Early Influence of Valve-Related Anticoagulation on False Lumen Thrombosis in Aortic Dissection Patients after Stented Elephant Trunk Surgery

Abstract

Background: Aim of the study was to assess the influence of anticoagulation on the false lumen after a stented elephant trunk procedure with mechanical valve replacement for aortic dissection patients. Methods: Between 2003 and 2008, 181 out of 232 aortic dissection patients undergoing stented elephant trunk procedure concomitant with arch and/or proximal surgery were enrolled in this study. Fifty-five patients received an aortic valve replacement (AVR) with mechanical prosthesis. Patients were divided into two groups: with and without AVR. The aorta was evaluated by CT, and the diameter ratios between the true lumen and the aorta were calculated and the extent of thrombosis of the false lumen was quantified. Results: Follow-up CT study at one year showed a significant difference between groups, mainly in the diameter ratios of the stent and aorta at the same level (p = 0.003, at the stent end). Accordingly, CT data after hospital discharge differed significantly with regard to the extent of false lumen thrombosis at the carina level (p = 0.020, at one year). Over one year after surgery, the residual false lumen around the stent-graft achieved complete thrombosis obliteration in 87.3 % of patients with AVR and in 98.4 % without AVR (p = 0.005). Conclusions: Valve-related anticoagulation is associated with delay in false lumen thrombosis around the stent-graft.

Key words

aortic disease - anticoagulation

References

• 1 Uchida N, Shibamura H, Katayama A et al. Operative strategy for acute type A aortic dissection: ascending aortic or hemi-arch versus total arch replacement with frozen elephant trunk.  Ann Thorac Surg. 2009;  87 773-777
• 2 Liu Z G, Sun L Z, Chang Q et al. Should the ‘ elephant trunk‘ be skeletonized? Total arch replacement combined with stented elephant trunk implantation for Stanford type A aortic dissection.  J Thorac Cardiovasc Surg. 2006;  131 107-113
• 3 Sun L Z, Qi R D, Chang Q et al. Surgery for Marfan patients with acute type A dissection using a stented elephant trunk procedure.  Ann Thorac Surg. 2008;  86 1821-1826
• 4 Sun L Z, Qi R D, Chang Q et al. Surgery for acute type A dissection with the tear in the descending aorta using a stented elephant trunk procedure.  Ann Thorac Surg. 2009;  87 1177-1180
• 5 Hu X P, Chang Q, Zhu J M et al. One-stage total or subtotal aortic replacement.  Ann Thorac Surg. 2006;  82 542-546
• 6 Karck M, Kamiya H. Progress of the treatment for extended aortic aneurysms; is the frozen elephant trunk technique the next standard in the treatment of complex aortic disease including the arch?.  Eur J Cardiothorac Surg. 2008;  33 1007-1013
• 7 Watanuki H, Ogino H, Minatoya K et al. Is emergency total arch replacement with a modified elephant trunk technique justified for acute type A aortic dissection?.  Ann Thorac Surg. 2007;  84 1585-1591
• 8 Etz C D, Plestis K A, Kari F A et al. Staged repair of thoracic and thoracoabdominal aortic aneurysms using the elephant trunk technique: a consecutive series of 215 first stage and 120 complete repairs.  Eur J Cardiothorac Surg. 2008;  34 605-614
• 9 Kantelhardt S R, Pasnoori V, Varma J et al. Recurrent aortic dissection in Marfan's syndrome: possible effects of anticoagulation.  Cardiol Rev. 2003;  11 240-243
• 10 Blunt D M, Impallomeni M G. Warfarin-associated thoracic aortic dissection in an elderly woman.  Age Ageing. 2004;  33 199-201
• 11 Uchida N, Shibamura H, Katayama A et al. Total arch replacement with an open stent-graft for acute type A aortic dissection: fate of the false lumen.  Eur J Cardiothorac Surg. 2009;  35 83-88