the thorax and their embryological basis. Br J Radiol, 2003, 76(907): 491-502.
21.	Li QL, Zhang XM, Zhang XM. Aortic dissection originating from an aberrant right subclavian artery. J Vasc Surg, 2007, 46(6): 1270-1273.
22.	Vistarini N, Aubert S, Gandjbakhch I, et al. Aberrant subclavian artery as origin of aortic dissection. Eur J Cardiothorac Surg, 2008, 34(5): 1109.
23.	Zhu JM, Qi RD, Liu YM, et al. Repair of complicated type B dissec-tion with an aberrant right subclavian artery. Interact Cardiovasc Thorac Surg, 2016, 22(6): 718-722.

1. Chaoui R, Rake A, Heling KS. Aortic arch with four vessels: aberrant right subclavian artery. Ultrasound Obstet Gynecol, 2008, 31(1): 115-117.
2. Freed K, Low VH. The aberrant subclavian artery. AJR Am J Roent-genol, 1997, 168(2): 481-484.
3. Kikuchi K, Makuuchi H, Oono M, et al. Surgery for aortic dissection involving an aberrant right subclavian artery. Jpn J Thorac Cardio-vasc Surg, 2005, 53(12): 632-634.
4. Nasir A, Jadoon M, Ellis P K, et al. Kommerell's diverticulum, risk factor for aortic dissection. J Card Surg, 2009, 24(4): 463.
5. Jalaie H, Grommes J, Sailer A, et al. Treatment of symptomatic aberrant subclavian arteries. Eur J Vasc Endovasc Surg, 2014, 48(5): 521-526.
6. Furukawa H, Takemura T, Ohno H, et al. Stanford type A acute aortic dissection involving an aberrant right subclavian artery--a successful operative case. Nihon Kyobu Geka Gakkai Zasshi, 1995, 43(4): 533-537.
7. Misumi T, Kudo M, Ito T, et al. Acute aortic dissection involving an aberrant right subclavian artery. Jpn J Thorac Cardiovasc Surg, 2002, 50(3): 119-121.
8. Battaloglu B, Secici S, Colak C, et al. Aberrant right subclavian artery and axillary artery cannulation in type a aortic dissection repair. Ann Thorac Surg, 2013, 96(1): e1-e2.
9. Kitamura H, Kimura A, Fukaya S, et al. Emergent total arch replace-ment for acute type A aortic dissection with aberrant right subclavian artery in a systemic lupus erythematosus patient. Gen Thorac Cardi-ovasc Surg, 2016, 64(1): 25-27.
10. Maxwell BG, Harrington KB, Beygui RE, et al. Congenital anomalies of the aortic arch in acute type-a aortic dissection: implications for monitoring, perfusion strategy, and surgical repair. J Cardiothorac Vasc Anesth, 2014, 28(3): 467-472.
11. Tanaka K, Tanaka K, Natsume K, et al. Successful surgical exclusion of rapidly expanding kommerell diverticulum following a total arch replacement for an acute type a aortic dissection. Ann Vasc Dis, 2014, 7(3): 339-342.
12. Li C, Shi J, Shi Y, et al. Unusual association of type A aortic disse-ction and aberrant right subclavian artery in Marfan syndrome. Int J Cardiol, 2014, 175(1): e14-e15.
13. Tanaka Y, Kitamura T, Horai T, et al. Two-stage operation for Stan-ford type A acute aortic dissection originating from Kommerell's diverticulum. Interact Cardiovasc Thorac Surg, 2016, 22(5): 695-697.
14. Ren C, Sun L, Huang L, et al. Hybrid procedure for acute stanford type a aortic dissection with aberrant right subclavian artery. J Card Surg, 2015, 30(3): 274-275.
15. Guo C, Zhu K, Xu D, et al. Open triple-branched stent graft applied to patient of acute type A aortic dissection with aberrant right subclavian artery. J Cardiothorac Surg, 2013, 8: 85.
16. Sun L, Qi R, Zhu J, et al. Total arch replacement combined with stented elephant trunk implantation: a new "standard" therapy for type a dissection involving repair of the aortic arch? Circulation, 2011, 123(9): 971-978.
17. Ma WG, Zhu JM, Zheng J, et al. Sun's procedure for complex aortic arch repair: total arch replacement using a tetrafurcate graft with stented elephant trunk implantation. Ann Cardiothorac Surg, 2013, 2(5): 642-648.
18. 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.
19. Zhu JM, Qi RD, Chen L, et al. Surgery for acute type A dissection using total arch replacement combined with stented elephant trunk implantation: Preservation of autologous brachiocephalic vessels. J Thorac Cardiovasc Surg, 2015, 150(1): 101-105.
20. Davies M, Guest PJ. Developmental abnormalities of the great vessels of the thorax and their embryological basis. Br J Radiol, 2003, 76(907): 491-502.
21. Li QL, Zhang XM, Zhang XM. Aortic dissection originating from an aberrant right subclavian artery. J Vasc Surg, 2007, 46(6): 1270-1273.
22. Vistarini N, Aubert S, Gandjbakhch I, et al. Aberrant subclavian artery as origin of aortic dissection. Eur J Cardiothorac Surg, 2008, 34(5): 1109.
23. Zhu JM, Qi RD, Liu YM, et al. Repair of complicated type B dissec-tion with an aberrant right subclavian artery. Interact Cardiovasc Thorac Surg, 2016, 22(6): 718-722.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Surgical Repair of Stanford Type A Aortic Dissection Involving an Aberrant Right Subc-lavian Artery

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