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Objeetive To summarize the resuhs of the surgical management of complicated type B dissection with an iso lated left vertebral artery(ILVA) using the stented elephant trunk technique.Methods Between February 2009 and September 2016,12 patients with complicated type B dissection(acute in 7 and chronic in 5) underwent the stented elephant trunk procedure under moderate circulatory arrest with selective antegrade cerebral perfusion.11 patients were males with a mean age of(50.9 ± 6.1) years(ranged 42-59 years).Preoperative limb ischaemia was obscrved in 2 patients,renal dysfunction in 1 patient.Results There was no in-hospital death.1 patient was suffered permanent hoarseness after the surgery.The cardiopulmonary bypass time was 143.1 ± 26.3 min and selective cerebral perfusion time was (27.2 ± 11.2) min.The follow-up time was 6-92 months,mean (40.9 ± 30.6) months.1 of the ischaemia of the limb patients was ameliorated after surgical stentgraft implantation,the other 1 was ameliorated after surgical stent-graft implantation combined with a bypass of the ascending aorta to the right femoral artery.No neurological deficits were observed in any patients prior to hospital discharge.2 patients underwent thoracic endovascular aortic repair and total thoracoabdominal aortic aneurysm repair respectively due to distal aortic aneurysm within the mean follow-up period.Conclusion Surgical repair of complicated type B dissection with an ILVA using the stented elephant trunk technique can obtain a satisfactory med-term clinical results.
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Objeetive To summarize the resuhs of the surgical management of complicated type B dissection with an iso lated left vertebral artery(ILVA) using the stented elephant trunk technique.Methods Between February 2009 and September 2016,12 patients with complicated type B dissection(acute in 7 and chronic in 5) underwent the stented elephant trunk procedure under moderate circulatory arrest with selective antegrade cerebral perfusion.11 patients were males with a mean age of(50.9 ± 6.1) years(ranged 42-59 years).Preoperative limb ischaemia was obscrved in 2 patients,renal dysfunction in 1 patient.Results There was no in-hospital death.1 patient was suffered permanent hoarseness after the surgery.The cardiopulmonary bypass time was 143.1 ± 26.3 min and selective cerebral perfusion time was (27.2 ± 11.2) min.The follow-up time was 6-92 months,mean (40.9 ± 30.6) months.1 of the ischaemia of the limb patients was ameliorated after surgical stentgraft implantation,the other 1 was ameliorated after surgical stent-graft implantation combined with a bypass of the ascending aorta to the right femoral artery.No neurological deficits were observed in any patients prior to hospital discharge.2 patients underwent thoracic endovascular aortic repair and total thoracoabdominal aortic aneurysm repair respectively due to distal aortic aneurysm within the mean follow-up period.Conclusion Surgical repair of complicated type B dissection with an ILVA using the stented elephant trunk technique can obtain a satisfactory med-term clinical results.
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Objective To summarize our clinical experience and results of Stanford type B dissection,and analyzed the risk factors of reoperation.Methods From February 2009 to December 2011,81 patients (54 male and 27 female) of Stanford type B aortic dissection underwent surgical procedure in Beijing Anzhen Hospital The mean age was 19 -77 years,averaged (41.6±11.7)years.Associated with hypeftension in 48 cases,Marfan syndrome in 15 case,aortic root aneurysm in 7cases,dilation of aortic sinus and ascending aorta each in one,coarctation of the aorta in 1 case.Reoperation was done in 22cases and 4 of 22 needed the third operation.The risk factors of reoperation were analyzed with Logistic regression analysis.Results Sun (s) procedure was operated on 16 cases,concomitant procedures included Bentall in 7 cases,David in 1,replacement of the ascending aorta in 2 cases,CABG in 1 case.The thoracoabdominal aortic replacement in 31 cases,the descending thoracic aortic replacement in 9 cases,the stented elephant trunk procedure in 24 cases.Concomitant procedures included the bypass from the left subclavian artery to the left common carotid artery in 5 cases,aortic valve replacement and ascending aortic plasty in 3 cases,left subclavian artery reconstruction in 2 cases,double valve replacement in 1 cases,and the bypass from ascending aorta to descending aorta each in one,repair of internal leakage in 1 case.2 patients underwent thoracoabdominal aorta replacement died after surgery due to multiple organ failure caused by postoperative bleeding.The hospital mortality was 2.5％(2/81 cases).Complications occurred in 6 patients (6/81 cases,7.4.％ ),including diastinal bleeding requiring reoperation in 3 cases,respiratory insufficiency and hoarseness each in one,postoperative esophageal fistula needed reoperation and jejunal fistulization in I case.No paraplegia or stroke occurred postoperatively.Logistic regression analysis shows Marfan syndrome is the risk factor of reoperation.Conclusion The surgery on Stanford B aortic dissection can achieve satisfactory clinical results and Marfan syndrome is the risk factor of reoperation.The mid- and long-term results need the further follow-up.
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Objective To summarize our clinical experience and results of intraoperative stented elephant trunk technique on Stanford type B dissection.Methods From March 2009 to December 2011,24 patients of Stanford type B aortic dissection with insufficient anchored zone or the left subclavian artery involvement underwent intraoperative stented elephant trunk technique in Beijing AnZhen Hospital.Of these patients,20 were male and 4 female,with a mean age of (50.6 ± 9.8) years,(36-77 years).Associated with hypertension in 20 cases,aortic root aneurysm in 1 case,aortic insufficiency in 2 cases,mitral insufficiency in 1 case,coarctation of the aorta in 1 case; 14 cases had a history of smoking.The postoperative internal fistula after descending thoracic aortic stent-graft occurred in 4 cases.Results 24 patients of Stanford type B aortic dissection with insufficient anchored zone or the left subclavian artery involvement underwent intraoperative stented elephant trunk technique.Concomitant procedures included the bypass from the left subclavian artery to the left common carotid artery in 5 cases,aortic valve replacement and ascending aortic plasty in 3 cases,left subclavian artery reconstruction in 2 cases,double valve replacement in 1 cases,the bypass from ascending aorta to descending aorta each in one.The times of cardiopulmonary bypass and selective cerebral perfusion averaged (163.1 ±48.6) min and (29.1 ± 12.4) min,respectively.There was no in-hospital mortality.Complications occurred in 2 patients (2/24,8.3％),including respiratory insufficiency and mediastinal bleeding requiring reoperation,each in one.No paraplegia or stroke occurred postoperatively.Follow-up was available in 23 patients (23/24,95.8％).During the follow-up,type Ⅰ endoleak occurred in 2 patient and needed surgical repair.One patient underwent endovascular aortic repair due to pseudoaneurysm of the distal end of the stent.The complete thrombosis ratio of the false lumen was 86.4％ (20/24).Conclusion The intraoperative stented elephant trunk technique was safe and feasible for Stanford type B aortic dissection with insufficient anchored zone or the left subclavian.artery involvement,a low rate of morbidity and mortality were achieved.The long-term results need the further follow-up.