To explore the safety and feasibility of endograft repair in refractory aortic dissection and dissecting aneurysm. The clinical data of 13 refractory cases of aortic dissection and dissecting aneurysm, 11 males and 2 females, aged 52 (38-82), out of the 68 consecutive patients with aortic dissection and dissecting aneurysm who underwent endograft repair from Jan 2001 to Oct 2004, were analyzed. Nine of the 13 cases were diagnoses as with aortic dissection and dissecting aneurysm of Stanford type A, 3 of which had tears in the ascending aorta (DeBakey type I), 3 had tears in aortic arch, and 3 had tears on the distal aortic arch with ascending aorta involved; and the other four out of the 13 cases were diagnosed as Stanford type B, one with Marfan's syndrome. Eight of the 13 cases had more than 2 entries, 3 of which had suffered from shock and hemathorax due to rupture preoperatively. Follow-up ranging 2 months to 3 years was carried out after the operation. Transluminal placement of stentgratf was technically successful in all patients. Three patients with DeBakey type I dissections received stent-grafts introduced through the left common carotid or right femoral artery, of which one case died from gastrointestinal hemorrhage 1 month postoperatively. For the patients with tears in aortic arch preliminary Y type bypass from ascending aorta to left common carotid artery and left subclivian artery was performed in 2 cases, and carotid-carotid artery bypass was performed in one case, and then stent-grafts were deployed through right femoral artery. The 3 cases with tears in the distal arch and ruptured aneurysm, received stent-grafts implantation through the femoral artery emergently, and closed thoracic drainage and anti-shock treatment, one of which died from another aneurysm rupture 27 hours postoperatively. Out of the 4 cases with Stanford type B dissection with multiple tear entries, 3 underwent multiple stent-grafts repair and 1 underwent emergent abdominal-bilateral iliac arteries Y-type graft bypass due to rupture of iliac dissecting aneurysm. During the follow-up CT, MRI and color Doppler sonography showed that all 11 patients remained healthy with the former tears well closed and thrombosis in the false lumen. Endograft repair for refractory aortic dissecting aneurysm is feasible and technically successful, especially for the patients with tears in the ascending aorta or aortic arch.
4Total Aortic Arch Replacements With a 4 Branched Frozen Elephant Trunk (FET) Graft in Acute Aortic Dissection (DeBakey type I)
Total Aortic Arch Replacements With a 4 Branched Frozen Elephant Trunk (FET) Graft in Acute Aortic Dissection (DeBakey type I)
Read more26Evolving Experience of Percutaneous Management of Type B Aortic Dissection
Evolving Experience of Percutaneous Management of Type B Aortic Dissection
Total aortic arch reconstruction with open placement of triple-branched stent graft for Stanford type A aortic dissection
Objective To report the primary experience of open placement of triple-branched stent graft for acute Stanford type A aortic dissection. Methods Between June 2008 and September 2009, 20 well-selected patients with acute Stanford type A aortic dissection underwent open placement of triple-branched stent graft for total arch reconstruction. When core cooling to a 20℃ nasophageal temperature, perfusion to the lower body was discontinued and the ascending aorta was transected at the base of the innominate artery. Through a transverse incision, the triple-branched stent graft was inserted into the true lumen of the arch and descending aorta, and each side arm of the stent graft was positioned one by one into the arch branches.The transected stump of the ascending aorta was reconstructed by inner proximal stent-free dacron tube of the main graft and outer teflon felt, and subsequently continuous anastomosis to the 1-branched dacron tube graft was made. Results Open placement of triple-branched stent graft was technically successful in all patients. The mean cardiopulmonary bypass time, aortic cross-clamp time and lower body arrest time were (163.2 ±19.2) min, (89.4 ±10.0) min and (32. 7 ±6. 6)min, respectively. Transient postoperative neurological dysfunction was observed in 1 patient and acute renal failure in 1 patient. All patients were discharged from the hospital. Their computed tomographic scans at 3 months postoperatively showed that all stent grafts were fully opened without distortion. In the vascular stent implantation site the dissected false lumen was eliminated. The false lumen of the descending aorta distal to the stent graft was closed with thrombus in 16 cases. Conclusion Open placement of triple-branched stent graft is a new effective technique for total arch reconstruction in acute type A aortic dissection. Patients have the indications of the extensive primary repair of the thoracic aorta without primary intimal tears in the arch may be the best candidates for this new technique. The size of the stent graft, the distances between two neighboring side arm grafts and the prevention of the intimal trauma during the placement are crucial for successful open placement of triple-branched stent graft. Key words: Aneurysm, dissecting; Blood vessel prosthesis; Stents; Aorta, thoracic
Read more1Surgical treatment strategy of acute Stanford A aortic dissection with coronary malperfusion
Objective To summarize the surgical treatment strategy of acute Stanford A aortic dissection with coronary malperfusion. Methods From January 2010 to November 2015, 307 patients of acute Stanford A aortic dissection underwent operation were included. The mean age was(51.3±13.0) years, ranged from 22 to 83. The BMI was(25.4±3.7) kg/m2 and 239(77.9%) were men. There were 210(71.2%) with hypertension, 9(2.9%) with Marfan syndrome, and 44(14.3%) with cardiac tamponade. Coronary malperfusion was confirmed in 43(14.0%) patients with 34 in right coronary artery, 5 in left coronary artery, and 4 in both. There were 26 type A, 8 type B, 9 type C in Neri system. We performed coronary ostia repair in 12 patients, Bentall in 16, coronary artery bypass grafting(CABG) in 9, and Bentall plus CABG in 6. CABG was also performed in 1 Bentall, 1 aortic valve repair, and 5 ascending aorta replacement in 264 patients without coronary malperfusion. Results The rate of CABG, cardiopulmonary bypass(CPB) time, aorta cross-clamp time were significantly higher in patients with coronary malperfusion(P<0.01). The in-hospital mortality was 32.6% in patients with coronary malperfusion and 14.4% in patients without coronary malperfusion. Thus, coronary malperfusion significantly increased in-hospital mortality(P<0.01). The mean follow-up time was(19.2±18.0) months with a 95% follow-up rate. The total follow-up survival rate is 97.5% and the rate of patients with coronary malperfusion is 100%. Multivariate logistic regression analysis shows that cardiac tamponade(OR=4.8, P<0.01) and CPB time(OR=1.0, P<0.01) was the independent risk factor of post-operation in-hospital mortality of acute Stanford A aortic dissection. Conclusion Acute Stanford A aortic dissection with coronary malperfusion has a significantly high in-hospital mortality with the indeed need of revascularization of coronary arteries rapidly. The treatment strategy depends on the specific clinical condition. Key words: Aortic dissection; Coronary malperfusion; Ssurgical operation
Read more18Dissection of the descending thoracic aorta extending into the ascending aorta
Dissection of the descending thoracic aorta extending into the ascending aorta
Reoperation on aortic disease in patients with previous aortic valve surgery
Objective Retrospectively analyze 47 cases received reoperation with aortic disease after aortic valve replacement to deepen the understanding of aortic valve disease.Methods From January 2003 to June 2012,47 patients with previous aortic valve replacement received aortic root or other aortic operation because of new aortic disease.38 male and 9 female,the interval (6.0 ± 3.8) years. All cases with new aortic disease were diagnosed by cardiac ultrasound and aortic computed tomography.Bentall's procedure were operated on 14 patients,total aortic arch replacement with elephant trunk procedure on 14 patients,aortic root and aortic arch with elephant trunk procedure on 7 patients,ascending aortic replacement on 10patients,total thoracic and abdominal aorta replacement on 2 cases.All patients were followed by clinic interview or telephone.Results Aortic dissection and aneurysmal dilatation were occurred on ascending aorta,each account for 50％,in patients with previous aortic valve replacement because of rheumatic valve disease and bicuspid aortic valve; 3 cases with Marfan syndrome occurred ascending aortic dilatation and 4 cases occurred aortic dissection.Diameter in ascending aorta increased (5.2 + 7.1)mm per year and aortic sinus (3.3 ± 3.1)mm per year.The value of ascending aortic dilatation per year in patients with rheumatic disease was higher than patients with Marfan syndrome(P ＜ 0.05).47 patients were re-operated in fuwai hospital,1 patients died in operating room because aortic dissection seriously involved right coronary artery.7 patients have renal insufficiency after operation and all were cured by hemofiltration; neurological complication occurred in 14 patients including that 7 patients stroked and 7 patients had transient brain dysfunciotn.There were no postoperative spinal cord deficits occurred.All patients were followed up,the mean follow up time were(53.49 +33.79) months.8 cases were died during follow-up and threeyear survival rate was 83％.There were no cases received operation due to aortic disease during follow-up.Conclusion Deepening the understanding of aortic valve disease combine ascending aorta changes,especially pay attention to patients with previous aortic valve replacement because of Marfan syndrome and rheumatic disease during follow-up after first operation,all efforts should decrease the occurrence of aortic adverse events in long term. Key words: Aortic valve; Heart valve prosthesis implantation; Aortic diseases; Reoperation
Read moreSurgical treatment of the aortic root aneurysm related to Marfan syndrome
To review the experience of surgical treatment of aortic root aneurysm of Marfan syndrome. We The clinical data of 84 Marfan syndrome patients, 61 males and 23 females, aged 35 +/- 12 (5 - 62), 41 cases presenting with aortic dissection (Debakey type I in 32 cases and type II in 9), 52 cases with moderate to severe aortic regurgitation, and 9 cases with moderate to severe mitral regurgitation, 43 cases with cardiac function of class I - II, 30 with class III and 11 with class IV according the New York Heart Association (NYHA) standard, who underwent surgical treatment for aortic root aneurysm with a mean diameter of 68 mm +/- 14 mm, were analyzed. Bentall procedure was performed in 68 cases, Wheat procedure in 6, Cabrol procedure in 5, and aortic valve replacement and aortoplasty in 5. Concomitant procedures included mitral value replacement and mitral valvuoplasty in 3 cases respectively. Urgent surgery was conducted in 28 cases, and elective operation in 56 cases. There were 3 in-hospital deaths (3.57%). 76 cases were followed up for a mean duration of 55 +/- 31 months. Three patients underwent reoperation. The cardiac function returned to class I - II except for 2 cases that remained at the class III. Bentall procedure should be the first choice of the surgery for aortic root aneurysm of Marfan syndrome with a low mortality and a good late outcome.
Read more1Strategies for handling the insufficiency of the proximal landing zone during endovascular thoracic aortic repair
To discuss two strategies for handling the insufficiency of the proximal landing zone (PLZ) during endovascular thoracic aortic repair. Ten patients underwent endovascular repair (EVR) in the thoracic aorta in one year. Nine patients had DeBakey type III aortic dissection aneurysm (ADA), and one had descending thoracic aortic aneurysm (DTAA). The PLZ, defined as the distance from the origin of the left subclavian artery (LSA) to the primary entry tear of the dissection or the proximal aspect of DTAA, was measured less than 15 mm in all instances by contrast-enhanced CT scan and digital subtraction angiography. The preliminary carotid-carotid and left carotid-subclavian bypass combined with EVR was employed in the DTAA and 3 ADA cases, and the EVR with the intentional coverage of the LSA without the preliminary bypass in the rest 6 ADA patients. The technical success was achieved in all instances. The case of DTAA died of the hemispheric cerebral infarction and subsequent multiple system organ failure, albeit the uneventful recovery from the prior cervical reconstruction. Dizziness occurred in 2 patients (ADA) after the EVR with the intentional bypass-absent coverage of the LSA, but noticeably resolved after the intravenous administration of mannitol for 4 to 5 days. No neurological deficits or limb ischemia developed perioperatively or during the follow-up range from 3 to 12 months. And complete thrombosis of the thoracic aortic false lumen and enlargement of the true lumen were revealed on CT at 3 months in all 9 patients with ADA. Both the adjunctive surgical bypass and the intentional bypass-absent coverage of the left subclavian artery appear feasible in handling the insufficiency of the proximal landing zone during the endovascular thoracic aortic repair. It can expand the EVR applicability in management of DeBakey type III ADAs and DTAAs.
Read moreResearch progress on endovascular aortic repair for treatment of acute Stanford type B aortic dissection
With the wide application and rapid development of thoracic endovascular aortic repair (TEVAR) , endovascular repair has become the main treatment for Stanford type B aortic dissection. The prognosis of endovascular repair of aortic dissection depends not only on the preoperative individualized preparation, fine and skilled operation, but also on the choice for surgical indication and surgical opportunity. For acute complicated type B aortic dissection, early TEVAR was advocated on the basis of drug therapy. But TEVAR was still controversial for uncomplicated type B aortic dissection during the acute phase. This article reviews the research progress of endovascular repair for treatment of acute type B aortic dissection. Key words: Stanford type B aortic dissection; Thoracic endovascular aortic repair; Angioplasty
Read more1Repair of Kommerell's Diverticulum and Aberrant Subclavian Arteries: Classification of the Five Groups in Declining Frequency and Their Operative Approaches
Repair of Kommerell's Diverticulum and Aberrant Subclavian Arteries: Classification of the Five Groups in Declining Frequency and Their Operative Approaches
Read moreInnovative improvement of circulatory arrest technique in acute stanford type A aortic dissection
Objective Total aortic arch replacement and stented elephant trunk surgery is an important surgical method for acute type A aortic dissection, and the short, middle, long term curative effect has been recognized by more and more experts at home and abroad. Circulatory arrest was an independent risk factor for postoperative complications and mortality in patients with type A aortic dissection. The aim of this article is to observed the effection of a new technology to block aortic arch, whicn can shorten the circulatory arrest time to 2 minutes and avoid harm of circulatory arrest on patients. Methods From May 2016 to February 2017, 68 patients with acute type A aortic dissection were divided into the conventional group and the modified group. All the patients underwent total arch replacement and stented elephant trunk surgery. The rectal temperature of the conventional group was 25℃ and circulatory arrest time was 20 min. While the rectal temperature of the modified group was 28℃ and and circulatory arrest time was 2 min. Results In the conventional operation group, 3 patients died after operation while all the patients in the modified group were cured and discharged. There are no differences between the two groups in the time of cardiopulmonary bypass(CPB) and heart arrest time(P>0.05). There are Significant differences in CPB time, circulatory arrest time, postoperative awake time, intubation time, amount of blood used, the amount of drainage during the first two days after operation, the time staying in ICU and the postoperative time in hospital. And the modified group was much better.(P<0.05) Conclusion The results of new technology blocking aortic arch in the patients with acute type A aortic dissection are better than the conventional surgical approach during the perioperative period. This technology is simple and effective. It is worth promoting. Key words: Aortic Dissection; Moderate hypothermic circulatory arrest
Read moreNursing care of patients with aneurysm of thoracic aorta and aortic dissecting aneurysm treated with the hybrid operation
Objective To explore the experience and management of intraoperative care of patients with aneurysm of thoracic aorta and aortic dissecting aneurysm treated with endovascular aneurysm repair and blood vessel bypass (the hybrid operation). Methods Ten patients with aneurysm of thoracic aorta and aortic dissecting aneurysm were treated with the hybrid operation in catheter lab. During the operation, nurses and doctors cooperated connivantly. Following measures were carried out to ensure the smooth operation and prevent the occurrence of complications: life signs were monitored carefully and medicines and equipments were prepared fully. Results 10 patients with aneurysm of thoracic aorta and aortic dissecting aneurysm underwent the hybrid operation successfully without no complications. Conclusions It was safe and effective to carry out the hybrid operation for patients with aneurysm of thoracic aorta and aortic dissecting aneurysm by strict management and specialist nurses raining. Skilled collaboration and strict life signs monitoring was pivotal to ensure the success of the hybrid operation. Key words: Thoracic aorta aneurysm; Aortic dissecting aneurysm; Endovascular aneurysm repair; Hybrid operation; Intervention nursing management
Read moreSun’s procedure with preservation of autologous brachiocephalic vessels for chronic type A aortic dissection
Objective To summarize the clinical outcomes and surgical indications for chronic type A aortic dissection(CTAD) by using Sun’s procedure with preservation of autologous brachiocephalic vessels. Methods From September 2010 to December 2013, 23 patients with CTAD underwent Sun’s procedure with preservation of autologous brachiocephalic vessels under moderate hypothermic circulatory arrest combined with selective cerebral perfusion in our center. The data was collected and analysed retrospectively. There were 20 males and 3 females patients with a mean age of(49.91±10.05) years. Preoperative comorbidities included Marfan syndrome in 1 patient, isolated left vertebral artery in 1, hypertension in 19, coronary artery disease in 2, heart dysfunction in 1, renal insufficiency in 1, mitral regurgitation in 1, and pulmonary infection in 1. Previous operation history included thoracic endovascular aortic repair in 3, percutaneous coronary intervention in 1, aortic valve replacement in 1, Bentall procedure in 1, and coronary artery bypass grafting in 1. Results The average operation time, cardiopulmonary bypass time, aortic cross clamping time and selective cerebral perfusion time was(6.43±1.03) h, (167.07±49.62) min, (80.74±29.00) min, and(27.35±6.03) min, respectively. Concomitant procedures included Bentall procedure in 6 patients, ascending aorta replacement in 17, ascending aorta-femoral artery bypass in 1, mitral valvuloplasty in 1, and CABG in 1. There were 2(8.70%) in hospital deaths. Three patients suffered temporary renal dysfunction, and 1 with renal failure recieved continuous renal replacement therapy. Postoperative hypoxemia were found in 2 patients, and 1 of them received reintubation. These patients recovered before discharge. The mean follow-up time was(52.52±9.89) months with a follow-up rate of 95.23%(20/21). One patient suffered cerebral embolism but recovered soon after treatment. The others were free from any complications. Conclusion Sun’s procedure with preservation of autologous brachiocephalic vessels simplified the aortic arch surgery and obtained satisfactory outcomes for suitable patients with CTAD, but surgical indications should be strictly considered. Key words: Chronic type A aortic dissection(CTAD) Sun’s procedure Total arch replacement En block technique
Read moreEndovascular repair for retrograde type A aortic dissection with an entry tear in the descending aorta
Objective To evaluate endovascular aortic repair for retrograde Stanford type A aortic dissection with an entry tear in the descending aorta.Methods From April 2006 to Dec 2012,31 patients with retrograde type A aortic dissection were treated with endovascular technique.22 patients had pleural effusion,14 patients had patent false lumen in the ascending aorta.Emergency operation was performed in 2 patients with acute right renal artery and right common iliac artery ischemia respectively.29 patients received endovascular treatment after 3 weeks conservative treatment.Chimney technique was used in 3 patients.Results All procedures were technically successful without severe complications.Ascending aorta recovered 1-3 months after operation.Pleural effusion subsided 3 days to 3 weeks after endovascular treatment.During follow-up of (31 ± 18) months,no severe complications developed,all the stent-grafts placed by chimney technique were patent.Conclusions Endovascular aortic repair can be used in the treatment of retrograde Stanford type A aortic dissection.Chimney technique can be used to reconstruct supra-aortic branches. Key words: Aneurysm, dissecting; Stents; Endovascular repair
Read moreTwo-stage repair for DeBakey type II acute aortic dissection and distal aortic arch aneurysm in a nonagenarian patient
Although total arch replacement would be performed in a patient with acute type A aortic dissection and concomitant aortic aneurysm in the distal aortic arch, total arch replacement may be too invasive in elderly patients with significant morbidities. A 92-year-old female with acute type II DeBakey aortic dissection and concomitant distal aortic arch aneurysm was successfully treated with hemi-arch replacement followed by thoracic endovascular aortic repair. Hybrid two-stage repair of DeBakey type II aortic dissection complicated by distal arch aneurysm using thoracic endovascular aortic repair after hemi-arch replacement may be effective.
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