Treatment of acute Stanford type A aortic dissection using the Sun’s procedure with preservation of autologous brachiocephalic artery_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

GUO Shichao , SUN Lizhong , CHEN Lei , QI Ruidong ,  ZHU Junming

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

Corresponding author：

ZHU Junming, Email: anzhenzjm@163.com

Keywords：

Aortic dissection; brachiocephalic artery; aortic arch; Sun’s procedure

DOI：

10.7507/1007-4848.201706005

Video：

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Objective To study surgical indication, technique for treating acute Stanford type A aortic dissection involving repair of the aortic arch using Sun’s procedure with preservation of autologous brachiocephalic artery. Methods We retrospectively analyzed the clinical data of 28 consecutive patients (23 males, 5 females) who underwent operations on acute Stanford type A aortic dissection using Sun’s procedure with preservation of autologous brachiocephalic artery in our hospital between August 2011 and October 2013. The mean age was 29-62 (47±8) years. There were 26 patients with hypertension and 2 patients with Mafan syndrome. Sun’s procedure with preservation of autologous brachiocephalic artery was performed in all patients, concomitant procedure included aortic root replacement (Bentall) in 4 patients, aortic root replacement (Bentall) and mitral valve replacement (MVR) in 1 patient, aortic valsalva sinus plasty in 6 patients. Results The cardiopulmonary bypass time was 167±37 min. The cross clamp time was 80±22 min. Selective cerebral perfusion time was 29±5 min. One patient died postoperatively from acute hepatic failure. Two patients suffered from transient neurologic deficit and recovered after treatment during follow-up. Computed tomography angiography (CTA) of aorta was performed in each patient before discharged from the hospital. The patency of the anastomotic site at brachiocephalic artery was identified. Descending aortic true lumen was significantly expanded. There was only 2 patients with endoleak and total thrombosis of false lumen was found near stent graft with 25 patients. The 27 patients were followed up for 47 (36-62) months. One patient with descending thoracic aortic dilatation underwent thoracoabdoninal aortic replacement. One combined with acute endometrial tear underwent thoracic endovascular aortic repair. Conclusion Sun’s procedure with preservation of autologous brachiocephalic artery is safe and effective in the treatment of acute Stanford type A dissection in patients without brachiocephalic artery involved. Low mortality and complication rate are achieved, but the long-term results need the further follow-up.

Citation： GUO Shichao, SUN Lizhong, CHEN Lei, QI Ruidong, ZHU Junming. Treatment of acute Stanford type A aortic dissection using the Sun’s procedure with preservation of autologous brachiocephalic artery. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2018, 25(6): 512-515. doi: 10.7507/1007-4848.201706005 Copy

1.	LeMaire SA, Price MD, Parenti JL, et al. Early outcomes after aortic arch replacement by using the Y-graft technique. Ann Thorac Surg, 2011, 91(3): 700-707.
2.	Nishimori H, Yamamoto M, Fukutomi T, et al. Operative results of total arch replacement with arch first technique using a trifurcated graft. Kyobu Geka, 2015, 68(3): 163-167.
3.	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.
4.	Pearce CW, Weichert RF 3rd, del Real RE. Aneurysms of aortic arch. Simplified technique for excision and prosthetic replacement. J Thorac Cardiovasc Surg, 1969, 58(6): 886-890.
5.	Chen LW, Dai XF, Wu XJ, et al. Ascending aorta and hemiarch replacement combined with modified triple-branched stent graft implantation for repair of acute DeBakey type I aortic dissection. Ann Thorac Surg, 2017, 103(2): 595-601.
6.	Ma WG, Zheng J, Dong SB, et al. Sun's procedure of total arch replacement using a tetrafurcated graft with stented elephant trunk implantation: analysis of early outcome in 398 patients with acute type A aortic dissection. Ann Cardiothorac Surg, 2013, 2(5): 621-628.
7.	Ma WG, Zhang W, Wang LF, et al. Type A aortic dissection with arch entry tear: Surgical experience in 104 patients over a 12-year period. J Thorac Cardiovasc Surg, 2016, 151(6): 1581-1592.
8.	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.
9.	Ma WG, Zheng J, Liu YM, et al. Dr. Sun's Procedure for Type A aortic dissection: total arch replacement using tetrafurcate graft with stented elephant trunk implantation. Aorta (Stamford), 2013, 1(1): 59-64.
10.	Sun LZ, Qi RD, Chang Q, et al. Is total arch replacement combined with stented elephant trunk implantation justified for patients with chronic Stanford type A aortic dissection? J Thorac Cardiovasc Surg, 2009, 138(4): 892-896.
11.	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(6): 1358-1362.
12.	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, (13): 47-51.
13.	朱俊明, 齐瑞东, 陈雷, 等. 保留自体头臂动脉的孙氏手术临床应用. 中华胸心血管外科杂志, 2016, 32(3): 143-146.
14.	Shrestha M, Martens A, Behrendt S, et al. Is the branched graft technique better than the en bloc technique for total aortic arch replacement? Eur J Cardiothorac Surg, 2014, 45(1): 181-186.
15.	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.

1. LeMaire SA, Price MD, Parenti JL, et al. Early outcomes after aortic arch replacement by using the Y-graft technique. Ann Thorac Surg, 2011, 91(3): 700-707.
2. Nishimori H, Yamamoto M, Fukutomi T, et al. Operative results of total arch replacement with arch first technique using a trifurcated graft. Kyobu Geka, 2015, 68(3): 163-167.
3. 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.
4. Pearce CW, Weichert RF 3rd, del Real RE. Aneurysms of aortic arch. Simplified technique for excision and prosthetic replacement. J Thorac Cardiovasc Surg, 1969, 58(6): 886-890.
5. Chen LW, Dai XF, Wu XJ, et al. Ascending aorta and hemiarch replacement combined with modified triple-branched stent graft implantation for repair of acute DeBakey type I aortic dissection. Ann Thorac Surg, 2017, 103(2): 595-601.
6. Ma WG, Zheng J, Dong SB, et al. Sun's procedure of total arch replacement using a tetrafurcated graft with stented elephant trunk implantation: analysis of early outcome in 398 patients with acute type A aortic dissection. Ann Cardiothorac Surg, 2013, 2(5): 621-628.
7. Ma WG, Zhang W, Wang LF, et al. Type A aortic dissection with arch entry tear: Surgical experience in 104 patients over a 12-year period. J Thorac Cardiovasc Surg, 2016, 151(6): 1581-1592.
8. 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.
9. Ma WG, Zheng J, Liu YM, et al. Dr. Sun's Procedure for Type A aortic dissection: total arch replacement using tetrafurcate graft with stented elephant trunk implantation. Aorta (Stamford), 2013, 1(1): 59-64.
10. Sun LZ, Qi RD, Chang Q, et al. Is total arch replacement combined with stented elephant trunk implantation justified for patients with chronic Stanford type A aortic dissection? J Thorac Cardiovasc Surg, 2009, 138(4): 892-896.
11. 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(6): 1358-1362.
12. 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, (13): 47-51.
13. 朱俊明, 齐瑞东, 陈雷, 等. 保留自体头臂动脉的孙氏手术临床应用. 中华胸心血管外科杂志, 2016, 32(3): 143-146.
14. Shrestha M, Martens A, Behrendt S, et al. Is the branched graft technique better than the en bloc technique for total aortic arch replacement? Eur J Cardiothorac Surg, 2014, 45(1): 181-186.
15. 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.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Treatment of acute Stanford type A aortic dissection using the Sun’s procedure with preservation of autologous brachiocephalic artery

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