Efficacy of In Situ Fenestrated Open Stent Technique (FeneOS) for the Surgery of Acute Aortic Dissection Type A Surgery / 日本心臓血管外科学会雑誌

ABSTRACT

Background : The surgical repair of acute aortic dissection type A [AAD (A)] by reconstructing the left subclavian artery (LSCA) is sometimes difficult because of the deep surgical field and the occurrence of left recurrent nerve palsy or bleeding. In Japan, since 2014, a commercially available open stent graft (J-graft OPEN STENT) has been used for promoting thrombosis of the false lumen in the descending aorta. This report presents an efficacy evaluation of the surgeon-made in situ Fenestrated Open Stent (FeneOS) for LSCA reconstruction in a patient with AAD (A). Method : We performed surgery with FeneOS using the open stent graft by first deploying it from the entry of the LSCA into the descending aorta and manually making a hole on the LSCA side of the stenting portion ; then, the four-branched J graft was anastomosed between the left common carotid (lt. CCA) and SCA (ZONE 2). At our institution, 47 patients with AAD (A) underwent this surgery with FeneOS from 2014 to 2019 (FeneOS group) and 97 patients with AAD (A) underwent a normal open-stenting procedure from 2008 to 2014 (non-FeneOS group). We analyzed the postoperative results of patients in the FeneOS and non-FeneOS groups. Results : Preoperative characteristics of patients in both groups were similar. Patients in the FeneOS group had an acceptable postoperative course, with no 30-day or in-hospital deaths. The mean operation time, cardiopulmonary bypass time, selective cerebral perfusion time, and open distal anastomosis time were significantly shorter in patients in the FeneOS group (p＜0.01). None of the patients had left recurrent nerve palsy, and postoperative computed tomography or arterial echo showed that the blood flow through the LSCA was intact and revealed no endoleakage. Conclusion : FeneOS is simple, fast, and less invasive for the reconstruction of the LSCA without the risk of left recurrent nerve palsy and can be effective for treating patients with AAD (A).