Total arch repair with open triple-branched stent graft placement for acute type A aortic dissection: Experience with 122 patients Liang-Wan Chen, MD,

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Presentation transcript:

Total arch repair with open triple-branched stent graft placement for acute type A aortic dissection: Experience with 122 patients Liang-Wan Chen, MD, Lin Lu, MD, Xiao-Fu Dai, MD, Xi-Jie Wu, MD, Gui-Can Zhang, MD, Guo-Feng Yang, MD, Yi Dong, MD The Journal of Thoracic and Cardiovascular Surgery Volume 148, Issue 2, Pages 521-528 (August 2014) DOI: 10.1016/j.jtcvs.2013.10.021 Copyright © 2014 The American Association for Thoracic Surgery Terms and Conditions

Figure 1 A, The triple-branched stent graft included a main stent graft and 3 sidearm stent grafts. B, The main stent graft and 3 sidearm stent grafts were individually mounted on 4 catheters and restrained by 4 silk sutures. The Journal of Thoracic and Cardiovascular Surgery 2014 148, 521-528DOI: (10.1016/j.jtcvs.2013.10.021) Copyright © 2014 The American Association for Thoracic Surgery Terms and Conditions

Figure 2 Schematic diagram of the operation. A, Through this distal ascending aortic transverse incision, the main stent graft was directly inserted into the true lumen of the arch and proximal descending aorta. B, Next, each sidearm stent graft was implanted 1 by 1 into the corresponding arch vessel. C, After the main stent graft and sidearm stent grafts were correctly placed, D-F, the triple-branched stent graft was deployed by withdrawing the restraining sutures. The Journal of Thoracic and Cardiovascular Surgery 2014 148, 521-528DOI: (10.1016/j.jtcvs.2013.10.021) Copyright © 2014 The American Association for Thoracic Surgery Terms and Conditions

Figure 3 Postoperative results on computed tomography images. A, The false lumen of the arch and descending aorta was completely closed by postoperative thrombus formation. B, A patient with typical aortic remodeling showing complete thrombus formation B1, in the false lumen around the stent graft and B2, at the diaphragmatic level 2 weeks after surgery. One year later, the false channel thrombosis had been nearly reabsorbed B3, around the stent graft and B4, at the diaphragmatic level. C, Innominate endoleak. D, A patient with innominate banding (D1, preoperatively; D2, postoperatively). The Journal of Thoracic and Cardiovascular Surgery 2014 148, 521-528DOI: (10.1016/j.jtcvs.2013.10.021) Copyright © 2014 The American Association for Thoracic Surgery Terms and Conditions

Figure 3 Postoperative results on computed tomography images. A, The false lumen of the arch and descending aorta was completely closed by postoperative thrombus formation. B, A patient with typical aortic remodeling showing complete thrombus formation B1, in the false lumen around the stent graft and B2, at the diaphragmatic level 2 weeks after surgery. One year later, the false channel thrombosis had been nearly reabsorbed B3, around the stent graft and B4, at the diaphragmatic level. C, Innominate endoleak. D, A patient with innominate banding (D1, preoperatively; D2, postoperatively). The Journal of Thoracic and Cardiovascular Surgery 2014 148, 521-528DOI: (10.1016/j.jtcvs.2013.10.021) Copyright © 2014 The American Association for Thoracic Surgery Terms and Conditions