Abstract
BackgroundThe primary experience of open triple-branched stent graft placement for acute aortic arch dissection was reported.MethodsBetween January 2011 and October 2011, 13 well-selected patients (mea age, 46±8.2 years; approximate range, 30~58 years) with acute aortic arch dissection underwent open triple-branched stent graft placement for total arch reconstruction. The triple-branched stent graft was a branched 1-piece graft consisting of a self-expandable nitinol stent and polyester vascular graft fabric (Yuhengjia Sci Tech Corp Ltd, Beijing, China).During hypothermic circulatory arrest, through the transverse incision of the ascending aorta, the main graft of the triple-branched stent graft was inserted into the true lumen of the arch and proximal descending aorta, and then each sidearm graft was positioned one by one into the aortic branch. Once the main graft and sidearm grafts were properly positioned, the restraining strings were withdrawn and then the main graft and sidearm grafts were deployed. Enhanced electric beam computed tomography was performed in each patient before discharge to evaluate the postoperative time course of the residual false lumen.ResultsOpen triple-branched stent graft placement was technically successful in all patients. The mean cardiopulmonary bypass time, aortic cross-clamp time and arrest time were 138.40±47.75 min, 70.60±28.94 min and 28.60±12.48 min, respectively. All patients were discharged from hospital. Their computed tomographic scans postoperatively showed that all stent grafts were fully opened and not kinked, there was no blood flow surrounding the triple-branched stent graft.ConclusionOpen triple-branched stent graft placement is a new effective technique for total arch reconstruction in acute arch dissection.
Highlights
The primary experience of open triple-branched stent graft placement for acute aortic arch dissection was reported
We describe the initial clinical results of our application of this new technique in 13 patients with acute arch dissection
The 13 patients were selected for extensive primary repair of the thoracic aorta by means of ascending aorta replacement combined with open placement of triple-branched stent graft because they satisfied following inclusion and exclusion criteria
Summary
The primary experience of open triple-branched stent graft placement for acute aortic arch dissection was reported. Crawford and associates [4] reported the complications of this method: kinking and occlusion of the graft, paraplegia as a result of clotting around the graft, and peripheral thromboembolism caused by flapping action. To avoid these potential complications of a long elephant trunk graft, Kato et al [5] inserted a graft, the distal part of which was sustained by an intraluminal stent into the the hybrid technique [5,6] of Kato or Sun’s is still a complex procedure, mainly because it still requires careful manipulation of the arch and elaborate anastomosis to the distal arch and three arch vessels. We describe the initial clinical results of our application of this new technique in 13 patients with acute arch dissection
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