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CC BY 4.0 · Aorta (Stamford) 2019; 07(06): 163-168
DOI: 10.1055/s-0039-3402071
Original Research Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Repeat Surgery in Chronic Aortic Dissection: A New Technique without Touching the Native Aorta

Gian Luca Martinelli 
1   Department of CardioVascular, Clinica San Gaudenzio-Gruppo Policlinico di Monza, Novara, Italy
,
Attilio Cotroneo
1   Department of CardioVascular, Clinica San Gaudenzio-Gruppo Policlinico di Monza, Novara, Italy
,
Valerio Tolva
2   Department of Vascular Surgery, Policlinico di Monza, Monza, Italy
,
Felice Armienti
3   Department of Radiology, Clinica San Gaudenzio-Gruppo Policlinico di Monza, Novara, Italy
,
Mario Bobbio
1   Department of CardioVascular, Clinica San Gaudenzio-Gruppo Policlinico di Monza, Novara, Italy
,
Gabriele Musica
1   Department of CardioVascular, Clinica San Gaudenzio-Gruppo Policlinico di Monza, Novara, Italy
,
Enrico Visetti
4   Department of Anesthesia, Clinica San Gaudenzio-Gruppo Policlinico di Monza, Novara, Italy
,
Ugo Filippo Tesler
1   Department of CardioVascular, Clinica San Gaudenzio-Gruppo Policlinico di Monza, Novara, Italy
› Institutsangaben Funding None.
Weitere Informationen

Publikationsverlauf

24. April 2018

02. November 2019

Publikationsdatum:
19. Februar 2020 (online)

   Lizenzen und Reprints

Abstract

Background Repeat surgery of the chronically dissected aorta following repair of a Type-A acute aortic dissection (AAD) still represents a challenge. The proposed surgical options are as follows: (1) staged procedure with elephant trunk (ET) technique, (2) traditional frozen elephant trunk (FET) intervention, and (3) beating heart cerebral vessel debranching followed by thoracic endovascular aortic repair (TEVAR). However, a marked enlargement of the proximal descending thoracic aorta might make it difficult to perform FET/ET intervention. Furthermore, because in conventional surgery for AAD, a prosthetic graft replacement is generally limited to the ascending aorta, and in repeat surgery, this short Dacron graft rarely provides enough room to allow a beating heart cerebral vessel debranching and obtaining a reliable landing zone for the implantation of a firmly anchored stent graft.

Methods We retrospectively reviewed all the five consecutive patients treated in our institution, between 2014 and 2017, for chronic aortic dissection after successful surgical treatment of acute Type-A aortic dissection with graft replacement limited to the ascending aorta. The five patients underwent repair utilizing a modified FET technique with total aortic arch and upper descending aorta exclusion without touching the native dissected aorta.

Results No early- or midterm mortality was observed. Mean time interval between the initial and the reoperative procedure was 26 months (range, 3–80 months). No patient had a minor/major neurologic event. Mean circulatory arrest time was 16 minutes (range, 11–25 minutes). Mean follow-up time was 22 months (range, 9–42 months).

Conclusions We report our initial experience with a modified FET technique realized by anastomosing the stent graft with the previously implanted ascending aortic graft in Hishimaru's zone 0 and by rerouting all cerebral vessels without “touching” the native chronically dissected aorta. A larger number of patients and a longer follow-up will be required to confirm these initial encouraging results.

Keywords

aortic dissection - repeat surgery - frozen elephant trunk technique
 

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