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Original Articles: Adult Cardiac

Surgery for Marfan Patients With Acute Type A Dissection Using a Stented Elephant Trunk Procedure

^a Department of Cardiovascular Surgery, Cardiovascular Institute and Fuwai Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
^b Department of Radiology, Cardiovascular Institute and Fuwai Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China

Accepted for publication August 11, 2008.

^_* Address correspondence to Dr Sun, Department of Cardiovascular Surgery, Cardiovascular Institute and Fuwai Hospital, 167 Beilishi Rd, Beijing, 100037, China (Email: slzh_2005{at}yahoo.com.cn).

Background: The purpose of the study was to assess the efficacy of total arch replacement combined with stented elephant trunk implantation for Marfan patients with acute Stanford type A aortic dissection involving the aortic arch.

Methods: Between January 2004 and April 2006, 13 consecutive Marfan patients (4 female, 9 male) with acute type A aortic dissection involving the aortic arch underwent total arch replacement combined with implantation of a stented elephant trunk. Aortic dissection extending to the iliac artery was seen in 10 patients, and to the abdominal aorta in 3 patients. Ages ranged from 17 to 65 years (mean, 39 ± 13). Computed tomography was done to evaluate the residual false lumen in the descending aorta.

Results: All patients survived and were discharged from hospital. One patient with thrombosis of the innominate artery suffered cerebral infarction and recovered during follow-up. One patient had ischemia of the left upper limb postoperatively, but recovered after axillary to axillary artery bypass. There was 1 death during the mean follow-up period of 27 ± 10 months. Complete thrombus formation was observed in 84.6% of patients (11 of 13) around the stented elephant trunk, and in 69.2% of patients (9 of 13) at the diaphragmatic level.

Conclusions: Total arch replacement combined with stented elephant trunk implantation for Marfan patients with acute type A aortic dissection involving the aortic arch results in less late dilatation of the dissected descending aorta. That prolongs the reoperation interval or reduces the number of late thoracoabdominal aortic replacements, unless there is a patent false lumen around the stented elephant trunk.

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Invited Commentary

Jacques Kpodonu
Ann. Thorac. Surg. 2008 86: 1826. [Extract] [Full Text] [PDF]

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				L.-Z. Sun, R.-D. Qi, Q. Chang, J.-M. Zhu, Y.-M. Liu, C.-T. Yu, B. Lv, J. Zheng, L.-X. Tian, and J.-G. Lu Is total arch replacement combined with stented elephant trunk implantation justified for patients with chronic Stanford type A aortic dissection? J. Thorac. Cardiovasc. Surg., October 1, 2009; 138(4): 892 - 896. [Abstract] [Full Text] [PDF]

				L. Sun, R. Qi, Q. Chang, J. Zhu, Y. Liu, C. Yu, H. Zhang, B. Lv, J. Zheng, L. Tian, et al. Surgery for Acute Type A Dissection With the Tear in the Descending Aorta Using a Stented Elephant Trunk Procedure Ann. Thorac. Surg., April 1, 2009; 87(4): 1177 - 1180. [Abstract] [Full Text] [PDF]

				J. Kpodonu Invited Commentary Ann. Thorac. Surg., December 1, 2008; 86(6): 1826 - 1826. [Full Text] [PDF]