Two-stage repair of DeBakey type IIIb aneurysm, using total arch replacement. (January 2020)

• Record Type: Journal Article
• Authors: Yanase, Yosuke; Ito, Toshiro; Arihara, Ayaka; Ohkawa, Akihito; Numaguchi, Ryosuke; Sato, Hiroshi; Yasuda, Naomi; Kuroda, Yosuke; Harada, Ryo; Kawaharada, Nobuyoshi
• Is Part Of: Asian cardiovascular & thoracic annals. Volume 28:Number 1(2020)
• Page Start: 7
• Page End: 14
• Publication Date: 2020-01
• Subjects: Aneurysm -- dissecting -- aortic aneurysm -- blood vessel prosthesis -- hypothermia -- induced -- postoperative complications -- treatment outcome; Heart -- Diseases -- Asia -- Periodicals; Heart -- Diseases -- Pacific Area -- Periodicals; Heart -- Diseases -- Periodicals; Heart -- Surgery -- Asia -- Periodicals; Heart -- Surgery -- Pacific Area -- Periodicals; Heart -- Surgery -- Periodicals; Chest -- Surgery -- Asia -- Periodicals; Chest -- Surgery -- Pacific Area -- Periodicals; Chest -- Surgery -- Periodicals; 617.412
• DOI: 10.1177/0218492319895377
• Languages: English
• ISSNs: 0218-4923

Abstract

Background: Open repair for chronic DeBakey type IIIb dissecting aortic aneurysm is an invasive procedure involving open proximal anastomosis under hypothermic cardiac arrest, with significant morbidity in high-risk patients. We adopted a two-stage repair strategy using total arch replacement with the elephant trunk technique, which enables aortic crossclamping and avoids open proximal anastomosis at the second-stage graft replacement through a left thoracotomy. Methods: From January 2008 to October 2018, we performed DeBakey type IIIb dissecting aortic aneurysm repair in 76 cases, and compared the results of two-stage repair (group 1, 25 cases) and single-stage repair using graft replacement with open proximal anastomosis through a left thoracotomy (group 2, 31 cases). Results: In group 1, the elephant trunk technique was successful in all cases. The second intervention included endovascular repair (13 cases) and graft replacement through a left thoracotomy (7 cases). Five cases were followed up conservatively because the false lumen was thrombosed after the elephant trunk technique. Aorta-related adverse events were seen in 5 cases in group 1 (1 re-dissection, 1 rupture, 2 stent-graft-induced new entries, 1 stent-graft migration) and 6 in group 2 (1 additional thoracic endovascular aortic repair, 1 rupture, 4 acute type A aortic dissections). There were no statistical differences between the two groups regarding aorta-related adverse events and death. The postoperative course was acceptable in both groups. Conclusions: Single-stage repair with open proximal anastomosis is an option in patients not at high risk for invasive surgery, while two-stage repair is recommended for high-risk patients.