Modified Total Arch Replacement for 38 Patients with Stanford A aortic dissection_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

LUHua , YANTao , YUHao , TONGGuang , MEILu-gang , LINZhao-ming , LIYao-yao ,  ZHANGWei-da , WANGXiao-wu , MATao , LIJie , WANGXiao-li

Department of Cardiovascular Surgery, Guangzhou general hospital, Guangzhou 510010, P. R. China;

Corresponding?author：

ZHANGWei-da, Email: weida_zhang@yeah.net

Keywords：

Aortic dissection; Total arch replacement; Moderate hypothermia; Left common carotid artery cannulation

DOI：

10.7507/1007-4848.20160189

Video：

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Objective To achieve a better early clinical result by modifying the total arch replacement and optimi-zing the procedure of operation. Method We retrospectively analyzed the clinical data of 38 patients patients with stanford a aortic dissection underwent the modifed total arch replacement in our hospital from September to December 2014. There were 26 males and 12 females with a mean age of 52.5 years ranging from 21-76 years. Three artery conduits were adopted during the surgical procedure. Right axillary artery and femoral artery cannulation were performed for cardiopulmonary bypass. The artificial graft and the left common carotid artery was anastomosed to provide simultaneous perfusion. Low rate bilateral brain perfusion began when circulation arrested at 26℃. Reperfusion restoration was obtained after the four-branch vascular graft anastomosed to the stent and aortic wall and completed the implantation of the elephant trunk. Then the aortic root and the vascular graft anastomosis were performed to reconstruct the ascending aorta. At last, the left subclavian artery and innominate artery were anastomosed to the branch of the vascular graft under the beating heart. Result All 38 operations were successful. The mean hypothermic circulatory time of the whole group was 18.8±4.2 min, the time of ascending aorta blocking was 86.1±14.2 min, the time of cardiopulmonary bypass was 178.4±71.4 min, the time of postoperative awakening was 4.7±2.0 h, the time of assisted mechanical ventilator was 38.7±19.9 h. One patient died because of multiple organ dysfunction syndrome (MODS), 3 patients accepted the hemodialysis, 6 patients suffered from transient neurological dysfunction, 1 patient suffered from paraparesis. There was no further complication during the follow-up of 1-3 months. Conclusion The modified total aortic arch replacement can shorten the circulatory arrest time, cardiac arrest time and cardiopulmonary time, provide effective organ perfusion, and reduce the neurological complication and visceral damage.

Citation： LUHua, YANTao, YUHao, TONGGuang, MEILu-gang, LINZhao-ming, LIYao-yao, ZHANGWei-da, WANGXiao-wu, MATao, LIJie, WANGXiao-li. Modified Total Arch Replacement for 38 Patients with Stanford A aortic dissection. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2016, 23(8): 788-791. doi: 10.7507/1007-4848.20160189 Copy

1.	?Ma WG, Zhu JM, Zheng J, et al. Sun, s procedure for complex aortic arch repair:total arch replacement using a tetrafurcate graft with stented elephant trunk implantation. Ann Cardiothorac Surg, 2013, 2(5):642-648.
2.	Ziganshin BA, Rajbanshi, BG, Tranquilli, M. Straight deep hypothermic circulatory arrest for cerebral protection during aortic arch surgery:Safe and effective. J Thorac Cardiovasc Surg, 2014, 148(3):888-898.
3.	Ueda Y. What is the best method for brain protection in surgery of the aortic arch? Retrograde cerebral perfusion. Cardiol Clin, 2010, 28(2):371-379.
4.	Misfeld M, Leontyev S, Borger MA, et al. What is the best atrategy for brain protection in patients undergoing aortic arch surgery? A single center experience of 636 patients. Ann Thorac Surg, 2012, 93(5):1502-1508.
5.	師恩祎, 谷天祥, 喻磊, 等.無名動脈插管簡化支架"象鼻"手術治療DeBakey Ⅰ型主動脈夾層.中國胸心血管外科臨床雜志, 2010, 17(5):433-435.
6.	Leshnower BG, Myung RJ, Kilgo PD, et al. Moderate hypothermia and unilateral selective antegrade cerebral perfusion:a contempo-rary cerebral protection strategy for aortic arch surgery. Ann Thorac Surg, 2010, 90(2):547-554.
7.	Patel HJ, Nguyen C, Diener AC, et al. Open arch reconstruction in the endovascular era:analysis of 721 patients over 17 years. J Thorac Cardiovasc Surg, 2011, 141(6):1417-1423.
8.	Okada K, Omura A, Kano H, et al. Recent advancements of total aortic arch replacement. J Thorac Cardiovasc Surg, 2012, 144(1):139-145.
9.	Ueda T, Shimizu H, Hashizume K, et al. Mortality and morbidity after total arch replacement using branched arch graft with selective antegrade cerebral perfusion. Ann Thorac Surg, 2003, 76(6):1951-1956.
10.	Spielvogel D, Halstead JC, Meier M, et al. Aortic arch replacement using a trifurcated graft:simple, versatile, and safe. Ann Thorac Surg, 2005, 80(1):90-95.
11.	Sasaki H, Ogino H, Matsuda H, et al. Integrated total arch replace-ment using selective cerebral perfusion:a 6-year experience. Ann Thorac Surg, 2007, 83(2):S805-810.
12.	Kazui T, Yamashita K, Washiyama N, et al. Aortic arch replacement using selective cerebral perfusion. Ann Thorac Surg, 2007, 83(2):S796-798.
13.	Sugiura T, Imoto K, Uchida K, et al. Comparative study of brain protection in ascending aorta replacement for acute type A aortic dissection:retrograde cerebral perfusion versus selective antegrade cerebral perfusion. Gen Thorac Cardiovasc Surg, 2012, 60(10):645-648.
14.	Kulik A, Castner CF, Kouchoukos NT. Outcomes after total aortic arch replacement with right axillary artery cannulation and a presewn multibranched graft. Ann Thorac Surg, 2011, 92(3):889-897.
15.	Nagamine H, Ueno Y, Ueda H, et al. A new classification system for branch artery perfusion patterns in acute aortic dissection for examining the effects of central aortic repair. Eur J Cardiothorac Surg, 2013, 44(1):146-153.
16.	Imanaka K, Kawata M, Matsuoka T, et al. Uncertainty of axillary artery perfusion during surgery for acute aortic dissection. Ann Thorac Surg, 2014, 97(5):1781-1782.
17.	Benedetto U, Mohamed H, Vitulli P, et al. Axillary versus femoral arterial cannulation in type A acute aortic dissection:evidence from a meta-analysis of comparative studies and adjusted risk estimates. Eur J Cardiothorac Surg, 2015, 48(6):953-959.
18.	Augoustides JG, Pochettino A, Ochroch EA, et al. Renal dysfunction after thoracic aortic surgery requiring deep hypothermic circulatory arrest:definition, incidence, and clinical predictors. J Cardiothorac Vasc Anesth, 2006, 20(5):673-677.
19.	Morimoto N, Morimoto K, Morimoto Y, et al. Sivelestat attenuates postoperative pulmonary dysfunction after total arch replacement under deep hypothermia. Eur J Cardiothorac Surg, 2008, 34(4):798-804.
20.	Chao YK, Wu YC, Yang KJ, et al. Pulmonary perfusion with L-arginine ameliorates post-cardiopulmonary bypass lung injury in a rabbit model. J Surg Res, 2011, 167(2):e77-e83.

1. ?Ma WG, Zhu JM, Zheng J, et al. Sun, s procedure for complex aortic arch repair:total arch replacement using a tetrafurcate graft with stented elephant trunk implantation. Ann Cardiothorac Surg, 2013, 2(5):642-648.
2. Ziganshin BA, Rajbanshi, BG, Tranquilli, M. Straight deep hypothermic circulatory arrest for cerebral protection during aortic arch surgery:Safe and effective. J Thorac Cardiovasc Surg, 2014, 148(3):888-898.
3. Ueda Y. What is the best method for brain protection in surgery of the aortic arch? Retrograde cerebral perfusion. Cardiol Clin, 2010, 28(2):371-379.
4. Misfeld M, Leontyev S, Borger MA, et al. What is the best atrategy for brain protection in patients undergoing aortic arch surgery? A single center experience of 636 patients. Ann Thorac Surg, 2012, 93(5):1502-1508.
5. 師恩祎, 谷天祥, 喻磊, 等.無名動脈插管簡化支架"象鼻"手術治療DeBakey Ⅰ型主動脈夾層.中國胸心血管外科臨床雜志, 2010, 17(5):433-435.
6. Leshnower BG, Myung RJ, Kilgo PD, et al. Moderate hypothermia and unilateral selective antegrade cerebral perfusion:a contempo-rary cerebral protection strategy for aortic arch surgery. Ann Thorac Surg, 2010, 90(2):547-554.
7. Patel HJ, Nguyen C, Diener AC, et al. Open arch reconstruction in the endovascular era:analysis of 721 patients over 17 years. J Thorac Cardiovasc Surg, 2011, 141(6):1417-1423.
8. Okada K, Omura A, Kano H, et al. Recent advancements of total aortic arch replacement. J Thorac Cardiovasc Surg, 2012, 144(1):139-145.
9. Ueda T, Shimizu H, Hashizume K, et al. Mortality and morbidity after total arch replacement using branched arch graft with selective antegrade cerebral perfusion. Ann Thorac Surg, 2003, 76(6):1951-1956.
10. Spielvogel D, Halstead JC, Meier M, et al. Aortic arch replacement using a trifurcated graft:simple, versatile, and safe. Ann Thorac Surg, 2005, 80(1):90-95.
11. Sasaki H, Ogino H, Matsuda H, et al. Integrated total arch replace-ment using selective cerebral perfusion:a 6-year experience. Ann Thorac Surg, 2007, 83(2):S805-810.
12. Kazui T, Yamashita K, Washiyama N, et al. Aortic arch replacement using selective cerebral perfusion. Ann Thorac Surg, 2007, 83(2):S796-798.
13. Sugiura T, Imoto K, Uchida K, et al. Comparative study of brain protection in ascending aorta replacement for acute type A aortic dissection:retrograde cerebral perfusion versus selective antegrade cerebral perfusion. Gen Thorac Cardiovasc Surg, 2012, 60(10):645-648.
14. Kulik A, Castner CF, Kouchoukos NT. Outcomes after total aortic arch replacement with right axillary artery cannulation and a presewn multibranched graft. Ann Thorac Surg, 2011, 92(3):889-897.
15. Nagamine H, Ueno Y, Ueda H, et al. A new classification system for branch artery perfusion patterns in acute aortic dissection for examining the effects of central aortic repair. Eur J Cardiothorac Surg, 2013, 44(1):146-153.
16. Imanaka K, Kawata M, Matsuoka T, et al. Uncertainty of axillary artery perfusion during surgery for acute aortic dissection. Ann Thorac Surg, 2014, 97(5):1781-1782.
17. Benedetto U, Mohamed H, Vitulli P, et al. Axillary versus femoral arterial cannulation in type A acute aortic dissection:evidence from a meta-analysis of comparative studies and adjusted risk estimates. Eur J Cardiothorac Surg, 2015, 48(6):953-959.
18. Augoustides JG, Pochettino A, Ochroch EA, et al. Renal dysfunction after thoracic aortic surgery requiring deep hypothermic circulatory arrest:definition, incidence, and clinical predictors. J Cardiothorac Vasc Anesth, 2006, 20(5):673-677.
19. Morimoto N, Morimoto K, Morimoto Y, et al. Sivelestat attenuates postoperative pulmonary dysfunction after total arch replacement under deep hypothermia. Eur J Cardiothorac Surg, 2008, 34(4):798-804.
20. Chao YK, Wu YC, Yang KJ, et al. Pulmonary perfusion with L-arginine ameliorates post-cardiopulmonary bypass lung injury in a rabbit model. J Surg Res, 2011, 167(2):e77-e83.

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