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Review
. 2017 Oct 3;12(1):86.
doi: 10.1186/s13019-017-0649-6.

Surgical repair and reconstruction of aortic arch in debakey type I aortic dissection: recent advances and single-center experience in the application of branched stent graft

Qian Zhang  1 , Xiaochun Ma  1 , Wenlong Zhang  1 , Zhengjun Wang  1 , Haizhou Zhang  1 , Xiaofeng Zhang  1 , Jian Song  1 , Chengwei Zou  2
Affiliations
Review

Surgical repair and reconstruction of aortic arch in debakey type I aortic dissection: recent advances and single-center experience in the application of branched stent graft

Qian Zhang et al. J Cardiothorac Surg. .

Abstract

Background: Aortic dissection (AD) represents a clinically uncommon aortic pathology which predicts a dismal prognosis if not promptly treated. In acute Debakey type I AD (ADIAD), aortic lesion extends from aortic root to even distal abdominal aorta among which aortic arch and its three main branches still remain a great surgical challenge for repair and reconstruction. Several decades have witnessed the painstaking efforts of cardiovascular surgeons across the globe for optimizing the surgical procedures, from total or hemi-arch replacement, "elephant trunk" technique to branched stent graft. However, operative mortality and morbidity still remain to be reduced and surgical strategy is to be advanced and simplified, particularly the repair and reconstruction of aortic arch and supra-aortic vessels.

Methods: In this paper, we reviewed the relevant literature concerning recent advances in surgical intervention of aortic arch and summarized our opinions in the application of branched stent graft in ADIAD.

Results: The operative strategy for acute Debakey type I aortic dissection still remain to be advanced and simplified, especially the repair and reconstruction of aortic arch and supra-aortic vessels. For selection of branched stent grafts, the anatomic features and pathological changes of diseased arch are the crucial factors for clinical decision making.

Conclusions: Branched stent graft is potentially an effective alternative for the treatment of type I AD with diseased aortic arch and supra-aortic vessels. The selection of branched stent grafts still remains to be further discussed in large-scale studies in the future.

Keywords: Aortic arch; Aortic dissection; Branched stent graft.

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Conflict of interest statement

Ethics approval and consent to participate

Ethics approval for this study was obtained from the ethics review committee for human studies of School of Medicine, Shandong University.

Consent for publication

The patients included in the study provided their informed consent.

Competing interests

The authors declare that they have no competing interests.

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Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
The triple-, two- and one-branched stent graft. a The triple-branched stent graft includes a main graft and three sidearms with different diameters which consist of the self-expanding nitinol stent covered with polyester fabric. The proximal part of the main graft is a stent-free Dacron tube previously designed for anastomosis. b The two-branched stent graft acts as a trimmed version of triple-branched stent graft, with the branch for innominate artery cut off. c The one-branched stent graft comprises of a main graft and only one sidearm for left subclavian artery
Fig. 2
Fig. 2
The anatomic features of diseased arch worth consideration for selection of branched stent grafts. a The diameter and curvature of the arch. b The diameters of arch vessels. c The distance between arch vessels. d The angles between arch and arch vessels
Fig. 3
Fig. 3
Three types of aortic arch. Aortic arch can be divided into three types according to the ratio between diameter of common carotid artery (CCA) to the distance between the horizontal line through the top of arch and the horizontal line through the orifice of innominate artery: a type I, less than 1; b type II, between 1 to 2, and c type III, more than 2
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