Total arch replacement with concomitant retrograde stent graft deployment via ministernotomy in acute aortic dissection

Abstract

Background: Acute aortic dissection is one of the most fatal conditions, with high surgical risks and severe postoperative complications. Treatment modalities vary from center to center, and a total arch replacement sometimes is not sufficient to provide a good result. Frozen elephant trunk (FET) offers a good option for a more complete repair. Because of its complexity and expense, however, this excellent technique is not always available. In this article, we present our hybrid technique including total arch replacement and retrograde thoracic endovascular aortic repair (TEVAR) for acute aortic dissection via a ministernotomy. Objective and methods: Our study aimed to estimate the safety, early results, and some midterm outcomes of total arch replacement in combination with retrograde TEVAR for acute aortic dissection from August 2013 to May 2017. We analyzed the intraoperative variables (duration of cross-clamp, circulatory arrest, ventilation, and intensive care unit stay), 30-day mortality, and early complications as well as the midterm results of these patients. Results: From August 2013 to May 2017, 22 patients (17 male) diagnosed with acute aortic dissection were treated with total arch replacement and concomitant retrograde endovascular repair via an upper ministernotomy. Mean age (± SD) was 60.8 ± 10.7 years. Thirty-day mortality was 4.5%: 1 patient died of acute renal failure. One patient had a postoperative stroke. The average number of stents used intraoperatively was 1.83. Midterm mortality was 1 patient (4.5%). Complete thrombosis of the false lumen in the thoracic aorta was achieved in 18 patients (90%). Conclusions: Retrograde TEVAR in combination with total arch replacement via an upper ministernotomy might be safe and effective in treating acute type A aortic dissection, with fairly low mortality and perioperative complications, and a very good rate of total false lumen thrombosis in midterm follow up.