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Total Arch Replacement with Stented Elephant Trunk Technique: A Proposed Treatment for Complicated Stanford Type B Aortic Dissection
Author(s) -
Li Bin,
Sun Lizhong,
Chang Qian,
Zhu Junming,
Yu Cuntao,
Liu Yongmin,
Zheng Jun,
Qi Ruidong
Publication year - 2009
Publication title -
journal of cardiac surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.428
H-Index - 58
eISSN - 1540-8191
pISSN - 0886-0440
DOI - 10.1111/j.1540-8191.2009.00925.x
Subject(s) - medicine , elephant trunks , surgery , aortic dissection , aortic arch , descending aorta , aorta , thrombus , paraplegia , dissection (medical) , radiology , psychiatry , spinal cord
Objectives : The treatment of Stanford type B aortic dissections involving the arch or associated with proximal aortic aneurysms remains a surgical challenge. We report our results with total arch replacement with the stented elephant trunk (SET) procedure for these complicated Stanford type B aortic dissections. Methods: Between December 2003 and June 2008, 31 patients were admitted for complicated type B dissection (12 acute, 19 chronic). The mean age at operation was 44.3 ± 10.6 years (range: 22‐68 years). The surgeries were performed by using total arch replacement combined with SET implantation. Enhanced computed tomography (CT) was performed before discharge as well as 3 months and annually to evaluate the condition of the graft and the residual false lumen. Results: The procedure was successful in all but two patients; two patients died of multiple organ failure following surgery. No paraplegia was observed after surgery. Follow‐up was completed in 27 of 29 patients and the mean follow‐up period was 18.4 ± 12.3 months (range: 6‐54 months). During follow‐up CT scans, thrombus formation was observed in the descending aortic false lumen excluded by the stented graft in most patients. One patient died during follow‐up while two patients with Marfan syndrome underwent successful operations for replacement of the remaining descending and abdominal aorta. Conclusion: Total arch replacement with the SET procedure has emerged as a viable option for complicated type B dissections and is associated with low morbidity and mortality. At mid‐term follow‐up, most patients have either thrombosed or have had no further increase in the false lumen of the descending aorta.