Document Detail

Surgery for acute type A dissection with the tear in the descending aorta using a stented elephant trunk procedure.
MedLine Citation:
PMID:  19324146     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Surgical management of acute type A dissection with the tear in the descending aorta is challenging because of the technical difficulty in managing proximal and distal aortic lesions through a median sternotomy or lateral thoracotomy using a single-stage procedure. METHODS: Thirty-three patients with acute type A dissection with the tear in the descending aorta underwent total arch replacement combined with stented elephant trunk implantation through a median sternotomy from April 2003 to June 2007. Preoperative complications included acute cardiac tamponade (n = 1), acute left heart failure (n = 1), acute myocardial infarction (n = 1), cerebral ischemia (n = 1), acute renal failure (n = 2), chronic renal dysfunction (n = 2), and acute mesenteric ischemia (n = 1) and lower extremity ischemia (n = 3). The residual false lumen was evaluated using postoperative computed tomography. RESULTS: Death at 30 days was 6.06% (2 of 33 patients). One patient with preoperative mesenteric ischemia died of postoperative multiple-organ failure. One patient with preoperative acute renal failure ceased treatment after three reoperations owing to uncontrollable bleeding. Left lower-extremity paraparesis occurred in 1 patient, and transient neurologic dysfunction occurred in 1 patient. Severe complications were not observed at a mean follow-up of 25 +/- 11 months. Thrombus obliteration of the false lumen was observed at the distal end of the stented graft in 29 patients (96.7%) and at the diaphragmatic level in 20 patients (66.7%) during follow-up. CONCLUSIONS: Encouraging outcomes favor this technique in patients with acute type A dissection with the tear in the descending aorta. Simultaneous repair of proximal aortic lesions and thrombosis of the false lumen in the descending aorta could be obtained.
LiZhong Sun; RuiDong Qi; Qian Chang; JunMing Zhu; YongMin Liu; ChunTao Yu; HaiTao Zhang; Bin Lv; Jun Zheng; LiangXin Tian; JinGuo Lu
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The Annals of thoracic surgery     Volume:  87     ISSN:  1552-6259     ISO Abbreviation:  Ann. Thorac. Surg.     Publication Date:  2009 Apr 
Date Detail:
Created Date:  2009-03-27     Completed Date:  2009-04-13     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  15030100R     Medline TA:  Ann Thorac Surg     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  1177-80     Citation Subset:  AIM; IM    
Department of Cardiovascular Surgery, Cardiovascular Institute and Fuwai Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China.
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MeSH Terms
Aneurysm, Dissecting / surgery*
Aorta, Thoracic / surgery
Aortic Aneurysm / surgery*
Blood Vessel Prosthesis
Blood Vessel Prosthesis Implantation
Middle Aged
Prosthesis Design
Young Adult
Comment In:
Ann Thorac Surg. 2009 Apr;87(4):1181   [PMID:  19324147 ]

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