Surgical treatment of De Bakey type Ⅰaortic dissection using the“elephant trunk technique”

Objectives To review the indications, operative methods and postoperative management of the “elephant trunk technique”, and to report two cases of DeBakey type Ⅰ aortic dissection treated with the “elephant trunk technique” Methods Two cases of DeBakey type Ⅰ aortic dissection were operated with selective cerebral perfusion via the right subclavian artery At the first stage, a tubular dangling aortic graft prosthesis (“elephant trunk”) was inserted into the distal aorta while replacing the ascending aorta and aortic arch The distal elephant trunk prosthesis was then used at the second stage involving the replacement of the sections of the distal aorta via a left sided thoracotomy Results The two operations were successful Ultrafast computed tomograph (UFCT) showed that the two patients were cured after the first stage operation, and the second stage procedure could have been avoided Conclusions The “elephant trunk technique” is a multiple stage approach in the treatment of extensive aneurysmal diseases of the aorta The procedure is indicated for patients who have combined diseases of both ascending aorta plus aortic arch segments and descending aortic aneurysm It can also be used for patients with DeBakey type Ⅰ aortic dissection Some patients can be cured after the first stage operation

Effect of total arch replacement combined with stent trunk on treating De Bakey typeⅠaortic dissection

Background Aortic dissection（AD） is a life-threatening surgical emergency. Total arch replacement combined with stent trunk has gradually become the standard procedure for De Bakey type Ⅰ AD in China, but the complication and mortality rates are still relatively high due to surgical technical difficulties and complexity. In principle, AD should be treated with emergency surgery once the diagnosis is confirmed, but the operation time varies greatly in China due to the restriction of medical conditions. Therefore, analyzing and comparing the surgical mortality and complications rate between acute and chronic phase may facilitate the clinicians to comprehensively evaluate the patient＇s condition, and thus select an appropriate operation timing. Methods A total of330 De Bakey type Ⅰ AD patients admitted and treated with total arch replacement combined with stent trunk procedure in Guangdong Cardiovascular Institute from Jan 2010 to Jan 2014 were retrospectively analyzed. According to whether the onset was longer than 2 w, patients were divided into acute phase group and chronic phase group. There were 231 cases in acute phase group（≤ 2 w）, and the average length from onset to operation was 5.6± 3.8 d; while 99 cases in chronic phase group（〉 2 w）, and the average length from onset to operation was 20.6 ±14.7 d. Results The total mortality rate was 13%. Acute renal failure, neurological dysfunction, and wound healing were the major complications after operation. The in-hospital morality rate was 16.0%（37/231） in the acute group, while 6.1 %（6/99） in the chronic group. The surgical data of the ratio of CABG, cardiopulmonary bypass（CPB） time, aortic cross clamp time, intra-operative RBC infusion were significant higher in the acute phase group（P 〈 0.05）. The postoperative data of ICU stay, mechanical ventilation time, the incidences of neurological dysfunction, CRRT-dependent acute renal failure, hepatic insufficiency, and poor wound healing were significant higher in the acute phase group（P 〈 0.05）. Conclusions The total arch replacement combined with stent trunk for De Bakey type Ⅰ aortic dissection is safe and effective. Patients in the acute phase show higher postoperative mortality and complications. The acute phase is associated with relatively higher risk of surgical treatment.