Novel arch fenestrated stent graft for acute Stanford Type A aortic dissection with open antegrade implantation.

Abstract

The best surgical strategy for acute Stanford Type A aortic dissection (aTAAD) involving the arch remains controversial. Here, we report on the satisfactory results following aTAAD repair using a novel arch fenestrated stent graft. From December 2014 to December 2015, 42 aTAAD patients (27 male and 15 female) underwent ascending aorta replacement and fenestrated stent graft implantation. The fenestrated stent graft was implanted into the true lumen of the aortic arch and proximal descending aorta, with the fenestration opening located at the ostia of 3 head vessels in the arch. The proximal end of the stent graft was anastomosed to the distal end of the Dacron tube graft that replaced the proximal ascending aorta. All patients underwent contrast-enhanced computed tomography angiography prior to discharge and during follow-up. The average cardiopulmonary bypass duration was 213 ± 49 min, aortic cross-clamp duration was 133 ± 39 min and unilateral cerebral perfusion and lower body arrest duration was 27 ± 8 min. There were 2 in-hospital deaths due to circulation failure (mortality 4.8%). During a mean follow-up period of 7.4 ± 3.2 months, 1 patient with Behçet's disease died of aortic root pseudoaneurysm. The 39 surviving patients underwent contrast-enhanced computed tomography scans at 3, 6 and 12 months, which indicated increasing false-lumen thrombosis. In aTAAD patients, the use of the novel arch fenestrated stent graft achieved excellent aortic remodelling of the aortic arch and descending aorta without any increase in the morbidity and mortality.