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J Thorac Cardiovasc Surg 2002;124:531-540
© 2002 The American Association for Thoracic Surgery
Surgery for Acquired Cardiovascular Disease (ACD) |
From the Division of Cardiovascular and Thoracic Surgery,a Department of Surgery, Saitama Medical School, Saitama, Japan, and the Division of Cardiovascular Surgery,b Osaka Prefectural Hospital, Osaka, Japan.
Supported by the Research Grant for Cardiovascular Disease (13A-2) from the Ministry of Health and Welfare.
Received for publication Aug 30, 2001. Revisions requested Dec 14, 2001; revisions received Jan 29, 2002. Accepted for publication Feb 7, 2002. Address for reprints: Masaask Kato, MD, Division of Cardiovascular & Thoracic Surgery, Saitama Medical School, 38 Morohonngou Moroyama-Chou, Irima-gunn, Saitama 350-0495, Japan (E-mail: mkato{at}xk9.so-net.ne.jp).
Background: One problem that conventional ascending treatment for type A aortic dissection has not satisfactorily resolved is chronic enlargement of residual dissection in the aortic arch and descending aorta. To address this problem, we have developed a new method for type A aortic dissection: total arch graft implantation with open-style stent-graft placement.
Methods: From October 1994 through October 1999, 19 patients with type A aortic dissection (13 acute and 6 chronic dissections) underwent total arch graft implantation with open-style stent-graft placement. After achievement of general anesthesia and hypothermic extracorporeal circulation, we replaced the dissected ascending aorta and neck vessels with a 4-branched graft and repaired the descending aorta with a stent graft to close the entry site completely and to obtain better peripheral perfusion. We then examined the acute-phase and chronic-phase results and the outcomes of the false lumen and dissected aorta.
Results: There were 1 (5.3%) hospital death and 2 late deaths. The survivals at 1 and 3 years were 89.5% and 82.6%, respectively. The following complications occurred in the perioperative period: 1 stroke, 2 cases of temporary paraparesis, 2 cases of temporary hemodialysis, and 3 cases of mediastinitis. No pulmonary complications were observed. Six months postoperatively, the targeted entry sites were completely closed in all cases, 80% (8/10) of preoperatively patent false lumina were clotted at the level of the end of the stent graft, and 60% (9/15) of the false lumina and 40% (6/15) of the dissected aorta had shrunk significantly. Two (13.3%) of 15 cases of postoperative dilatation in the dissected aorta were observed, and reoperation related to residual dissected aorta was performed in only 1 (1/17 [5.9%]) patient during the mean follow-up period of 2.4 ± 1.6 years.
Conclusion: Our preliminary review of the total arch graft implantation with a stent graft suggests that this new procedure for type A aortic dissection might provide better results in both the acute and the chronic phase, especially with regard to the outcome for the false lumen and dissected aorta.
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