Total arch replacement combined with stented elephant trunk implantation for type A dissection was associated with 3.09% in-hospital mortality versus 5.00% for conventional repair.
Cohort (n=411)
Does total arch replacement combined with stented elephant trunk implantation improve outcomes compared to conventional surgical repair in patients with type A dissection involving the arch?
Total arch replacement combined with stented elephant trunk implantation demonstrates low mortality and high rates of false lumen obliteration, suggesting it as a viable standard therapy for type A dissection involving the arch.
Absolute Event Rate: 3.09% vs 5%
BACKGROUND: Appropriate surgical management of type A dissection is a critical factor for achieving satisfactory outcome, but the choice of optimal procedure is controversial. We retrospectively reviewed our experience with aortic arch replacement for type A dissection involving the arch. METHODS AND RESULTS: Excluding 14 cases of subtotal or total aortic replacement, 411 of 544 patients with type A dissection (stented elephant trunk=291, conventional surgical repair=120) underwent aortic arch replacement between January 2003 and September 2008. In-hospital mortality was 3.09% (9 of 291) for stented (acute=4.73%, 7 of 148; chronic=1.40%, 2 of 143) and 5.00% (6 of 120) for conventional repairs (acute=6.06%, 4 of 66; chronic=3.70%, 2 of 54). Spinal cord injury was 2.41% (7 of 291) in the stented and 0.83% (1 of 120) in the conventional group. The overall prevalence of stroke was 1.95% (8 of 411) (stented=2.41%, 7 of 291; conventional=0.83, 1 of 120). Secondary intervention was 2.34% (5 of 214) for acute dissection (stented=1 and conventional=4; P=0.031) and 3.05% (6 of 197) for chronic dissection (stented=4 and conventional=2; P=0.661) during follow-up. Obliteration of the false lumen around the stented elephant trunk occurred in 94.2% (130 of 138) of patients with acute dissection and in 92.0% (126 of 137) of patients with chronic dissection. CONCLUSIONS: Total arch replacement combined with stented elephant trunk implantation demonstrated the superiority of the combination of the surgical and interventional approaches while avoiding the weaknesses associated with the individual methods. The encouraging surgical results could enable this procedure to become the new "standard" therapy for type A dissection involving repair of the aortic arch.
“This technique simplified hemostasis and anastomosis, reduced the size of the residual aortic patch wall, and preserved the autologous brachiocephalic vessels, yielding satisfactory surgical results.”
Sun et al. (Mon,) conducted a cohort in Type A aortic dissection involving the arch (n=411). Total arch replacement combined with stented elephant trunk implantation vs. Conventional surgical repair was evaluated on In-hospital mortality. Total arch replacement combined with stented elephant trunk implantation for type A dissection was associated with 3.09% in-hospital mortality versus 5.00% for conventional repair.