Endovascular Repair Prior to Total Aortic Arch Replacement for Stanford A Acute Aortic Dissection with Abdominal Organ Ischemia / 日本心臓血管外科学会雑誌

A 47-year-old man was admitted to our hospital complaining of chest and back pain. Enhanced CT scan revealed Stanford type A acute aortic dissection. The celiac artery (CA) was not enhanced and the superior mesenteric artery (SMA) appeared on the delayed phase. There was a small amount of pericardial effusion. Blood gas analysis showed metabolic acidosis. To treat mesenteric malperfusion, we initially performed thoracic endovascular aortic repair (TEVAR) by the PETTICOAT technique and stenting to CA and SMA. The acidosis gradually normalized after TEVAR. We then performed surgical central repair (total arch replacement). He temporarily showed paraplegia after the operation but soon recovered by treatment for spinal ischemia. He was discharged 68 days post operatively without any complication. Surgical central repair is not always effective for treating organ ischemia, so endovascular repair before surgical operation is sometimes taken into consideration.

A Case of Ascending Aorta Replacement for Chronic Aortic Dissection by Minimally Invasive Cardiac Surgery / 日本心臓血管外科学会雑誌

The number of surgical treatments for acute aortic dissection in octogenarians is increasing. They should return to their daily life as soon as possible after the operation without any complications. Some literature reported that minimally invasive cardiac surgery (MICS) helps quick recovery for the patients. We report a case of minimally invasive ascending aorta replacement for Stanford type A chronic thrombosed aortic dissection in an octogenarian to help quick recovery. An 81-year-old man was admitted in our hospital suffering from chest and back pain. Enhanced CT scan showed Stanford type A acute thrombosed aortic dissection. The diameter of ascending aorta was 45 mm and the diameter of false lumen was 7 mm. Therefore we decided on medical treatment for this patient according to the guideline. After four weeks medical treatment, ascending aorta was dilated to 49 mm and the false lumen also expanded to 9 mm. He underwent minimally invasive ascending aorta replacement to help quick recovery considering his age. He was discharged 11 days postoperatively without any complications. MICS offers a better cosmetic result, less blood loss, less pain, better respiratory function and quick recovery. Thus, minimally invasive operation for the elderly is also very satisfactory.