Short-term outcome of ascending aorta replacement combined with total aortic arch fenestration technique for acute type A aortic dissection_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

MA Xiantao , ZHU Zhangqiang , FENG Yi , LI Shiliang , Wajeehullahi Akilu , WEI Xiang ,  CHENG Cai

Department of Cardiac and Vascular Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, P. R. China;

Corresponding?author：

CHENG Cai, Email: Cai.cheng@hotmail.com

Keywords：

Acute type A aortic dissection; thoracic endovascular aortic repair; fenestration technique; endovascular treatment; hybrid technique; branched stent-graft

DOI：

10.7507/1007-4848.202111022

Video：

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Objective To report our clinical experience and outcomes of thoracic endovascular aortic repair (TEVAR) for acute Stanford type A dissection using ascending aorta replacement combined with implantation of a fenestrated stent-graft of the entire aortic arch through a minimally invasive technique. Methods From 2016 to 2020 in our hospital, 24 patients (17 males and 7 females, aged 45-72 years) with complicated Stanford type A aortic dissection, underwent replacement of the proximal ascending aorta with TEVAR. None of the patients with dissection involved the three branches of the superior arch, and all patients were replaced with artificial blood vessels of the ascending aorta under non-hypothermic cardiopulmonary bypass, preserving the arch and the three branches above the arch, and individualized stent graft fenestration. Results Surgical technical success rate was 100.0%. There was no intraoperative complication or evidence of endo-leak in 1 month postoperatively. Hospital stay was 10±5 d. During postoperative follow-up, the stent was unobstructed without displacement, the preserved branch of the aortic arch was unobstructed, and the true lumen of the descending aorta was enlarged. Conclusion This hybrid technique by using TEVAR with fenestrated treatment is a minimally invasive and effective method to treat high-risk patients with acute Stanford type A aortic dissection.

Citation： MA Xiantao, ZHU Zhangqiang, FENG Yi, LI Shiliang, Wajeehullahi Akilu, WEI Xiang, CHENG Cai. Short-term outcome of ascending aorta replacement combined with total aortic arch fenestration technique for acute type A aortic dissection. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2022, 29(5): 577-584. doi: 10.7507/1007-4848.202111022 Copy

1.	孫立忠, 劉志剛, 常謙, 等. 主動脈弓替換加支架"象鼻"手術治療Stanford A型主動脈夾層. 中華外科雜志, 2004, 42(13): 812-816.
2.	Bavaria J, Milewski RK, Baker J, et al. Classic hybrid evolving approach to distal arch aneurysms: Toward the zone zero solution. J Thorac Cardiovasc Surg, 2010, 140(6 Suppl): S77-S80.
3.	舒暢, 施俊哲, 葛建軍, 等. 雜交技術治療累及弓部主動脈病變的中國專家共識. 中國循環雜志, 2020, 35(2): 124-129.
4.	Zhang L, Yu C, Yang X, et al. Hybrid and frozen elephant trunk for total arch replacement in DeBakey type Ⅰ dissection. J Thorac Cardiovasc Surg, 2019, 158(5): 1285-1292.
5.	朱志成, 柳克祥, 王天策, 等. 改良“三明治”近端主動脈成形法在Stanford A型主動脈夾層中的應用. 中國循環雜志, 2013, 28(z1): 215.
6.	陸清聲. 主動脈弓疾病腔內治療體外開窗技巧. 中國血管外科雜志(電子版), 2019, 11(2): 83-85.
7.	Tan TW, Coulter AH, Zhang WW. Percutaneous in situ left subclavian artery fenestration using reentry catheter during endovascular thoracic aortic aneurysm repair. Int J Angiol, 2016, 25(5): e77-e80.
8.	Mészáros I, Mórocz J, Szlávi J, et al. Epidemiology and clinicopathology of aortic dissection. Chest, 2000, 117(5): 1271-1278.
9.	Hagan PG, Nienaber CA, Isselbacher EM, et al. The International Registry of Acute Aortic Dissection (IRAD): New insights into an old disease. JAMA, 2000, 283(7): 897-903.
10.	Mizuno T, Toyama M, Tabuchi N, et al. Stented elephant trunk procedure combined with ascending aorta and arch replacement for acute type A aortic dissection. Eur J Cardiothorac Surg, 2002, 22(4): 504-509.
11.	Etz CD, Weigang E, Hartert M, et al. Contemporary spinal cord protection during thoracic and thoracoabdominal aortic surgery and endovascular aortic repair: A position paper of the vascular domain of the European Association for Cardio-Thoracic Surgery. Eur J Cardiothorac Surg, 2015, 47(6): 943-957.
12.	Kazimierczak A, Jedrzejczak T, Rynio P, et al. Favorable remodeling after hybrid arch debranching and modified provisional extension to induce complete attachment technique in type A aortic dissection: A case report. Medicine (Baltimore), 2018, 97(37): e12409.
13.	Gaudino M, Bakaeen F, Davierwala P, et al. New strategies for surgical myocardial revascularization. Circulation, 2018, 138(19): 2160-2168.
14.	Moulakakis KG, Mylonas SN, Markatis F, et al. A systematic review and meta-analysis of hybrid aortic arch replacement. Ann Cardiothorac Surg, 2013, 2(3): 247-260.
15.	Aboyans V, Desormais I, Magne J, et al. Renal artery stenosis in patients with peripheral artery disease: Prevalence, risk factors and long-term prognosis. Eur J Vasc Endovasc Surg, 2017, 53(3): 380-385.
16.	石烽, 王志維, 吳紅兵, 等. 雜交手術治療Stanford A型主動脈夾層. 實用醫學雜志, 2019, 35(13): 2175-2179.
17.	趙名賢, 張理, 李國杰. Castor分支型覆膜支架治療錨定區不足的B型主動脈夾層的效果分析. 臨床外科雜志, 2021, 29(9): 869-871.
18.	Luebke T, Brunkwall J. Outcome of patients with open and endovascular repair in acute complicated type B aortic dissection: A systematic review and meta-analysis of case series and comparative studies. J Cardiovasc Surg (Torino), 2010, 51(5): 613-632.
19.	Stone DH, Brewster DC, Kwolek CJ, et al. Stent-graft versus open-surgical repair of the thoracic aorta: mid-term results. J Vasc Surg, 2006, 44(6): 1188-1197.
20.	成青鑒, 何瑜媛, 車轍, 等. 腔內治療破口位于升主動脈的 Stanford A 型主動脈夾層. 中國普外基礎與臨床雜志, 2020, 27(6): 729-733.
21.	Murphy EH, Stanley GA, Ilves M, et al. Thoracic endovascular repair (TEVAR) in the management of aortic arch pathology. Ann Vasc Surg, 2012, 26(1): 55-66.
22.	陸清聲. 分支支架技術在弓部分支血管重建中的應用及評價. 中國實用外科雜志, 2018, 38(12): 1369-1373.
23.	舒暢, 王暾, 黎明, 等. “煙囪”技術在治療累及主動脈弓分支動脈的Stanford B型主動脈夾層中的應用. 中華醫學雜志, 2012, 92(47): 3320-3323.
24.	舒暢, 王暾, 李全明, 等. 腔內修復聯合輔助技術治療累及主動脈弓的Stanford B型夾層動脈瘤. 中華普通外科雜志, 2011, 26(11): 899-903.
25.	吳明樂, 陳旭, 汪華, 等. 轉流技術在Standford B型主動脈夾層治療中的應用及療效評價. 世界中醫藥, 2015, 10(A02): 821-822.
26.	陳燕青, 陸清聲. 多層裸支架技術治療動脈瘤的研究進展. 中華普通外科雜志, 2016, 31(8): 699-701.
27.	李曉曄, 陸清聲. 主動脈弓疾病腔內治療分支重建進展. 中華血管外科雜志, 2021, 6(2): 77-80.
28.	Malaisrie SC, Szeto WY, Halas M, et al. 2021 The American Association for Thoracic Surgery expert consensus document: Surgical treatment of acute type A aortic dissection. J Thorac Cardiovasc Surg, 2021, 162(3): 735-758.

1. 孫立忠, 劉志剛, 常謙, 等. 主動脈弓替換加支架"象鼻"手術治療Stanford A型主動脈夾層. 中華外科雜志, 2004, 42(13): 812-816.
2. Bavaria J, Milewski RK, Baker J, et al. Classic hybrid evolving approach to distal arch aneurysms: Toward the zone zero solution. J Thorac Cardiovasc Surg, 2010, 140(6 Suppl): S77-S80.
3. 舒暢, 施俊哲, 葛建軍, 等. 雜交技術治療累及弓部主動脈病變的中國專家共識. 中國循環雜志, 2020, 35(2): 124-129.
4. Zhang L, Yu C, Yang X, et al. Hybrid and frozen elephant trunk for total arch replacement in DeBakey type Ⅰ dissection. J Thorac Cardiovasc Surg, 2019, 158(5): 1285-1292.
5. 朱志成, 柳克祥, 王天策, 等. 改良“三明治”近端主動脈成形法在Stanford A型主動脈夾層中的應用. 中國循環雜志, 2013, 28(z1): 215.
6. 陸清聲. 主動脈弓疾病腔內治療體外開窗技巧. 中國血管外科雜志(電子版), 2019, 11(2): 83-85.
7. Tan TW, Coulter AH, Zhang WW. Percutaneous in situ left subclavian artery fenestration using reentry catheter during endovascular thoracic aortic aneurysm repair. Int J Angiol, 2016, 25(5): e77-e80.
8. Mészáros I, Mórocz J, Szlávi J, et al. Epidemiology and clinicopathology of aortic dissection. Chest, 2000, 117(5): 1271-1278.
9. Hagan PG, Nienaber CA, Isselbacher EM, et al. The International Registry of Acute Aortic Dissection (IRAD): New insights into an old disease. JAMA, 2000, 283(7): 897-903.
10. Mizuno T, Toyama M, Tabuchi N, et al. Stented elephant trunk procedure combined with ascending aorta and arch replacement for acute type A aortic dissection. Eur J Cardiothorac Surg, 2002, 22(4): 504-509.
11. Etz CD, Weigang E, Hartert M, et al. Contemporary spinal cord protection during thoracic and thoracoabdominal aortic surgery and endovascular aortic repair: A position paper of the vascular domain of the European Association for Cardio-Thoracic Surgery. Eur J Cardiothorac Surg, 2015, 47(6): 943-957.
12. Kazimierczak A, Jedrzejczak T, Rynio P, et al. Favorable remodeling after hybrid arch debranching and modified provisional extension to induce complete attachment technique in type A aortic dissection: A case report. Medicine (Baltimore), 2018, 97(37): e12409.
13. Gaudino M, Bakaeen F, Davierwala P, et al. New strategies for surgical myocardial revascularization. Circulation, 2018, 138(19): 2160-2168.
14. Moulakakis KG, Mylonas SN, Markatis F, et al. A systematic review and meta-analysis of hybrid aortic arch replacement. Ann Cardiothorac Surg, 2013, 2(3): 247-260.
15. Aboyans V, Desormais I, Magne J, et al. Renal artery stenosis in patients with peripheral artery disease: Prevalence, risk factors and long-term prognosis. Eur J Vasc Endovasc Surg, 2017, 53(3): 380-385.
16. 石烽, 王志維, 吳紅兵, 等. 雜交手術治療Stanford A型主動脈夾層. 實用醫學雜志, 2019, 35(13): 2175-2179.
17. 趙名賢, 張理, 李國杰. Castor分支型覆膜支架治療錨定區不足的B型主動脈夾層的效果分析. 臨床外科雜志, 2021, 29(9): 869-871.
18. Luebke T, Brunkwall J. Outcome of patients with open and endovascular repair in acute complicated type B aortic dissection: A systematic review and meta-analysis of case series and comparative studies. J Cardiovasc Surg (Torino), 2010, 51(5): 613-632.
19. Stone DH, Brewster DC, Kwolek CJ, et al. Stent-graft versus open-surgical repair of the thoracic aorta: mid-term results. J Vasc Surg, 2006, 44(6): 1188-1197.
20. 成青鑒, 何瑜媛, 車轍, 等. 腔內治療破口位于升主動脈的 Stanford A 型主動脈夾層. 中國普外基礎與臨床雜志, 2020, 27(6): 729-733.
21. Murphy EH, Stanley GA, Ilves M, et al. Thoracic endovascular repair (TEVAR) in the management of aortic arch pathology. Ann Vasc Surg, 2012, 26(1): 55-66.
22. 陸清聲. 分支支架技術在弓部分支血管重建中的應用及評價. 中國實用外科雜志, 2018, 38(12): 1369-1373.
23. 舒暢, 王暾, 黎明, 等. “煙囪”技術在治療累及主動脈弓分支動脈的Stanford B型主動脈夾層中的應用. 中華醫學雜志, 2012, 92(47): 3320-3323.
24. 舒暢, 王暾, 李全明, 等. 腔內修復聯合輔助技術治療累及主動脈弓的Stanford B型夾層動脈瘤. 中華普通外科雜志, 2011, 26(11): 899-903.
25. 吳明樂, 陳旭, 汪華, 等. 轉流技術在Standford B型主動脈夾層治療中的應用及療效評價. 世界中醫藥, 2015, 10(A02): 821-822.
26. 陳燕青, 陸清聲. 多層裸支架技術治療動脈瘤的研究進展. 中華普通外科雜志, 2016, 31(8): 699-701.
27. 李曉曄, 陸清聲. 主動脈弓疾病腔內治療分支重建進展. 中華血管外科雜志, 2021, 6(2): 77-80.
28. Malaisrie SC, Szeto WY, Halas M, et al. 2021 The American Association for Thoracic Surgery expert consensus document: Surgical treatment of acute type A aortic dissection. J Thorac Cardiovasc Surg, 2021, 162(3): 735-758.

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Short-term outcome of ascending aorta replacement combined with total aortic arch fenestration technique for acute type A aortic dissection

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