Interstage mortality in two‐stage elephant trunk surgery

Hybrid two-stage repair of Stanford A dissection with visceral or peripheral malperfusion

Journal of Cardiothoracic Surgery ◽

10.1186/s13019-020-01307-8 ◽

2020 ◽

Vol 15 (1) ◽

Author(s):

Zanxin Wang ◽

Xianmian Zhuang ◽

Bailang Chen ◽

Junmin Wen ◽

Minxin Wei

Keyword(s):

False Lumen ◽

Case Series ◽

Celiac Artery ◽

True Lumen ◽

Elephant Trunk ◽

Two Stage ◽

Aortic Repair ◽

Initial Surgery ◽

Cord Injury

Abstract Background The present study aimed to evaluate the effect of two-stage hybrid aortic repair at the distal aorta of Stanford A dissection with malperfusion. Methods This retrospective case series included 20 patients with Stanford A dissection administered two-stage thoracic endovascular aortic repair (TEVAR) about 1 month after central repair because of visceral or limb malperfusion. The patients were examined by computed tomography (CT) angiography at 3, 6, 12 and 24 months after operation. Recovery of malperfusion and true lumen index were evaluated during follow-up. Results Twenty patients underwent two-stage hybrid aortic repair, including 11 males and 9 females. The follow-up time was 24 ± 7 months. No intervention-related complications were observed, including stent graft-induced new re-entry tears, death, stroke and spinal cord injury. Malperfusion in all cases was corrected. The true lumen was not enlarged enough 1 month after the first surgery. Thrombosis of the false lumen was observed around the elephant trunk at the carina level and the celiac artery. Three months after second stage TEVAR, the false lumen thrombosis was resorbed; in addition, the trunk was fully expanded at the carina level, and the true lumen was enlarged at the celiac artery. Conclusions Two-stage hybrid aortic repair for residual true lumen in the distal aorta 1 month after initial surgery is helpful for descending aorta remodeling and effective in treating malperfusion. This procedure may be a good option for patients suffering from Stanford A dissection with small true lumen in the distal aorta and malperfusion.

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Two-stage repair of DeBakey type IIIb aneurysm, using total arch replacement

Asian Cardiovascular and Thoracic Annals ◽

10.1177/0218492319895377 ◽

2019 ◽

Vol 28 (1) ◽

pp. 7-14

Author(s):

Yosuke Yanase ◽

Toshiro Ito ◽

Ayaka Arihara ◽

Akihito Ohkawa ◽

Ryosuke Numaguchi ◽

...

Keyword(s):

High Risk ◽

Graft Replacement ◽

Proximal Anastomosis ◽

Elephant Trunk ◽

Two Stage ◽

Left Thoracotomy ◽

Type Iiib ◽

Elephant Trunk Technique ◽

Group 2 ◽

Group 1

Background Open repair for chronic DeBakey type IIIb dissecting aortic aneurysm is an invasive procedure involving open proximal anastomosis under hypothermic cardiac arrest, with significant morbidity in high-risk patients. We adopted a two-stage repair strategy using total arch replacement with the elephant trunk technique, which enables aortic crossclamping and avoids open proximal anastomosis at the second-stage graft replacement through a left thoracotomy. Methods From January 2008 to October 2018, we performed DeBakey type IIIb dissecting aortic aneurysm repair in 76 cases, and compared the results of two-stage repair (group 1, 25 cases) and single-stage repair using graft replacement with open proximal anastomosis through a left thoracotomy (group 2, 31 cases). Results In group 1, the elephant trunk technique was successful in all cases. The second intervention included endovascular repair (13 cases) and graft replacement through a left thoracotomy (7 cases). Five cases were followed up conservatively because the false lumen was thrombosed after the elephant trunk technique. Aorta-related adverse events were seen in 5 cases in group 1 (1 re-dissection, 1 rupture, 2 stent-graft-induced new entries, 1 stent-graft migration) and 6 in group 2 (1 additional thoracic endovascular aortic repair, 1 rupture, 4 acute type A aortic dissections). There were no statistical differences between the two groups regarding aorta-related adverse events and death. The postoperative course was acceptable in both groups. Conclusions Single-stage repair with open proximal anastomosis is an option in patients not at high risk for invasive surgery, while two-stage repair is recommended for high-risk patients.

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Inter-Stage Mortality in Two-Stage Elephant Trunk Surgery

10.22541/au.160322415.51549563/v1 ◽

2020 ◽

Author(s):

Ayman Saeyeldin ◽

Anton Gryaznov ◽

Mohammad Zafar ◽

Jinlin Wu ◽

Sandip Mukherjee ◽

...

Keyword(s):

Elephant Trunk ◽

Two Stage

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Two-Stage Elephant Trunk approach for open management of distal aortic arch and descending aortic pathology in patients with Marfan syndrome

Annals of Cardiothoracic Surgery ◽

10.21037/acs.2017.11.11 ◽

2017 ◽

Vol 6 (6) ◽

pp. 712-720 ◽

Cited By ~ 2

Author(s):

Camilo A. Velasquez ◽

Mohammad A. Zafar ◽

Ayman Saeyeldin ◽

Syed Usman Bin Mahmood ◽

Adam J. Brownstein ◽

...

Keyword(s):

Aortic Arch ◽

Marfan Syndrome ◽

Elephant Trunk ◽

Two Stage ◽

Aortic Pathology ◽

Open Management

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Two-Stage Elephant Trunk approach for open management of distal aortic arch and descending aortic pathology in patients with Marfan syndrome

ASVIDE ◽

10.21037/asvide.2017.541 ◽

2017 ◽

Vol 4 ◽

pp. 541-541

Author(s):

Camilo A. Velasquez ◽

Mohammad A. Zafar ◽

Ayman Saeyeldin ◽

Syed Usman Bin Mahmood ◽

Adam J. Brownstein ◽

...

Keyword(s):

Aortic Arch ◽

Marfan Syndrome ◽

Elephant Trunk ◽

Two Stage ◽

Aortic Pathology ◽

Open Management

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Two-stage self-seeding method for preparation of single crystals of poly(phenylene sulfide)

Proceedings, annual meeting, Electron Microscopy Society of America ◽

10.1017/s0424820100153816 ◽

1989 ◽

Vol 47 ◽

pp. 368-369

Author(s):

Sengshiu Chung ◽

Peggy Cebe

Keyword(s):

Single Crystals ◽

High Performance ◽

Dilute Solution ◽

Two Stage ◽

Annealing Behavior ◽

High Performance Polymers ◽

Seeding Method ◽

Phenylene Sulfide

We are studying the crystallization and annealing behavior of high performance polymers, like poly(p-pheny1ene sulfide) PPS, and poly-(etheretherketone), PEEK. Our purpose is to determine whether PPS, which is similar in many ways to PEEK, undergoes reorganization during annealing. In an effort to address the issue of reorganization, we are studying solution grown single crystals of PPS as model materials.Observation of solution grown PPS crystals has been reported. Even from dilute solution, embrionic spherulites and aggregates were formed. We observe that these morphologies result when solutions containing uncrystallized polymer are cooled. To obtain samples of uniform single crystals, we have used two-stage self seeding and solution replacement techniques.

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