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J Thorac Cardiovasc Surg 2009;138:892-896
© 2009 The American Association for Thoracic Surgery

Acquired Cardiovascular Disease

Is total arch replacement combined with stented elephant trunk implantation justified for patients with chronic Stanford type A aortic dissection?

Li-Zhong Sun, MDa,*,*, Rui-Dong Qi, MDb,*, Qian Chang, MDa, Jun-Ming Zhu, MDa, Yong-Min Liu, MDa, Chun-Tao Yu, MDa, Bin Lv, MDc, Jun Zheng, MDa, Liang-Xin Tian, MDa, Jin-Guo Lu, MDc

a Department of Cardiovascular Surgery, Cardiovascular Institute and Fuwai Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
b Department of Cardiovascular Surgery, Tianjin Cardiovascular Institute and Tianjin Chest Hospital, Tianjin, China
c Department of Radiology, Cardiovascular Institute and Fuwai Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China

Received for publication October 14, 2008; revisions received February 9, 2009; accepted for publication February 22, 2009.

* Address for reprints: Li-Zhong Sun, MD, Department of Cardiovascular Surgery, Cardiovascular Institute and Fuwai Hospital, 167 Beilishi Rd, Beijing, 100037, China. (Email: slzh_2005{at}yahoo.com.cn).

Objective: Surgical treatment of chronic Stanford type A aortic dissection using total arch replacement combined with stented elephant trunk implantation is controversial owing to the visceral arteries and intercostal arteries originating from the false lumen.

Methods: Eighty-nine patients (mean age, 45.67 ± 10.18 years; range, 21–68 years) with chronic type A dissection underwent total arch replacement combined with stented elephant trunk implantation between April 2003 and March 2007. Careful assessment of the visceral arteries and location of entry and re-entry was done before surgery. Postoperative patency of the visceral arteries and diameter of the aortic artery and the residual false lumen were evaluated by computed tomography.

Results: One (1.12%) hospital death and 2 (2.25%) late deaths occurred at a mean follow-up of 28.5 months (range, 8–52 months). Visceral malperfusion was not observed. Two patients had spinal cord injury and recovered during follow-up. One patient had a transient neurologic deficit and recovered completely before discharge. One patient underwent thoracoabdominal aortic replacement for aneurysmal dilatation of the residual descending aorta 3 months after the operation. Thrombus obliteration of the false lumen at the distal edge of the stented elephant trunk and at the diaphragmatic level was 94.2% (81/86) and 61.6% (53/86), respectively.

Conclusions: Satisfactory results with low morbidity and mortality were obtained. No visceral malperfusion and a low risk of postoperative spinal cord injury favor this technique in patients with chronic type A dissection.

Abbreviations and Acronyms CPB = cardiopulmonary bypass; CT = computed tomography; SCP = selective cerebral perfusion






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