<strong>Objectives:</strong> To describe our technique for the implantation of the Thoraflex Hybrid prosthesis for replacement of the aortic arch in a safe and reproducible way. <strong>Materials:<...<strong>Objectives:</strong> To describe our technique for the implantation of the Thoraflex Hybrid prosthesis for replacement of the aortic arch in a safe and reproducible way. <strong>Materials:</strong> Thoraflex<span style="font-size:12.0pt;line-height:107%;font-family:;" "="">™</span> Hybrid Plexus Device (Terumo Aortic).<strong> Design:</strong> Drawing on our own experience over the past 4 years in the management of acute type A aortic dissection, we have distilled the essentials of our “Frozen Elephant Trunk” technique which have led us through our own learning curve to the improved management of this taxing condition. <strong>Method/ Results:</strong> Small extension of the median sternotomy incision along the medial border of sternocleidomastoid muscle. End to side graft anastomosis near the origin of the left subclavian artery during cooling on bypass towards 20 degrees. Attention to cardiac protection and maintenance of cerebral perfusion during the shortened corporeal arrest period. Excellent results in 24 consecutive AAAD patients with just one hospital mortality. <strong>Conclusions:</strong> We believe we are entering a new phase in the treatment of AAAD, facilitated by the availability of a hybrid prosthesis which combines expanding stent technology with familiar surgical graft material. Our particular management of the left subclavian artery and of the cerebral circulation during implantation has contributed to an expeditious and reproducible method of treating dissection within the arch of the aorta and beyond.展开更多
Objective To summarize the clinical study of modified total aortic arch replacement and stent elephant trunk technique treatment to patients with DeBakey Ⅰ thoracic aortic dissection. Methods From January 2006 to Oct...Objective To summarize the clinical study of modified total aortic arch replacement and stent elephant trunk technique treatment to patients with DeBakey Ⅰ thoracic aortic dissection. Methods From January 2006 to October 2010,101 cases of DeBakeyⅠaortic dissection were treated by modified total arch replacement and stent elephant trunk technique,in which emergencey surgery were performed on 73 cases. There were 76 male and 25展开更多
Objective To summarize the experiences of ligating left subclavian artery ( LSA ) in total arch peplacement and stented elephant trunk implantation for Stanford type A aortic dissection patients with difficulty in exp...Objective To summarize the experiences of ligating left subclavian artery ( LSA ) in total arch peplacement and stented elephant trunk implantation for Stanford type A aortic dissection patients with difficulty in exposing the LSA. Methods Total arch replacement and stented elephant trunk implantation were performed on 79 consecutive展开更多
Background Aortic dissection(AD) is a life-threatening surgical emergency. Total arch replacement combined with stent trunk has gradually become the standard procedure for De Bakey type Ⅰ AD in China, but the complic...Background Aortic dissection(AD) is a life-threatening surgical emergency. Total arch replacement combined with stent trunk has gradually become the standard procedure for De Bakey type Ⅰ AD in China, but the complication and mortality rates are still relatively high due to surgical technical difficulties and complexity. In principle, AD should be treated with emergency surgery once the diagnosis is confirmed, but the operation time varies greatly in China due to the restriction of medical conditions. Therefore, analyzing and comparing the surgical mortality and complications rate between acute and chronic phase may facilitate the clinicians to comprehensively evaluate the patient's condition, and thus select an appropriate operation timing. Methods A total of330 De Bakey type Ⅰ AD patients admitted and treated with total arch replacement combined with stent trunk procedure in Guangdong Cardiovascular Institute from Jan 2010 to Jan 2014 were retrospectively analyzed. According to whether the onset was longer than 2 w, patients were divided into acute phase group and chronic phase group. There were 231 cases in acute phase group(≤ 2 w), and the average length from onset to operation was 5.6± 3.8 d; while 99 cases in chronic phase group(> 2 w), and the average length from onset to operation was 20.6 ±14.7 d. Results The total mortality rate was 13%. Acute renal failure, neurological dysfunction, and wound healing were the major complications after operation. The in-hospital morality rate was 16.0%(37/231) in the acute group, while 6.1 %(6/99) in the chronic group. The surgical data of the ratio of CABG, cardiopulmonary bypass(CPB) time, aortic cross clamp time, intra-operative RBC infusion were significant higher in the acute phase group(P < 0.05). The postoperative data of ICU stay, mechanical ventilation time, the incidences of neurological dysfunction, CRRT-dependent acute renal failure, hepatic insufficiency, and poor wound healing were significant higher in the acute phase group(P < 0.05). Conclusions The total arch replacement combined with stent trunk for De Bakey type Ⅰ aortic dissection is safe and effective. Patients in the acute phase show higher postoperative mortality and complications. The acute phase is associated with relatively higher risk of surgical treatment.展开更多
文摘<strong>Objectives:</strong> To describe our technique for the implantation of the Thoraflex Hybrid prosthesis for replacement of the aortic arch in a safe and reproducible way. <strong>Materials:</strong> Thoraflex<span style="font-size:12.0pt;line-height:107%;font-family:;" "="">™</span> Hybrid Plexus Device (Terumo Aortic).<strong> Design:</strong> Drawing on our own experience over the past 4 years in the management of acute type A aortic dissection, we have distilled the essentials of our “Frozen Elephant Trunk” technique which have led us through our own learning curve to the improved management of this taxing condition. <strong>Method/ Results:</strong> Small extension of the median sternotomy incision along the medial border of sternocleidomastoid muscle. End to side graft anastomosis near the origin of the left subclavian artery during cooling on bypass towards 20 degrees. Attention to cardiac protection and maintenance of cerebral perfusion during the shortened corporeal arrest period. Excellent results in 24 consecutive AAAD patients with just one hospital mortality. <strong>Conclusions:</strong> We believe we are entering a new phase in the treatment of AAAD, facilitated by the availability of a hybrid prosthesis which combines expanding stent technology with familiar surgical graft material. Our particular management of the left subclavian artery and of the cerebral circulation during implantation has contributed to an expeditious and reproducible method of treating dissection within the arch of the aorta and beyond.
文摘Objective To summarize the clinical study of modified total aortic arch replacement and stent elephant trunk technique treatment to patients with DeBakey Ⅰ thoracic aortic dissection. Methods From January 2006 to October 2010,101 cases of DeBakeyⅠaortic dissection were treated by modified total arch replacement and stent elephant trunk technique,in which emergencey surgery were performed on 73 cases. There were 76 male and 25
文摘Objective To summarize the experiences of ligating left subclavian artery ( LSA ) in total arch peplacement and stented elephant trunk implantation for Stanford type A aortic dissection patients with difficulty in exposing the LSA. Methods Total arch replacement and stented elephant trunk implantation were performed on 79 consecutive
基金supported by The Medical Scientific Research Foundation of Guangdong Province(No.A2016028/No.A2015458)
文摘Background Aortic dissection(AD) is a life-threatening surgical emergency. Total arch replacement combined with stent trunk has gradually become the standard procedure for De Bakey type Ⅰ AD in China, but the complication and mortality rates are still relatively high due to surgical technical difficulties and complexity. In principle, AD should be treated with emergency surgery once the diagnosis is confirmed, but the operation time varies greatly in China due to the restriction of medical conditions. Therefore, analyzing and comparing the surgical mortality and complications rate between acute and chronic phase may facilitate the clinicians to comprehensively evaluate the patient's condition, and thus select an appropriate operation timing. Methods A total of330 De Bakey type Ⅰ AD patients admitted and treated with total arch replacement combined with stent trunk procedure in Guangdong Cardiovascular Institute from Jan 2010 to Jan 2014 were retrospectively analyzed. According to whether the onset was longer than 2 w, patients were divided into acute phase group and chronic phase group. There were 231 cases in acute phase group(≤ 2 w), and the average length from onset to operation was 5.6± 3.8 d; while 99 cases in chronic phase group(> 2 w), and the average length from onset to operation was 20.6 ±14.7 d. Results The total mortality rate was 13%. Acute renal failure, neurological dysfunction, and wound healing were the major complications after operation. The in-hospital morality rate was 16.0%(37/231) in the acute group, while 6.1 %(6/99) in the chronic group. The surgical data of the ratio of CABG, cardiopulmonary bypass(CPB) time, aortic cross clamp time, intra-operative RBC infusion were significant higher in the acute phase group(P < 0.05). The postoperative data of ICU stay, mechanical ventilation time, the incidences of neurological dysfunction, CRRT-dependent acute renal failure, hepatic insufficiency, and poor wound healing were significant higher in the acute phase group(P < 0.05). Conclusions The total arch replacement combined with stent trunk for De Bakey type Ⅰ aortic dissection is safe and effective. Patients in the acute phase show higher postoperative mortality and complications. The acute phase is associated with relatively higher risk of surgical treatment.
