Open Surgery for the Treatment of Complex Acute Stanford Type B Aortic Dissection: An Open Stented Elephant Trunk Procedure_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

CHENGLi-jian , LIUWei , QIAOZhi-yu , CHENLei , LICheng-nan , HUHai-ou , GEYi-peng ,  ZHUJun-ming

Department of Cardiovascular Surgery, Beijing Anzhen Hospital of Capital Medical University, Beijing Aortic Disease Center, Beijing 100029, P. R. China;

Corresponding?author：

ZHUJun-ming, Email: anzhenjzm@163.com

Keywords：

Stented elephant trunk procedure; Stanford type B aortic dissection; Cardiac surgery

DOI：

10.7507/1007-4848.20150004

Video：

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Objective To summarize clinical experience and surgical indications of open stented elephant trunk (sET) procedure for the treatment of complex acute Stanford type B aortic dissection (AD). Methods From February 2009 to April 2013, 25 patients with complex acute Stanford type B AD underwent open sET procedure in Beijing Anzhen Hospital. There were 22 male and 3 female patients with their age of 46.92±9.12 years (range, 30 to 66 years). There were 16 patients with hypertension and 3 patients with preoperative acute renal failure. All the patients received sET implantation via an aortic arch incision under deep hypothermic circulatory arrest. Concomitant procedures included extra-anatomic bypass grafting in 11 patients, Bentall procedure in 1 patient, aortic valve replacement in 3 patients, and ascending aorta plasty in 3 patients. Computed tomography angiography (CTA) was performed before discharge and during follow-up for all the patients. Results Operation time was 4-7 (5.5±0.7) hours, cardiopulmonary bypass time was 93-206 (137.64±30.02) minutes, aortic cross-clamping time was 28-109 (57.96±21.05) minutes, and selective cerebral perfusion time was 15-76 (26.76±11.88) minutes. There was no in-hospital death. Postoperatively, there were 2 patients with pulmonary complications, 2 patients with type I endoleak, 1 patient with acute renal failure, 1 patient with temporary neurological disorder, 1 patient with sudden ventricular fibrillation, and 1 patient with delayed wound healing. Mean follow-up time was 6-54 (25.76±16.15) months, and 2 patients were lost during follow-up. The follow-up rate was 92%.There was no late death during follow-up. Conclusions Open sET procedure is a reliable and efficacious therapeutic strategy for patients with complex acute Stanford type B AD. Surgical indications include complex Stanford type B AD without enough landing zone, type B AD with ascending aortic disease, aortic root disease, valvular heart disease, coronary artery disease and congenital heart defects, and type B AD caused by genetic connective tissue disorder.

Citation： CHENGLi-jian, LIUWei, QIAOZhi-yu, CHENLei, LICheng-nan, HUHai-ou, GEYi-peng, ZHUJun-ming. Open Surgery for the Treatment of Complex Acute Stanford Type B Aortic Dissection: An Open Stented Elephant Trunk Procedure. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2015, 22(1): 15-18. doi: 10.7507/1007-4848.20150004 Copy

1.	?Daily PO, Trueblood HW, Stinson EB, et al. Management of acute aortic dissections. Ann Thorac Surg, 1970, 10(3):237-247.
2.	Toda K, Taniguchi K, Masai T, et al. Arch aneurysm repair with long elephant trunk:a 10-year experience in 111 patients. Ann Thorac Surg, 2009, 88(1):16-22.
3.	孫立忠, 劉寧寧, 常謙, 等. 主動脈夾層的細化分型及其應用. 中華外科雜志, 2005, 43(18):1171-1176.
4.	程力劍, 孫立忠, 朱俊明, 等. 63 例全胸腹主動脈置換術患者中期結果分析. 中國胸心血管外科臨床雜志, 2009, 16(5):339-343.
5.	Zhu J, Cheng L, Liu Y, et al. One-stage repair for stanford type B aortic dissection concomitant with cardiac diseases:open stented elephant trunk technique combined with cardiac operation. Thorac Cardiovasc Surg, 2012, 60(1):11-16.
6.	Svensson LG, Kouchoukos NT, Miller DC, et al. Expert consensus document on the treatment of descending thoracic aortic disease using endovascular stent-grafts. Ann Thorac Surg, 2008, 85(1 Suppl):S1-S41.
7.	Wheat MJ, Palmer RF, Bartley TD, et al. Treatment of dissectiong aneurysms of the aorta without surgery. J Thorac Cardiovasc Surg,1965, 50:364-373.
8.	Coady MA, Rizzo JA, Goldstein LJ, et al. Natural history, pathogenesis, and etiology of thoracic aortic aneurysms and dissections. Cardiol Clin, 1999, 17(4):615-635.
9.	戈小虎, 方青波, 管圣, 等. Stanford B 型主動脈夾層的腔內治療(附134 例報告). 中國微創外科雜志, 2012, 12(9):774-776.
10.	Hanna JM, Andersen ND, Ganapathi AM, et al. Five-year results for endovascular repair of acute complicated type B aortic dissection. J Vasc Surg, 2014, 59(1):96-106.
11.	Ma H, Yang H, Xu W, et al. Endovascular repair with the chimney technique for Stanford type B aortic dissection involving right-sided arch with mirror image branching. J Endovasc Ther, 2013, 20(3):283-288.
12.	Bunger CM, Kische S, Liebold A, et al. Hybrid aortic arch repair for complicated type B aortic dissection. J Vasc Surg, 2013, 58(6):1490-1496.
13.	Hiratzka LF, Bakris GL, Beckman JA, et al. 2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM guidelines for the diagnosis and management of patients with Thoracic Aortic Disease:a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, American Association for Thoracic Surgery, American College of Radiology, American Stroke Association, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of Thoracic Surgeons, and Society for Vascular Medicine. Circulation, 2010, 121(13):e266-e369.
14.	程力劍, 鄭軍, 孫立忠. 象鼻手術的應用與發展. 中華胸心血管外科雜志, 2012, 28(1):49-53.
15.	谷天祥, 于洋, 師恩祎, 等. "改良"次全弓置換加支架象鼻手術治療Stanford A型主動脈夾層. 中國胸心血管外科臨床雜志, 2012, 19(1):4-7.
16.	劉宸鋮, 郭應強, 蒙煒, 等. 全主動脈弓置換加支架象鼻手術治療A型主動脈夾層. 中國胸心血管外科臨床雜志, 2009, 16(2):148-149.

1. ?Daily PO, Trueblood HW, Stinson EB, et al. Management of acute aortic dissections. Ann Thorac Surg, 1970, 10(3):237-247.
2. Toda K, Taniguchi K, Masai T, et al. Arch aneurysm repair with long elephant trunk:a 10-year experience in 111 patients. Ann Thorac Surg, 2009, 88(1):16-22.
3. 孫立忠, 劉寧寧, 常謙, 等. 主動脈夾層的細化分型及其應用. 中華外科雜志, 2005, 43(18):1171-1176.
4. 程力劍, 孫立忠, 朱俊明, 等. 63 例全胸腹主動脈置換術患者中期結果分析. 中國胸心血管外科臨床雜志, 2009, 16(5):339-343.
5. Zhu J, Cheng L, Liu Y, et al. One-stage repair for stanford type B aortic dissection concomitant with cardiac diseases:open stented elephant trunk technique combined with cardiac operation. Thorac Cardiovasc Surg, 2012, 60(1):11-16.
6. Svensson LG, Kouchoukos NT, Miller DC, et al. Expert consensus document on the treatment of descending thoracic aortic disease using endovascular stent-grafts. Ann Thorac Surg, 2008, 85(1 Suppl):S1-S41.
7. Wheat MJ, Palmer RF, Bartley TD, et al. Treatment of dissectiong aneurysms of the aorta without surgery. J Thorac Cardiovasc Surg,1965, 50:364-373.
8. Coady MA, Rizzo JA, Goldstein LJ, et al. Natural history, pathogenesis, and etiology of thoracic aortic aneurysms and dissections. Cardiol Clin, 1999, 17(4):615-635.
9. 戈小虎, 方青波, 管圣, 等. Stanford B 型主動脈夾層的腔內治療(附134 例報告). 中國微創外科雜志, 2012, 12(9):774-776.
10. Hanna JM, Andersen ND, Ganapathi AM, et al. Five-year results for endovascular repair of acute complicated type B aortic dissection. J Vasc Surg, 2014, 59(1):96-106.
11. Ma H, Yang H, Xu W, et al. Endovascular repair with the chimney technique for Stanford type B aortic dissection involving right-sided arch with mirror image branching. J Endovasc Ther, 2013, 20(3):283-288.
12. Bunger CM, Kische S, Liebold A, et al. Hybrid aortic arch repair for complicated type B aortic dissection. J Vasc Surg, 2013, 58(6):1490-1496.
13. Hiratzka LF, Bakris GL, Beckman JA, et al. 2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM guidelines for the diagnosis and management of patients with Thoracic Aortic Disease:a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, American Association for Thoracic Surgery, American College of Radiology, American Stroke Association, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of Thoracic Surgeons, and Society for Vascular Medicine. Circulation, 2010, 121(13):e266-e369.
14. 程力劍, 鄭軍, 孫立忠. 象鼻手術的應用與發展. 中華胸心血管外科雜志, 2012, 28(1):49-53.
15. 谷天祥, 于洋, 師恩祎, 等. "改良"次全弓置換加支架象鼻手術治療Stanford A型主動脈夾層. 中國胸心血管外科臨床雜志, 2012, 19(1):4-7.
16. 劉宸鋮, 郭應強, 蒙煒, 等. 全主動脈弓置換加支架象鼻手術治療A型主動脈夾層. 中國胸心血管外科臨床雜志, 2009, 16(2):148-149.

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Open Surgery for the Treatment of Complex Acute Stanford Type B Aortic Dissection: An Open Stented Elephant Trunk Procedure

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