Results of "elephant trunk" total aortic arch replacement using a multi-branched, collared graft prosthesis

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• 作者：Stefan R.B. Schneider ; Angelo M. Dell'Aquila ; Ali Akil…
• 关键词：Aortic arch replacement ; Elephant trunk procedure ; Ascending aortic aneurysm ; Aortic dissection
• 刊名：Heart and Vessels
• 出版年：2016
• 出版时间：March 2016
• 年：2016
• 卷：31
• 期：3
• 页码：390-396
• 全文大小：665 KB
• 参考文献：1.Borst HG, Walterbusch G, Schaps D (1983) Extensive aortic replacement using “elephant trunk” prosthesis. Thorac Cardiovasc Surg 31:37–40CrossRef PubMed
  2.Neri E, Massetti M, Sani G (2004) The “elephant trunk” technique made easier. Ann Thorac Surg 78:e17–e18CrossRef PubMed
  3.Minatoya K, Ogino H, Matsuda H, Sasaki H, Tanaka H, Kobayashi J, Yagihara T, Kitamura S (2008) Evolving selective cerebral perfusion for aortic arch replacement: high flow rate with moderate hypothermic circulatory arrest. Ann Thorac Surg 86:1827–1831CrossRef PubMed
  4.Strauch JT, Bohme Y, Franke UF, Wittwer T, Madershahian N, Wahlers T (2005) Selective cerebral perfusion via right axillary artery direct cannulation for aortic arch surgery. Thorac Cardiovasc Surg 53:334–340CrossRef PubMed
  5.Orihashi K, Sueda T, Okada K, Imai K (2004) Near-infrared spectroscopy for monitoring cerebral ischemia during selective cerebral perfusion. Eur J Cardiothorac Surg 26:907–911CrossRef PubMed
  6.Guilmet D, Bachet J, Goudot B, Laurian C, Gigou F, Bical O, Barbagelatta M (1979) Use of biological glue in acute aortic dissection. preliminary clinical results with a new surgical technique. J Thorac Cardiovasc Surg 77:516–521PubMed
  7.Bingley JA, Gardner MAH, Stafford EG, Mau TK, Pohlner PG, Tam RKW, Jalali H, Tesar PJ, O’Brien MF (2000) Late complications of tissue glues in aortic surgery. Ann Thorac Surg 69:1764–1768CrossRef PubMed
  8.Boeken U, Assmann A, Mehdiani A, Akhyari P, Lichtenberg A (2011) Open chest management after cardiac operations: outcome and timing of delayed sternal closure. Eur J Cardiothorac Surg 40:1146–1150PubMed
  9.Kodama K, Nishigami K, Sakamoto T, Sawamura T, Hirayama T, Misumi H, Nakao K (2008) Tight heart rate control reduces secondary adverse events in patients with type B acute aortic dissection. Circulation 118:S167–S170CrossRef PubMed
  10.Ohnuma T, Kimura N, Sasabuchi Y, Asaka K, Shiotsuka J, Komuro T, Mouri H, Lefor AT, Adachi H, Sanui M (2014) Lower heart rate in the early postoperative period does not correlate with long-term outcomes after repair of type A acute aortic dissection. Heart Vessels. doi:10.​1007/​s00380-014-0486-7 PubMed PubMedCentral
  11.Wheat MW (1965) Treatment of dissecting aneurysms of the aorta without surgery. J Thorac Cardiovasc Surg 50:364–373PubMed
  12.Brooke BS, Habashi JP, Judge DP, Patel N, Loeys B, Dietz HC (2008) Angiotensin II blockade and aortic-root dilation in marfan’s syndrome. N Engl J Med 358:2787–2795CrossRef PubMed PubMedCentral
  13.Habashi JP, Judge DP, Holm TM, Cohn RD, Loeys BL, Cooper TK, Myers L, Klein EC, Liu G, Calvi C, Podowski M, Neptune ER, Halushka MK, Bedja D, Gabrielson K, Rifkin DB, Carta L, Ramirez F, Huso DL, Dietz HC (2006) Losartan, an AT1 antagonist, prevents aortic aneurysm in a mouse model of marfan syndrome. Science 312:117–121CrossRef PubMed PubMedCentral
  14.Lunder M, Žiberna L, Janić M, Jerin A, Skitek M, Šabovič M, Drevenšek G (2013) Low-dose atorvastatin, losartan, and particularly their combination, provide cardiovascular protection in isolated rat heart and aorta. Heart Vessels 28:246–254CrossRef PubMed
  15.Song S, Yoo K, Kim D, Cho B, Yi G, Chang B (2011) Effects of early anticoagulation on the degree of thrombosis after repair of acute DeBakey type I aortic dissection. Ann Thorac Surg 92:1367–1375CrossRef PubMed
  16.Watanuki H, Ogino H, Minatoya K, Matsuda H, Sasaki H, Ando M, Kitamura S (2007) Is emergency total arch replacement with a modified elephant trunk technique justified for acute type A aortic dissection? Ann Thorac Surg 84:1585–1591CrossRef PubMed
  17.Kieffer E, Koskas F, Godet G, Bertrand M, Bahnini A, Benhamou A, Cluzel P, Eyraud D (2000) Treatment of aortic arch dissection using the elephant trunk technique. Ann Vasc Surg 14:612–619CrossRef PubMed
  18.Ius F, Hagl C, Haverich A, Pichlmaier M (2011) Elephant trunk procedure 27 years after borst: what remains and what is new? Eur J Cardiothorac Surg 40:1–12CrossRef PubMed
  19.Authors/Task Force Members, Steg PG, James SK, Atar D, Badano LP, Lundqvist CB, Borger MA, Di Mario C, Dickstein K, Ducrocq G, Fernandez-Aviles F, Gershlick AH, Giannuzzi P, Halvorsen S, Huber K, Juni P, Kastrati A, Knuuti J, Lenzen MJ, Mahaffey KW, Valgimigli M, van’t Hof A, Widimsky P, Zahger D, ESC Committee for Practice Guidelines (CPG), Bax JJ, Baumgartner H, Ceconi C, Dean V, Deaton C, Fagard R, Funck-Brentano C, Document Reviewers, Hasdai D, Hoes A, Kirchhof P, Knuuti J, Kolh P, McDonagh T, Moulin C, Popescu BA, Reiner Ž, Sechtem U, Sirnes PA, Tendera M, Torbicki A, Vahanian A, Windecker S, Hasdai D, Astin F, Åström-Olsson K, Budaj A, Clemmensen P, Collet J, Fox KA, Fuat A, Gustiene O, Hamm CW, Kala P, Lancellotti P, Maggioni AP, Merkely B, Neumann F, Piepoli MF, Van de Werf F, Verheugt F, Wallentin L (2012) ESC guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The task force on the management of ST-segment elevation acute myocardial infarction of the european society of cardiology (ESC). Eur Heart J 33:2569–2619CrossRef
  20.Wilde JT (1997) Hematological consequences of profound hypothermic circulatory arrest and aortic dissection. J Card Surg 12(2 Suppl):201–206PubMed
  21.Delsart P, Beregi J, Devos P, Haulon S, Midulla M, Mounier-Vehier C (2014) Thrombocytopenia: an early marker of late mortality in type B aortic dissection. Heart Vessels 29:220–230CrossRef PubMed
  22.Hanke AA, Herold U, Dirkmann D, Tsagakis K, Jakob H, Görlinger K (2012) Thromboelastometry based early goal-directed coagulation management reduces blood transfusion requirements, adverse events, and costs in acute type A aortic dissection: a pilot study. Transfus Med Hemother 39:121–128CrossRef PubMed PubMedCentral
  23.Svensson LG (1992) Rationale and technique for replacement of the ascending aorta, arch, and distal aorta using a modified elephant trunk procedure. J Card Surg 7:301–312CrossRef PubMed
  24.Konishi T, Higuchi K, Fukata M, Takeda M, Akisima S, Fukuda S (1999) Extended aortic replacement in acute dissection by the separated elephant trunk technique. Ann Thorac Surg 67:1664–1668CrossRef PubMed
  25.Iida Y, Koizumi N, Matsuyama K, Ogino H (2013) Flanged elephant trunk technique at distal anastomosis for total arch replacement with multibranched arch graft. Ann Vasc Surg 27:831–833CrossRef PubMed
  26.Shrestha M, Martens A, Krüger H, Maeding I, Ius F, Fleissner F, Haverich A (2014) Total aortic arch replacement with the elephant trunk technique: single-centre 30-year results. Eur J Cardiothorac Surg 45:289–296CrossRef PubMed
  27.Park K, Lim C, Choi JH, Chung E, Choi SI, Chun EJ, Sung K (2009) Midterm change of descending aortic false lumen after repair of acute type I dissection. Ann Thorac Surg 87:103–108CrossRef PubMed
  
• 作者单位：Stefan R.B. Schneider (1)
  Angelo M. Dell’Aquila (1)
  Ali Akil (1)
  Dominik Schlarb (1)
  Guiseppe Panuccio (2)
  Sven Martens (1)
  Andreas Rukosujew (1)
  
  1. Division of Cardiac Surgery, Department of Cardiothoracic Surgery, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1, Gebäude A1, 48149, Münster, Germany
  2. Department of Vascular and Endovascular Surgery, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1, Gebäude A1, 48149, Münster, Germany
  
• 刊物类别：Medicine
• 刊物主题：Medicine & Public Health
  Cardiology
  Cardiac Surgery
  Vascular Surgery
  Biomedical Engineering
  Interventional Radiology
  Ultrasound
  
• 出版者：Springer Japan
• ISSN：1615-2573

文摘

We report on our experience with a simplified elephant trunk (ET) procedure with a multi-branched prosthesis (Vascutek® Siena™ Collared Graft). It consists of a proximal portion (20 cm) with prefabricated side branches, a collar and a distal portion (30 cm). The collar, which can be trimmed into any desired diameter, constitutes the suture portion to the descending aorta. Radiopaque markers in the distal portion indicate the landing zone. Between January 2011 and June 2013, 20 consecutive patients (10 women; mean age, 66 ± 9.3 years) underwent ET procedure, including 6 re-do cases. Underlying aortic diseases were acute dissection (n = 6), chronic dissection (n = 4), aneurysm (n = 8) and PAU (n = 2). Mean preoperative diameter of the descending aorta was 49.1 ± 12.9 mm (range 74.7–29.7 mm). Concomitant procedures included ascending aortic replacement in 16 patients; root replacement in 2; AVR in 2, CABG in 3 and mitral repair in 1 patient. CPB time was 263 ± 94 min; mean duration of ACP was 65 ± 14 min. Two patients died on POD 8 and 78, respectively. Major adverse events included stroke (n = 1), resternotomy for bleeding (n = 2), renal failure requiring temporary dialysis (n = 1) and recurrent nerve paresis (n = 2). After a mean follow-up of 10 ± 8 months, all discharged patients were alive. Seven patients underwent stent-graft implantation of the descending aorta and one patient underwent open descending aortic replacement. The last generation of multi-branched arch prosthesis and especially the Vascutek® Siena™ Collared Graft make ET procedure a reasonable treatment option even in patients with acute aortic dissection.