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Original Articles: Adult Cardiac

Surgery for Acute Type A Dissection With the Tear in the Descending Aorta Using a Stented Elephant Trunk Procedure

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

Accepted for publication January 16, 2009.

^_* 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: Surgical management of acute type A dissection with the tear in the descending aorta is challenging because of the technical difficulty in managing proximal and distal aortic lesions through a median sternotomy or lateral thoracotomy using a single-stage procedure.

Methods: Thirty-three patients with acute type A dissection with the tear in the descending aorta underwent total arch replacement combined with stented elephant trunk implantation through a median sternotomy from April 2003 to June 2007. Preoperative complications included acute cardiac tamponade (n = 1), acute left heart failure (n = 1), acute myocardial infarction (n = 1), cerebral ischemia (n = 1), acute renal failure (n = 2), chronic renal dysfunction (n = 2), and acute mesenteric ischemia (n = 1) and lower extremity ischemia (n = 3). The residual false lumen was evaluated using postoperative computed tomography.

Results: Death at 30 days was 6.06% (2 of 33 patients). One patient with preoperative mesenteric ischemia died of postoperative multiple-organ failure. One patient with preoperative acute renal failure ceased treatment after three reoperations owing to uncontrollable bleeding. Left lower-extremity paraparesis occurred in 1 patient, and transient neurologic dysfunction occurred in 1 patient. Severe complications were not observed at a mean follow-up of 25 ± 11 months. Thrombus obliteration of the false lumen was observed at the distal end of the stented graft in 29 patients (96.7%) and at the diaphragmatic level in 20 patients (66.7%) during follow-up.

Conclusions: Encouraging outcomes favor this technique in patients with acute type A dissection with the tear in the descending aorta. Simultaneous repair of proximal aortic lesions and thrombosis of the false lumen in the descending aorta could be obtained.

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Martin Czerny and Michael Grimm
Ann. Thorac. Surg. 2009 87: 1181. [Extract] [Full Text] [PDF]

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				M. Czerny and M. Grimm Invited Commentary Ann. Thorac. Surg., April 1, 2009; 87(4): 1181 - 1181. [Full Text] [PDF]