Effect on false-lumen status of a combined vascular and endovascular approach for the treatment of acute type A aortic dissection

• Published in: European journal of cardio-thoracic surgery Vol. 41; no. 2; pp. 409 - 413
• Main Authors: Czerny, Martin, Stöhr, Sybilla, Aymard, Thierry, Sodeck, Gottfried H., Ehrlich, Marek, Dziodzio, Tomasz, Juraszek, Andrzej, Carrel, Thierry
• Format: Journal Article
• Language: English
• Published: Oxford Oxford University Press 01.02.2012
• Subjects: Acute Disease; Aneurysm, Dissecting - diagnostic imaging; Aneurysm, Dissecting - surgery; Aortic Aneurysm, Thoracic - diagnostic imaging; Aortic Aneurysm, Thoracic - surgery; Biological and medical sciences; Blood Vessel Prosthesis; Blood Vessel Prosthesis Implantation - methods; Cardiology. Vascular system; Female; Follow-Up Studies; Humans; Male; Medical sciences; Middle Aged; Pneumology; Prosthesis Design; Reoperation; Stents; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the heart; Tomography, X-Ray Computed; Treatment Outcome; Type A aortic dissection; Bare stent; False-lumen patency; Endoprosthesis; Acute; Instrumentation therapy; Endovascular route; Stent; Dissecting aneurysm; Blood vessel; Aorta; Surgical approach; Circulatory system; Cardiology; Pneumology
• ISSN: 1010-7940; 1873-734X
• DOI: 10.1016/j.ejcts.2011.05.063

OBJECTIVE The aim of the study is to evaluate midterm results with regard to false-lumen status of a combined vascular and endovascular approach for the treatment of acute type A aortic dissection. METHODS We performed ascending/hemiarch replacement during hypothermic circulatory arrest with additional open implantation of the Djumbodis Dissection System (non-self-expanding bare metal stent) to readapt the dissected layers in the arch and the proximal descending aorta in a consecutive series of 15 patients (mean age 61 years, 20% female) suffering from acute type A aortic dissections. The primary end point was the status of the false lumen at the level of the stent. RESULTS We observed three in-hospital deaths (20%). Complete thrombosis of the false lumen was observed in one patient (8%). In 25% of patients, partial thrombosis of the false lumen was observed. The remaining patients had continuing antegrade perfusion. Surgical conversion during a mean follow-up of 37 months was required in two patients (16%) due to continuing enlargement of the distal arch and the proximal descending aorta. No late deaths were observed. CONCLUSION Additional implantation of the Djumbodis Dissection System to readapt the dissected layers in the arch and the proximal descending aorta does not seem to have additive value as an adjunct to standard ascending/hemiarch replacement with regard to closure of the false lumen in the arch and the proximal descending aorta. The most limiting factor seems to be the non-self-expanding capability of the device.