Short-term outcome of ascending aorta replacement combined with total aortic arch fenestration technique for acute type A aortic dissection_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

MA Xiantao , ZHU Zhangqiang , FENG Yi , LI Shiliang , Wajeehullahi Akilu , WEI Xiang ,  CHENG Cai

Department of Cardiac and Vascular Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, P. R. China;

Corresponding author：

CHENG Cai, Email: Cai.cheng@hotmail.com

Keywords：

Acute type A aortic dissection; thoracic endovascular aortic repair; fenestration technique; endovascular treatment; hybrid technique; branched stent-graft

DOI：

10.7507/1007-4848.202111022

Video：

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Objective To report our clinical experience and outcomes of thoracic endovascular aortic repair (TEVAR) for acute Stanford type A dissection using ascending aorta replacement combined with implantation of a fenestrated stent-graft of the entire aortic arch through a minimally invasive technique. Methods From 2016 to 2020 in our hospital, 24 patients (17 males and 7 females, aged 45-72 years) with complicated Stanford type A aortic dissection, underwent replacement of the proximal ascending aorta with TEVAR. None of the patients with dissection involved the three branches of the superior arch, and all patients were replaced with artificial blood vessels of the ascending aorta under non-hypothermic cardiopulmonary bypass, preserving the arch and the three branches above the arch, and individualized stent graft fenestration. Results Surgical technical success rate was 100.0%. There was no intraoperative complication or evidence of endo-leak in 1 month postoperatively. Hospital stay was 10±5 d. During postoperative follow-up, the stent was unobstructed without displacement, the preserved branch of the aortic arch was unobstructed, and the true lumen of the descending aorta was enlarged. Conclusion This hybrid technique by using TEVAR with fenestrated treatment is a minimally invasive and effective method to treat high-risk patients with acute Stanford type A aortic dissection.

Citation： MA Xiantao, ZHU Zhangqiang, FENG Yi, LI Shiliang, Wajeehullahi Akilu, WEI Xiang, CHENG Cai. Short-term outcome of ascending aorta replacement combined with total aortic arch fenestration technique for acute type A aortic dissection. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2022, 29(5): 577-584. doi: 10.7507/1007-4848.202111022 Copy

1.	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.
2.	Bavaria J, Milewski RK, Baker J, et al. Classic hybrid evolving approach to distal arch aneurysms: Toward the zone zero solution. J Thorac Cardiovasc Surg, 2010, 140(6 Suppl): S77-S80.
3.	舒畅, 施俊哲, 葛建军, 等. 杂交技术治疗累及弓部主动脉病变的中国专家共识. 中国循环杂志, 2020, 35(2): 124-129.
4.	Zhang L, Yu C, Yang X, et al. Hybrid and frozen elephant trunk for total arch replacement in DeBakey type Ⅰ dissection. J Thorac Cardiovasc Surg, 2019, 158(5): 1285-1292.
5.	朱志成, 柳克祥, 王天策, 等. 改良“三明治”近端主动脉成形法在Stanford A型主动脉夹层中的应用. 中国循环杂志, 2013, 28(z1): 215.
6.	陆清声. 主动脉弓疾病腔内治疗体外开窗技巧. 中国血管外科杂志(电子版), 2019, 11(2): 83-85.
7.	Tan TW, Coulter AH, Zhang WW. Percutaneous in situ left subclavian artery fenestration using reentry catheter during endovascular thoracic aortic aneurysm repair. Int J Angiol, 2016, 25(5): e77-e80.
8.	Mészáros I, Mórocz J, Szlávi J, et al. Epidemiology and clinicopathology of aortic dissection. Chest, 2000, 117(5): 1271-1278.
9.	Hagan PG, Nienaber CA, Isselbacher EM, et al. The International Registry of Acute Aortic Dissection (IRAD): New insights into an old disease. JAMA, 2000, 283(7): 897-903.
10.	Mizuno T, Toyama M, Tabuchi N, et al. Stented elephant trunk procedure combined with ascending aorta and arch replacement for acute type A aortic dissection. Eur J Cardiothorac Surg, 2002, 22(4): 504-509.
11.	Etz CD, Weigang E, Hartert M, et al. Contemporary spinal cord protection during thoracic and thoracoabdominal aortic surgery and endovascular aortic repair: A position paper of the vascular domain of the European Association for Cardio-Thoracic Surgery. Eur J Cardiothorac Surg, 2015, 47(6): 943-957.
12.	Kazimierczak A, Jedrzejczak T, Rynio P, et al. Favorable remodeling after hybrid arch debranching and modified provisional extension to induce complete attachment technique in type A aortic dissection: A case report. Medicine (Baltimore), 2018, 97(37): e12409.
13.	Gaudino M, Bakaeen F, Davierwala P, et al. New strategies for surgical myocardial revascularization. Circulation, 2018, 138(19): 2160-2168.
14.	Moulakakis KG, Mylonas SN, Markatis F, et al. A systematic review and meta-analysis of hybrid aortic arch replacement. Ann Cardiothorac Surg, 2013, 2(3): 247-260.
15.	Aboyans V, Desormais I, Magne J, et al. Renal artery stenosis in patients with peripheral artery disease: Prevalence, risk factors and long-term prognosis. Eur J Vasc Endovasc Surg, 2017, 53(3): 380-385.
16.	石烽, 王志维, 吴红兵, 等. 杂交手术治疗Stanford A型主动脉夹层. 实用医学杂志, 2019, 35(13): 2175-2179.
17.	赵名贤, 张理, 李国杰. Castor分支型覆膜支架治疗锚定区不足的B型主动脉夹层的效果分析. 临床外科杂志, 2021, 29(9): 869-871.
18.	Luebke T, Brunkwall J. Outcome of patients with open and endovascular repair in acute complicated type B aortic dissection: A systematic review and meta-analysis of case series and comparative studies. J Cardiovasc Surg (Torino), 2010, 51(5): 613-632.
19.	Stone DH, Brewster DC, Kwolek CJ, et al. Stent-graft versus open-surgical repair of the thoracic aorta: mid-term results. J Vasc Surg, 2006, 44(6): 1188-1197.
20.	成青鉴, 何瑜媛, 车辙, 等. 腔内治疗破口位于升主动脉的 Stanford A 型主动脉夹层. 中国普外基础与临床杂志, 2020, 27(6): 729-733.
21.	Murphy EH, Stanley GA, Ilves M, et al. Thoracic endovascular repair (TEVAR) in the management of aortic arch pathology. Ann Vasc Surg, 2012, 26(1): 55-66.
22.	陆清声. 分支支架技术在弓部分支血管重建中的应用及评价. 中国实用外科杂志, 2018, 38(12): 1369-1373.
23.	舒畅, 王暾, 黎明, 等. “烟囱”技术在治疗累及主动脉弓分支动脉的Stanford B型主动脉夹层中的应用. 中华医学杂志, 2012, 92(47): 3320-3323.
24.	舒畅, 王暾, 李全明, 等. 腔内修复联合辅助技术治疗累及主动脉弓的Stanford B型夹层动脉瘤. 中华普通外科杂志, 2011, 26(11): 899-903.
25.	吴明乐, 陈旭, 汪华, 等. 转流技术在Standford B型主动脉夹层治疗中的应用及疗效评价. 世界中医药, 2015, 10(A02): 821-822.
26.	陈燕青, 陆清声. 多层裸支架技术治疗动脉瘤的研究进展. 中华普通外科杂志, 2016, 31(8): 699-701.
27.	李晓晔, 陆清声. 主动脉弓疾病腔内治疗分支重建进展. 中华血管外科杂志, 2021, 6(2): 77-80.
28.	Malaisrie SC, Szeto WY, Halas M, et al. 2021 The American Association for Thoracic Surgery expert consensus document: Surgical treatment of acute type A aortic dissection. J Thorac Cardiovasc Surg, 2021, 162(3): 735-758.

1. 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.
2. Bavaria J, Milewski RK, Baker J, et al. Classic hybrid evolving approach to distal arch aneurysms: Toward the zone zero solution. J Thorac Cardiovasc Surg, 2010, 140(6 Suppl): S77-S80.
3. 舒畅, 施俊哲, 葛建军, 等. 杂交技术治疗累及弓部主动脉病变的中国专家共识. 中国循环杂志, 2020, 35(2): 124-129.
4. Zhang L, Yu C, Yang X, et al. Hybrid and frozen elephant trunk for total arch replacement in DeBakey type Ⅰ dissection. J Thorac Cardiovasc Surg, 2019, 158(5): 1285-1292.
5. 朱志成, 柳克祥, 王天策, 等. 改良“三明治”近端主动脉成形法在Stanford A型主动脉夹层中的应用. 中国循环杂志, 2013, 28(z1): 215.
6. 陆清声. 主动脉弓疾病腔内治疗体外开窗技巧. 中国血管外科杂志(电子版), 2019, 11(2): 83-85.
7. Tan TW, Coulter AH, Zhang WW. Percutaneous in situ left subclavian artery fenestration using reentry catheter during endovascular thoracic aortic aneurysm repair. Int J Angiol, 2016, 25(5): e77-e80.
8. Mészáros I, Mórocz J, Szlávi J, et al. Epidemiology and clinicopathology of aortic dissection. Chest, 2000, 117(5): 1271-1278.
9. Hagan PG, Nienaber CA, Isselbacher EM, et al. The International Registry of Acute Aortic Dissection (IRAD): New insights into an old disease. JAMA, 2000, 283(7): 897-903.
10. Mizuno T, Toyama M, Tabuchi N, et al. Stented elephant trunk procedure combined with ascending aorta and arch replacement for acute type A aortic dissection. Eur J Cardiothorac Surg, 2002, 22(4): 504-509.
11. Etz CD, Weigang E, Hartert M, et al. Contemporary spinal cord protection during thoracic and thoracoabdominal aortic surgery and endovascular aortic repair: A position paper of the vascular domain of the European Association for Cardio-Thoracic Surgery. Eur J Cardiothorac Surg, 2015, 47(6): 943-957.
12. Kazimierczak A, Jedrzejczak T, Rynio P, et al. Favorable remodeling after hybrid arch debranching and modified provisional extension to induce complete attachment technique in type A aortic dissection: A case report. Medicine (Baltimore), 2018, 97(37): e12409.
13. Gaudino M, Bakaeen F, Davierwala P, et al. New strategies for surgical myocardial revascularization. Circulation, 2018, 138(19): 2160-2168.
14. Moulakakis KG, Mylonas SN, Markatis F, et al. A systematic review and meta-analysis of hybrid aortic arch replacement. Ann Cardiothorac Surg, 2013, 2(3): 247-260.
15. Aboyans V, Desormais I, Magne J, et al. Renal artery stenosis in patients with peripheral artery disease: Prevalence, risk factors and long-term prognosis. Eur J Vasc Endovasc Surg, 2017, 53(3): 380-385.
16. 石烽, 王志维, 吴红兵, 等. 杂交手术治疗Stanford A型主动脉夹层. 实用医学杂志, 2019, 35(13): 2175-2179.
17. 赵名贤, 张理, 李国杰. Castor分支型覆膜支架治疗锚定区不足的B型主动脉夹层的效果分析. 临床外科杂志, 2021, 29(9): 869-871.
18. Luebke T, Brunkwall J. Outcome of patients with open and endovascular repair in acute complicated type B aortic dissection: A systematic review and meta-analysis of case series and comparative studies. J Cardiovasc Surg (Torino), 2010, 51(5): 613-632.
19. Stone DH, Brewster DC, Kwolek CJ, et al. Stent-graft versus open-surgical repair of the thoracic aorta: mid-term results. J Vasc Surg, 2006, 44(6): 1188-1197.
20. 成青鉴, 何瑜媛, 车辙, 等. 腔内治疗破口位于升主动脉的 Stanford A 型主动脉夹层. 中国普外基础与临床杂志, 2020, 27(6): 729-733.
21. Murphy EH, Stanley GA, Ilves M, et al. Thoracic endovascular repair (TEVAR) in the management of aortic arch pathology. Ann Vasc Surg, 2012, 26(1): 55-66.
22. 陆清声. 分支支架技术在弓部分支血管重建中的应用及评价. 中国实用外科杂志, 2018, 38(12): 1369-1373.
23. 舒畅, 王暾, 黎明, 等. “烟囱”技术在治疗累及主动脉弓分支动脉的Stanford B型主动脉夹层中的应用. 中华医学杂志, 2012, 92(47): 3320-3323.
24. 舒畅, 王暾, 李全明, 等. 腔内修复联合辅助技术治疗累及主动脉弓的Stanford B型夹层动脉瘤. 中华普通外科杂志, 2011, 26(11): 899-903.
25. 吴明乐, 陈旭, 汪华, 等. 转流技术在Standford B型主动脉夹层治疗中的应用及疗效评价. 世界中医药, 2015, 10(A02): 821-822.
26. 陈燕青, 陆清声. 多层裸支架技术治疗动脉瘤的研究进展. 中华普通外科杂志, 2016, 31(8): 699-701.
27. 李晓晔, 陆清声. 主动脉弓疾病腔内治疗分支重建进展. 中华血管外科杂志, 2021, 6(2): 77-80.
28. Malaisrie SC, Szeto WY, Halas M, et al. 2021 The American Association for Thoracic Surgery expert consensus document: Surgical treatment of acute type A aortic dissection. J Thorac Cardiovasc Surg, 2021, 162(3): 735-758.

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Short-term outcome of ascending aorta replacement combined with total aortic arch fenestration technique for acute type A aortic dissection

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