Off Pump Banding with or Without Stenting of the Ascending Aorta for Stanford Type A Acute Aortic Dissection

Abstract

Introduction: Conventional surgical treatment of Stanford type A acute aortic dissection is associated with considerable in-hospital morbi-mortality especially in elderly patients. Here we evaluate the results of a less invasive surgical approach by external off-pump wrapping of the ascending aorta (+/- aortic arch) with or without stenting Methods: From 2008 to 2019, 36 patients (22 males) with a mean age of 76.5 years with Stanford type A acute aortic dissection without coronary malperfusion neither significant aortic regurgitation underwent off-pump wrapping of ascending aorta (n=15) or ascending aorta and aortic arch (n=21). Operation was carried on through median sternotomy under controlled arterial hypotension. After dividing ascending aorta from pulmonary artery bifurcation, a Teflon graft was placed around the aorta and was shaped with a running suture to tighten and wrap the ascending aorta. A second graft for aortic arch was tailored to leave the passage to supra aortic trunks. An endovascular treatment of the ascending aorta was performed after CT scan control in case of flap obstruction. Survival analysis was performed through a Kaplan Meier analysis. Results: Follow up was complete. Survival rates were 94.5%, 94.5%, and 83.7% at 30 days, 6 months and 5 years respectively(4 deaths unrelated to the aortic pathology). In-hospital mortality was 5.5% related to acute kidney injury (day 2 and day 7). Mean hospital stay was 17 days. Secondarily ascending aortic stenting was performed in 16.7%: 4 patients had an uncovered stenting of reinforced ascending aorta, to prevent the proximal progression of the false lumen toward aortic root and 2 others had endovascular stenting of aortic isthmus and descending aorta. All survivors (n=34) were home discharged and were self-catering. Conclusion: In our experience, off-pump wrapping of ascending aorta improve early and late prognostic of Stanford type A acute aortic dissectionin elderly or high risk patients. Endovascular stenting is needed in few cases. Disclosure: Nothing to disclose