Total Arch Replacement Combined With Stented Elephant Trunk Implantation For Stanford Type A Aortic Dissection

Objective:The frozen elephant trunk technique allows for single-stage repair of combined aortic arch and descending aortic aneurysms by using a stented elephant trunk. This report summarizes the operative and follow-up data with this new treatment.Methods:Between June 2008 and February 2009,5 patients(1 women;mean age,52 years) were admitted in our hospital.Indication for operation was acute aortic dissection. The stented end of the hybrid prosthesis was placed through the opened aortic arch under hypothermic circulatory arrest and selective antegrade cerebral perfusion.Either right femoral artery or right axillary artery cannulation was used for cardiopulmonary bypass and brachiocephalic trunk was used for selected cerebral perfusion.The stented elephant trunk was a 10cm long self expandable graft.Enhanced electric beam computed tomography(EBCT) was performed in each patient before discharge and three month after surgery to evaluate the residual false lumen.Results:Cardiopulmonary bypass time was(169±27)min,average cross-clamp time was(126±19) min,and average antegrade selective cerebral perfusion time was (32±5) min.No patient died in hospital.One patient suffered from anastomotic bleeding postoperatively.His families requested for discharge and he died during follow up.There was no late death of the other 4 patients during follow up.Conclusions:This procedure is performed through a median sternotomy and combines the concepts of the elephant trunk principle and endovascular stenting of descending aortic aneurysms.Favorable intraoperative and postoperative results indicate that total arch replacement combined with stented elephant trunk implantation is a safe and effective treatment for acute Stanford type A aortic dissection.