Midterm results of extensive primary repair of the thoracic aorta by means of total arch replacement with open stent graft placement for an acute type A aortic dissection

Abstract

Objectives: We sought to describe the midterm results of extensive primary repair of the thoracic aorta by means of the modified elephant trunk technique with a stent graft for acute type A aortic dissection, particularly the changes of the false lumen shown by enhanced computed tomographic scanning.

Methods: The subjects were 35 consecutive patients who received arch replacement with open stent grafting for type A acute aortic dissection between December 1997 and April 2002. The mean follow-up period was 55 months (range, 30-83 months). Computed tomographic scanning was performed at 1, 3, 12, and 36 months postoperatively to detect thrombosis and obliteration of the false lumen after its exclusion by the stent graft. The diameter of the aorta was measured at 3 levels: the distal edge of the stent graft, the diaphragm, and the origin of the superior mesenteric artery.

Results: Two patients died in the initial operation, but no patients required additional surgical treatment of the thoracic aorta. The mean diameter of the stent grafts was 26.2 mm, and the mean length was 8.9 cm. Thrombus formation in the false lumen was recognized at the distal edge of the graft in all patients, at the diaphragmatic level in 26 patients, and at the superior mesenteric artery level in 15 patients. Obliteration of the false lumen was recognized at the distal edge of the graft in all patients, at the diaphragmatic level in 20 patients, and at the superior mesenteric artery level in 15 patients. The aorta distal to the stent graft showed minimal changes.

Conclusions: In patients with acute type A aortic dissections, it is possible to perform extensive primary repair of the thoracic aorta with relative safety by using a synthetic graft with a self-expanding stent, and this method might reduce the necessity of further operations not only for the distal descending aorta but also for the thoracoabdominal aorta.