scholarly journals Open descending aortic replacement in a patient with a fractured Djumbodis™ dissection system

2020 ◽  
Vol 58 (1) ◽  
pp. 199-201 ◽  
Author(s):  
Takuya Fujikawa ◽  
Simon C Y Chow ◽  
Aliss T C Chang ◽  
Randolph H L Wong
Keyword(s):  
Aortic Arch ◽  
Acute Type ◽  
Aortic Arch Replacement ◽  
Type A Aortic Dissection ◽  
Endovascular Interventions ◽  
Aortic Replacement ◽  
Stent System ◽  
High Incidence ◽  
Descending Aortic Aneurysm

Abstract The Djumbodis™ dissection system was introduced as an alternative to aortic arch replacement in acute type A aortic dissection involving the arch. In our own experience, some patients with Djumbodis implantation developed distal aortic arch and descending aortic aneurysm during subsequent follow-up and required additional interventions. However, as there is a high incidence of fracture associated with the Djumbodis system, further endovascular interventions are not feasible. We report a case of successful open descending aortic replacement in a patient with a fractured Djumbodis stent system.

Frozen elephant trunk infection: to defrost or to debranch?

2020 ◽  
Author(s):  
Joseph Nader ◽  
Yuthiline Chabry ◽  
Houda Nazih ◽  
Thierry Caus
Keyword(s):  
Proximal Part ◽  
Acute Type ◽  
Frozen Elephant Trunk ◽  
Elephant Trunk ◽  
Aortic Arch Replacement ◽  
Descending Aorta ◽  
Type A Aortic Dissection ◽  
Hybrid Prosthesis

Abstract Infections of frozen elephant trunk hybrid prosthesis (HP) are not well documented in the literature and their management is not standardized yet. We report herein the case of a 59-year-old patient who benefited from a Thoraflex™ HP aortic arch replacement for an acute type A aortic dissection. He presented a year later with a Staphylococcus aureus infection of the proximal part of this prosthesis. We performed a replacement of the proximal compound of the HP accompanied by a complete debranching of the 3 supra-aortic vessels with an inter-carotidal retro-oesophageal bypass. As we left in situ the endovascular graft within the descending aorta, a life-long antibiotic therapy was introduced. The postoperative follow-up was uneventful, and the patient discharged home 2 weeks after his surgery. As an alternative to a more radical redo surgery with major risk, a hybrid medical and surgical treatment of infected frozen elephant trunk could be considered.

scholarly journals Stroke in acute type A aortic dissection: the Nordic Consortium for Acute Type A Aortic Dissection (NORCAAD)

2020 ◽  
Vol 58 (5) ◽  
pp. 1027-1034 ◽  
Author(s):  
Raphaelle A Chemtob ◽  
Simon Fuglsang ◽  
Arnar Geirsson ◽  
Anders Ahlsson ◽  
Christian Olsson ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Aortic Arch ◽  
Type A ◽  
Pericardial Tamponade ◽  
Acute Type ◽  
Aortic Arch Replacement ◽  
Type A Aortic Dissection ◽  
Total Aortic Arch Replacement ◽  
Cerebral Malperfusion ◽  
Mortality Hazard Ratio

Abstract OBJECTIVES Stroke is a serious complication in patients with acute type A aortic dissection (ATAAD). Previous studies investigating stroke in ATAAD patients have been limited by small cohorts and have shown diverging results. We sought to identify risk factors for stroke and to evaluate the effect of stroke on outcomes in surgical ATAAD patients. METHODS The Nordic Consortium for Acute Type A Aortic Dissection database included patients operated for ATAAD at 8 Scandinavian Hospitals between 2005 and 2014. RESULTS Stroke occurred in 177 (15.7%) out of 1128 patients. Patients with stroke presented more frequently with cerebral malperfusion (20.6% vs 6.3%, P < 0.001), syncope (30.6% vs 17.6%, P < 0.001), cardiogenic shock (33.1% vs 20.7%, P < 0.001) and pericardial tamponade (25.9% vs 14.7%, P < 0.001) and more often underwent total aortic arch replacement (10.7% vs 4.7%, P = 0.016), compared to patients without stroke. In the 86 patients presenting with cerebral malperfusion, 38.4% developed stroke. Thirty-day and 5-year mortality in patients with and without stroke were 27.1% vs 13.6% and 42.9% vs 25.6%, respectively. Stroke was an independent predictor of early- [odds ratio 2.02, 95% confidence interval (CI) 1.34–3.05; P < 0.001] and midterm mortality (hazard ratio 1.68, 95% CI 1.27–2.23; P < 0.001). CONCLUSIONS Stroke in ATAAD patients is associated with increased early- and midterm mortality. Preoperative cerebral malperfusion and impaired haemodynamics, as well as total aortic arch replacement, were more frequent among patients who developed stroke. Importantly, a large proportion of patients presenting with cerebral malperfusion did not develop a permanent stroke, indicating that signs of cerebral malperfusion should not be considered a contraindication for surgery.

scholarly journals Cabrol's Method in Association with Aortic Arch Replacement for Recurrent Acute Type A Aortic Dissection.

1997 ◽  
Vol 26 (5) ◽  
pp. 338-341
Author(s):  
Yukinori Moriyama ◽  
Hitoshi Toyohira ◽  
Tamahiro Kinjho ◽  
Mikio Hukueda ◽  
Koichi Hisatomi ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Aortic Arch ◽  
Type A ◽  
Acute Type ◽  
Aortic Arch Replacement ◽  
Type A Aortic Dissection

Total aortic arch replacement for acute type A aortic dissection

ASVIDE ◽  
2021 ◽  
Vol 8 ◽  
pp. 316-316
Author(s):  
Rizwan Q. Attia ◽  
Duke E. Cameron ◽  
Thoralf M. Sundt III ◽  
Arminder S. Jassar
Keyword(s):  
Aortic Dissection ◽  
Aortic Arch ◽  
Type A ◽  
Acute Type ◽  
Aortic Arch Replacement ◽  
Type A Aortic Dissection ◽  
Total Aortic Arch Replacement

scholarly journals Repair of residual aortic dissections with frozen elephant trunk technique

2020 ◽  
Vol 28 (3) ◽  
pp. 419-425
Author(s):  
Mustafa Akbulut
Keyword(s):  
Aortic Dissection ◽  
False Lumen ◽  
Type A ◽  
Acute Type ◽  
Frozen Elephant Trunk ◽  
Elephant Trunk ◽  
Type A Aortic Dissection ◽  
Aortic Replacement ◽  
Elephant Trunk Procedure

Background: In this study, we present our mid-term results of reoperation with the frozen elephant trunk procedure due to patent false lumen-related complications in patients previously undergoing supracoronary aortic repair for acute type A aortic dissection. Methods: Between January 2013 and September 2018, a total of 23 patients (17 males, 6 females; mean age 51.5±9.7 years; range, 30 to 67 years) who underwent ascending aortic replacement due to type A aortic dissection and, later, frozen elephant trunk procedure for residual distal dissection were included. For diagnostic purposes and follow-up, computed tomography angiography was performed in all patients, and both re-entry and aortic diameters were evaluated. Echocardiography was used to evaluate cardiac function and valve pathologies. Results: The Ishimaru zone 0 (n=11, 47.8%), Ishimaru zone 1 (n=1, 4.3%), Ishimaru zone 2 (n=4, 17.4%), and Ishimaru zone 3 (n=7, 30.4%) were used for frozen elephant trunk stent graft fixation. The mean duration of cardiopulmonary bypass and antegrade selective cerebral perfusion was 223.9±71.2 min and 88.9±60.3 min, respectively. In-hospital mortality was 13%, while there was one (4.3%) aortic-related death and four (17.4%) re-interventions during follow-up. Conclusion: Early repair should be considered in the presence of persistent dissections due to alarmingly high mortality rates of reoperations. Reoperation with the frozen elephant trunk procedure has acceptable results and the decision of the procedure to be performed should be based on preoperative risk factors of the patient.

scholarly journals Anatomy of the retrograde type A aortic dissection after endovascular repair of type B aortic dissection: a case report

2021 ◽  
Vol 0 (Ahead of Print) ◽  
Author(s):  
Uliana Pidvalna ◽  
Marianna Mirchuk ◽  
Anna Voitovych ◽  
Dmytro Beshley
Keyword(s):  
Aortic Dissection ◽  
Aortic Arch ◽  
Type A ◽  
Ascending Aorta ◽  
Medical Attention ◽  
Acute Type ◽  
Type B ◽  
Type B Aortic Dissection ◽  
Type A Aortic Dissection ◽  
Aortic Replacement

Aortic dissection requires immediate medical attention. The optimal treatment approach of Type B aortic dissection is still a matter of debate. Possible options include open surgery, endovascular aortic repair (EVAR), and hybrid procedure. The indication for surgery is the dissection that involves the ascending aorta and the aortic arch (Type A Stanford, Types I and II DeBakey). Hybrid or endovascular procedures seem to be an attractive alternative treatment for patients with the complex aortic disease and a high risk of surgery. Endovascular treatment of acute Type B aortic dissections is designed to prevent the retrograde dissection of the ascending aorta and the aortic arch. The occurrence of retrograde Type A aortic dissection (RTAD) is rare, but the mortality rate is high. We report a case of a 55-year-old gentleman who had undergone thoracic EVAR. Thirty months after the given procedure he presented with RTAD and underwent supracoronary aortic replacement. The article is intended to remind the clinicians of the importance of early detection of the possible complications when performing EVAR, and the significance of a rapid response.

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