Total arch repair for acute type a aortic dissection with open placement of a modified triple-branched stent graft and the arch open technique

Xiao-Fu Dai,Qianzhen Li ,Lin Lü ,Xi-Jie Wu,Dong-Shan Liao,Liangwan Chen ,Chao Li

doi:10.1186/preaccept-1685782693127158

Xiao-Fu Dai, Qianzhen Li

Open Access

https://doi.org/10.1186/preaccept-1685782693127158

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Abstract

BackgroundIn total arch repair with open placement of a triple-branched stent graft for acute type A aortic dissection, the diameters of the native arch vessels and the distances between 2 neighboring arch vessels did not always match the available sizes of the triple-branched stent grafts, and insertion of the triple-branched stent graft through the distal ascending aortic incision was not easy in some cases. To reduce those two problems, we modified the triple-branched stent graft and developed the arch open technique.Methods and resultsTotal arch repair with open placement of a modified triple-branched stent graft and the arch open technique was performed in 25 consecutive patients with acute type A aortic dissection. There was 1 surgical death. Most survivors had an uneventful postoperative course. All implanted stents were in a good position and wide expansion, there was no space or blood flow surrounding the stent graft. Complete thrombus obliteration of the false lumen was found around the modified triple-branched stent graft in all survivors and at the diaphragmatic level in 20 of 24 patients.ConclusionsThe modified triple-branched stent graft could provide a good match with the different diameters of the native arch vessels and the various distances between 2 neighboring arch vessels, and it’s placement could become much easier by the arch open technique. Consequently, placement of a modified triple-branched stent graft could be easily used in most patients with acute type A aortic dissection for effective total arch repair.

Highlights

In total arch repair with open placement of a triple-branched stent graft for acute type A aortic dissection, the diameters of the native arch vessels and the distances between 2 neighboring arch vessels did not always match the available sizes of the triple-branched stent grafts, and insertion of the triple-branched stent graft through the distal ascending aortic incision was not easy in some cases
The modified triple-branched stent graft could provide a good match with the different diameters of the native arch vessels and the various distances between 2 neighboring arch vessels, and it’s placement could become much easier by the arch open technique
Placement of a modified triple-branched stent graft could be used in most patients with acute type A aortic dissection for effective total arch repair

Summary

Introduction

In total arch repair with open placement of a triple-branched stent graft for acute type A aortic dissection, the diameters of the native arch vessels and the distances between 2 neighboring arch vessels did not always match the available sizes of the triple-branched stent grafts, and insertion of the triple-branched stent graft through the distal ascending aortic incision was not easy in some cases. Total arch replacement is very complex and highly invasive if it is performed with the traditional method, which makes the risk of this procedure very high in patients with acute type A aortic dissection [2]. Whether this traditional total arch replacement with possible additional operative risk can be justified from the viewpoint of potential long-term benefits remains controversial [9,10]. Traditional total arch replacement can’t be widely accepted as preferred surgical treatment for acute type A aortic dissection during the emergency repair

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