Hybrid debranching and TEVAR of the aortic arch off-pump, in re-do patients with complicated chronic type-A aortic dissections : a critical report

Background: Patients suffering from acute type A aortic dissection undergo replacement of the ascending aorta, the proximal hemiarch or complete aortic arch, depending on the extent of the individual pathology. In a subs
Background: Patients suffering from acute type A aortic dissection undergo replacement of the ascending aorta, the proximal hemiarch or complete aortic arch, depending on the extent of the individual pathology. In a subset of these treated patients, secondary pathologies of the distal anastomosis or the remaining distal part of the aorta occur. The treatment of these pathologies is challenging, requiring major surgical re-do procedures with aortic arch replacement under extracorporeal circulation and hypothermic circulatory arrest.
Methods: We report our experience of five patients with complex aortic pathologies after previous aortic surgery treated with a single stage re-do hybrid procedure, consisting of bypass grafting of the supraaortic branches off-pump, stent graft placement for endovascular aortic repair (TEVAR) and surgical debranching of the aortic arch.
Results: In all patients the surgical vascular grafts and stent grafts were deployed successfully, there were no intraoperative deaths. Four out of five patients were discharged from hospital in good clinical condition. One patient died postoperatively due to cardiac tamponade. In one patient a type I endoleak persisted leading to occlusion of a bypass branch requiring surgical revision at one year after debranching.
Conclusion: We discuss the prerequisites, all steps and potential pitfalls of this hybrid aortic arch replacement. The current procedure avoids cardiopulmonary bypass and circulatory arrest, which may benefit early patient outcome; however, patient and device selection plays a key role for immediate success and midterm outcomes. In addition, precise procedural planning and development of customized stents may help to develop this procedure into a true alternative for conventional aortic arch replacement.
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Metadaten
Author:Klaus Brechtel, Günay Kalender, Ulrich Alfred Stock, Stephen M. Wildhirt
URN:urn:nbn:de:hebis:30:3-317222
URL:http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3846913/
DOI:http://dx.doi.org/10.1186/1749-8090-8-188
ISSN:1749-8090
Pubmed Id:http://www.ncbi.nlm.nih.gov/pubmed?term=24007462
Parent Title (English):Journal of cardiothoracic surgery
Publisher:BioMed Central
Place of publication:London
Document Type:Article
Language:English
Date of Publication (online):2013/09/04
Date of first Publication:2013/09/04
Publishing Institution:Universitätsbibliothek Johann Christian Senckenberg
Release Date:2013/10/07
Tag:Aortic debranching; Aortic dissection; Off-pump surgery; TEVAR
Volume:8
Issue:188
Pagenumber:10
First Page:1
Last Page:10
Note:
© 2013 Brechtel et al.; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
HeBIS PPN:353306886
Institutes:Medizin
Dewey Decimal Classification:610 Medizin und Gesundheit
Sammlungen:Universitätspublikationen
Licence (German):License LogoCreative Commons - Namensnennung 2.0

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