The results of total arch graft implantation with open stent-graft placement for type A aortic dissection
Background: One problem that conventional ascending treatment for type A aortic dissection has not satisfactorily resolved is chronic enlargement of residual dissection in the aortic arch and descending aorta. To address this problem, we have developed a new method for type A aortic dissection: tota...
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| Veröffentlicht in: | The Journal of thoracic and cardiovascular surgery 2002-09, Vol.124 (3), p.531-540 |
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| description | Background: One problem that conventional ascending treatment for type A aortic dissection has not satisfactorily resolved is chronic enlargement of residual dissection in the aortic arch and descending aorta. To address this problem, we have developed a new method for type A aortic dissection: total arch graft implantation with open-style stent-graft placement. Methods: From October 1994 through October 1999, 19 patients with type A aortic dissection (13 acute and 6 chronic dissections) underwent total arch graft implantation with open-style stent-graft placement. After achievement of general anesthesia and hypothermic extracorporeal circulation, we replaced the dissected ascending aorta and neck vessels with a 4-branched graft and repaired the descending aorta with a stent graft to close the entry site completely and to obtain better peripheral perfusion. We then examined the acute-phase and chronic-phase results and the outcomes of the false lumen and dissected aorta. Results: There were 1 (5.3%) hospital death and 2 late deaths. The survivals at 1 and 3 years were 89.5% and 82.6%, respectively. The following complications occurred in the perioperative period: 1 stroke, 2 cases of temporary paraparesis, 2 cases of temporary hemodialysis, and 3 cases of mediastinitis. No pulmonary complications were observed. Six months postoperatively, the targeted entry sites were completely closed in all cases, 80% (8/10) of preoperatively patent false lumina were clotted at the level of the end of the stent graft, and 60% (9/15) of the false lumina and 40% (6/15) of the dissected aorta had shrunk significantly. Two (13.3%) of 15 cases of postoperative dilatation in the dissected aorta were observed, and reoperation related to residual dissected aorta was performed in only 1 (1/17 [5.9%]) patient during the mean follow-up period of 2.4 ± 1.6 years. Conclusion: Our preliminary review of the total arch graft implantation with a stent graft suggests that this new procedure for type A aortic dissection might provide better results in both the acute and the chronic phase, especially with regard to the outcome for the false lumen and dissected aorta.
J Thorac Cardiovasc Surg 2002;124:531-40 |
| doi_str_mv | 10.1067/mtc.2002.124388 |
| format | Article |
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J Thorac Cardiovasc Surg 2002;124:531-40</description><identifier>ISSN: 0022-5223</identifier><identifier>EISSN: 1097-685X</identifier><identifier>DOI: 10.1067/mtc.2002.124388</identifier><identifier>PMID: 12202870</identifier><identifier>CODEN: JTCSAQ</identifier><language>eng</language><publisher>Philadelphia, PA: Elsevier Inc</publisher><subject>Adult ; Aged ; Aneurysm, Dissecting - mortality ; Aneurysm, Dissecting - surgery ; Aorta, Thoracic - diagnostic imaging ; Aorta, Thoracic - pathology ; Aorta, Thoracic - transplantation ; Aortic Aneurysm - mortality ; Aortic Aneurysm - surgery ; Biological and medical sciences ; Blood and lymphatic vessels ; Blood Vessel Prosthesis Implantation ; Cardiology. Vascular system ; Device Removal ; Diseases of the aorta ; Echocardiography, Doppler, Color ; Female ; Follow-Up Studies ; Hospital Mortality ; Humans ; Male ; Medical sciences ; Middle Aged ; Postoperative Complications - etiology ; Postoperative Complications - mortality ; Stents ; Time Factors ; Tomography, X-Ray Computed ; Treatment Outcome ; Vascular Patency - physiology</subject><ispartof>The Journal of thoracic and cardiovascular surgery, 2002-09, Vol.124 (3), p.531-540</ispartof><rights>2002 American Association for Thoracic Surgery</rights><rights>2002 INIST-CNRS</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c446t-6574cc5d7cef07d915a09aa5ca3e7d49247998dcd4c56412f03b804fafd0c48d3</citedby><cites>FETCH-LOGICAL-c446t-6574cc5d7cef07d915a09aa5ca3e7d49247998dcd4c56412f03b804fafd0c48d3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0022522302001162$$EHTML$$P50$$Gelsevier$$Hfree_for_read</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=13895067$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/12202870$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Kato, Masaaki</creatorcontrib><creatorcontrib>Kuratani, Toru</creatorcontrib><creatorcontrib>Kaneko, Mitsunori</creatorcontrib><creatorcontrib>Kyo, Shunei</creatorcontrib><creatorcontrib>Ohnishi, Kenji</creatorcontrib><title>The results of total arch graft implantation with open stent-graft placement for type A aortic dissection</title><title>The Journal of thoracic and cardiovascular surgery</title><addtitle>J Thorac Cardiovasc Surg</addtitle><description>Background: One problem that conventional ascending treatment for type A aortic dissection has not satisfactorily resolved is chronic enlargement of residual dissection in the aortic arch and descending aorta. To address this problem, we have developed a new method for type A aortic dissection: total arch graft implantation with open-style stent-graft placement. Methods: From October 1994 through October 1999, 19 patients with type A aortic dissection (13 acute and 6 chronic dissections) underwent total arch graft implantation with open-style stent-graft placement. After achievement of general anesthesia and hypothermic extracorporeal circulation, we replaced the dissected ascending aorta and neck vessels with a 4-branched graft and repaired the descending aorta with a stent graft to close the entry site completely and to obtain better peripheral perfusion. We then examined the acute-phase and chronic-phase results and the outcomes of the false lumen and dissected aorta. Results: There were 1 (5.3%) hospital death and 2 late deaths. The survivals at 1 and 3 years were 89.5% and 82.6%, respectively. The following complications occurred in the perioperative period: 1 stroke, 2 cases of temporary paraparesis, 2 cases of temporary hemodialysis, and 3 cases of mediastinitis. No pulmonary complications were observed. Six months postoperatively, the targeted entry sites were completely closed in all cases, 80% (8/10) of preoperatively patent false lumina were clotted at the level of the end of the stent graft, and 60% (9/15) of the false lumina and 40% (6/15) of the dissected aorta had shrunk significantly. Two (13.3%) of 15 cases of postoperative dilatation in the dissected aorta were observed, and reoperation related to residual dissected aorta was performed in only 1 (1/17 [5.9%]) patient during the mean follow-up period of 2.4 ± 1.6 years. Conclusion: Our preliminary review of the total arch graft implantation with a stent graft suggests that this new procedure for type A aortic dissection might provide better results in both the acute and the chronic phase, especially with regard to the outcome for the false lumen and dissected aorta.
J Thorac Cardiovasc Surg 2002;124:531-40</description><subject>Adult</subject><subject>Aged</subject><subject>Aneurysm, Dissecting - mortality</subject><subject>Aneurysm, Dissecting - surgery</subject><subject>Aorta, Thoracic - diagnostic imaging</subject><subject>Aorta, Thoracic - pathology</subject><subject>Aorta, Thoracic - transplantation</subject><subject>Aortic Aneurysm - mortality</subject><subject>Aortic Aneurysm - surgery</subject><subject>Biological and medical sciences</subject><subject>Blood and lymphatic vessels</subject><subject>Blood Vessel Prosthesis Implantation</subject><subject>Cardiology. Vascular system</subject><subject>Device Removal</subject><subject>Diseases of the aorta</subject><subject>Echocardiography, Doppler, Color</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Hospital Mortality</subject><subject>Humans</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Postoperative Complications - etiology</subject><subject>Postoperative Complications - mortality</subject><subject>Stents</subject><subject>Time Factors</subject><subject>Tomography, X-Ray Computed</subject><subject>Treatment Outcome</subject><subject>Vascular Patency - physiology</subject><issn>0022-5223</issn><issn>1097-685X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2002</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1kE1v1DAURS0EokNhzQ55A11l6q_EybKqoCBVYlMkdpb7_Ny4SuJge6j67_EoI3XFyrJ87vV7h5CPnO056_TlXGAvGBN7LpTs-1dkx9mgm65vf78mu_ogmlYIeUbe5fzIGNOMD2_JGReCiV6zHQl3I9KE-TCVTKOnJRY7UZtgpA_J-kLDvE52KbaEuNCnUEYaV1xoLriUZkMqADjXO_Ux0fK8Ir2iNqYSgLqQM8Ix_J688XbK-OF0npNf377eXX9vbn_e_Li-um1Aqa40XasVQOs0oGfaDby1bLC2BStROzUIpYehd-AUtJ3iwjN53zPlrXcMVO_kOfmy9a4p_jlgLmYOGXCqW2A8ZKMFk1r0vIKXGwgp5pzQmzWF2aZnw5k52jXVrjnaNZvdmvh0qj7cz-he-JPOCnw-ATaDnXyyC4T8wsl-aGtx5S42bgwP41NIaPJsp6nWcvNYINf_jDStPA45bCRWZX8DJpMh4ALoagqKcTH8d9x_VKCk1w</recordid><startdate>20020901</startdate><enddate>20020901</enddate><creator>Kato, Masaaki</creator><creator>Kuratani, Toru</creator><creator>Kaneko, Mitsunori</creator><creator>Kyo, Shunei</creator><creator>Ohnishi, Kenji</creator><general>Elsevier Inc</general><general>AATS/WTSA</general><general>Elsevier</general><scope>6I.</scope><scope>AAFTH</scope><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20020901</creationdate><title>The results of total arch graft implantation with open stent-graft placement for type A aortic dissection</title><author>Kato, Masaaki ; Kuratani, Toru ; Kaneko, Mitsunori ; Kyo, Shunei ; Ohnishi, Kenji</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c446t-6574cc5d7cef07d915a09aa5ca3e7d49247998dcd4c56412f03b804fafd0c48d3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2002</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Aneurysm, Dissecting - mortality</topic><topic>Aneurysm, Dissecting - surgery</topic><topic>Aorta, Thoracic - diagnostic imaging</topic><topic>Aorta, Thoracic - pathology</topic><topic>Aorta, Thoracic - transplantation</topic><topic>Aortic Aneurysm - mortality</topic><topic>Aortic Aneurysm - surgery</topic><topic>Biological and medical sciences</topic><topic>Blood and lymphatic vessels</topic><topic>Blood Vessel Prosthesis Implantation</topic><topic>Cardiology. Vascular system</topic><topic>Device Removal</topic><topic>Diseases of the aorta</topic><topic>Echocardiography, Doppler, Color</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Hospital Mortality</topic><topic>Humans</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Postoperative Complications - etiology</topic><topic>Postoperative Complications - mortality</topic><topic>Stents</topic><topic>Time Factors</topic><topic>Tomography, X-Ray Computed</topic><topic>Treatment Outcome</topic><topic>Vascular Patency - physiology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Kato, Masaaki</creatorcontrib><creatorcontrib>Kuratani, Toru</creatorcontrib><creatorcontrib>Kaneko, Mitsunori</creatorcontrib><creatorcontrib>Kyo, Shunei</creatorcontrib><creatorcontrib>Ohnishi, Kenji</creatorcontrib><collection>ScienceDirect Open Access Titles</collection><collection>Elsevier:ScienceDirect:Open Access</collection><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>The Journal of thoracic and cardiovascular surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Kato, Masaaki</au><au>Kuratani, Toru</au><au>Kaneko, Mitsunori</au><au>Kyo, Shunei</au><au>Ohnishi, Kenji</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>The results of total arch graft implantation with open stent-graft placement for type A aortic dissection</atitle><jtitle>The Journal of thoracic and cardiovascular surgery</jtitle><addtitle>J Thorac Cardiovasc Surg</addtitle><date>2002-09-01</date><risdate>2002</risdate><volume>124</volume><issue>3</issue><spage>531</spage><epage>540</epage><pages>531-540</pages><issn>0022-5223</issn><eissn>1097-685X</eissn><coden>JTCSAQ</coden><abstract>Background: One problem that conventional ascending treatment for type A aortic dissection has not satisfactorily resolved is chronic enlargement of residual dissection in the aortic arch and descending aorta. To address this problem, we have developed a new method for type A aortic dissection: total arch graft implantation with open-style stent-graft placement. Methods: From October 1994 through October 1999, 19 patients with type A aortic dissection (13 acute and 6 chronic dissections) underwent total arch graft implantation with open-style stent-graft placement. After achievement of general anesthesia and hypothermic extracorporeal circulation, we replaced the dissected ascending aorta and neck vessels with a 4-branched graft and repaired the descending aorta with a stent graft to close the entry site completely and to obtain better peripheral perfusion. We then examined the acute-phase and chronic-phase results and the outcomes of the false lumen and dissected aorta. Results: There were 1 (5.3%) hospital death and 2 late deaths. The survivals at 1 and 3 years were 89.5% and 82.6%, respectively. The following complications occurred in the perioperative period: 1 stroke, 2 cases of temporary paraparesis, 2 cases of temporary hemodialysis, and 3 cases of mediastinitis. No pulmonary complications were observed. Six months postoperatively, the targeted entry sites were completely closed in all cases, 80% (8/10) of preoperatively patent false lumina were clotted at the level of the end of the stent graft, and 60% (9/15) of the false lumina and 40% (6/15) of the dissected aorta had shrunk significantly. Two (13.3%) of 15 cases of postoperative dilatation in the dissected aorta were observed, and reoperation related to residual dissected aorta was performed in only 1 (1/17 [5.9%]) patient during the mean follow-up period of 2.4 ± 1.6 years. Conclusion: Our preliminary review of the total arch graft implantation with a stent graft suggests that this new procedure for type A aortic dissection might provide better results in both the acute and the chronic phase, especially with regard to the outcome for the false lumen and dissected aorta.
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| subjects | Adult Aged Aneurysm, Dissecting - mortality Aneurysm, Dissecting - surgery Aorta, Thoracic - diagnostic imaging Aorta, Thoracic - pathology Aorta, Thoracic - transplantation Aortic Aneurysm - mortality Aortic Aneurysm - surgery Biological and medical sciences Blood and lymphatic vessels Blood Vessel Prosthesis Implantation Cardiology. Vascular system Device Removal Diseases of the aorta Echocardiography, Doppler, Color Female Follow-Up Studies Hospital Mortality Humans Male Medical sciences Middle Aged Postoperative Complications - etiology Postoperative Complications - mortality Stents Time Factors Tomography, X-Ray Computed Treatment Outcome Vascular Patency - physiology |
| title | The results of total arch graft implantation with open stent-graft placement for type A aortic dissection |
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