Total arch repair with open triple-branched stent graft placement for acute type A aortic dissection: Experience with 122 patients

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Abstract

Objective To summarize the clinical experiences and midterm follow-up results of total arch repair with open triple-branched stent graft placement for acute type A aortic dissection. Methods From June 2008 to March 2013, 122 patients (95 men and 27 women; mean age, 50.9 ± 10.4 years) with acute type A aortic dissection underwent total arch repair with open placement of a triple-branched stent graft under hypothermic cardiopulmonary bypass and selective cerebral perfusion. During the follow-up period, enhanced computed tomography and echocardiography were performed at 3 months postoperatively and annually thereafter. Results Placement of the triple-branched stent graft into the true lumen of the descending aorta, arch, and 3 arch vessels was technically successful in 121 patients. The cardiopulmonary bypass time was 186.50 ± 38.23 minutes, and the selective antegrade cerebral perfusion time was 31.97 ± 10.08 minutes. The in-hospital mortality was 4.93%. No permanent neurologic dysfunction or paraplegia was observed. Three patients were lost to follow-up. The mean follow-up period was 30.24 ± 12.35 months. After hospital discharge, 3 patients died. On the 3-month postoperative scans, complete thrombus formation around the triple-branched stent graft was observed in 89.38% of the patients. Endoleaks were detected in 12 patients; 8 patients refused any management for the endoleaks, but they maintained a good quality of life. The other 4 patients were successfully treated by additional surgery. Conclusions Total arch repair with open triple-branched stent graft placement is an effective technique with satisfactory early and midterm results. This technique could be an attractive alternative to conventional total arch replacement. Copyright © 2014 by The American Association for Thoracic Surgery.

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Chen, L. W., Lu, L., Dai, X. F., Wu, X. J., Zhang, G. C., Yang, G. F., & Dong, Y. (2014). Total arch repair with open triple-branched stent graft placement for acute type A aortic dissection: Experience with 122 patients. Journal of Thoracic and Cardiovascular Surgery, 148(2), 521–528. https://doi.org/10.1016/j.jtcvs.2013.10.021

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