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Case Reports
. 2024 Oct 14;19(1):604.
doi: 10.1186/s13019-024-03113-y.

Redo aortic arch repair using trifurcated hybrid prosthesis after failed Ascyrus medical dissection stent treatment

Mustafa Al-Obaidi  1 , Razan Salem  1 , Thomas Walther  1 , Tomas Holubec  2
Affiliations
Case Reports

Redo aortic arch repair using trifurcated hybrid prosthesis after failed Ascyrus medical dissection stent treatment

Mustafa Al-Obaidi et al. J Cardiothorac Surg. .

Abstract

Background: The management of acute type A aortic dissection (ATAAD) using the Ascyrus Medical Dissection Stent (AMDS) can lead to complications due to the persistence of the false lumen (FL). This case report presents two instances of failed AMDS treatment for ATAAD, highlighting the novel use of a trifurcated hybrid prosthesis for redo aortic arch repair using a minimally invasive frozen elephant trunk (FET) technique.

Case presentation: Case 1: A 57-year-old male, previously treated with AMDS for ATAAD, presented with an enlarging aortic arch and persistent FL two years post-surgery caused by re-entry in the distal aortic arch. Redo surgery using the FET technique with an E-vita OPEN NEO Trifurcated hybrid prosthesis resulted in successful repair and partial FL thrombosis. Case 2: A 51-year-old male with prior AMDS treatment for ATAAD presented with severe aortic valve regurgitation and a maintained FL perfusion due to a residual re-entry in the proximal region of the descending aorta. Redo surgery using the FET technique with the same hybrid prosthesis led to successful repair and good recovery, confirmed by follow-up imaging.

Conclusions: The use of the E-vita OPEN NEO Trifurcated hybrid prosthesis in the FET technique offers a promising solution for redo aortic arch repair in cases of failed AMDS treatment for ATAAD. This approach can improve patient outcomes by addressing complications associated with persistent FL and enhancing long-term survival.

Keywords: Acute type a aortic dissection (ATAAD); Ascyrus medical dissection stent (AMDS); E-vita OPEN NEO trifurcated hybrid prosthesis; Frozen elephant trunk (FET) technique; Minimal invasive surgery.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Redo surgery with minimally invasive FET using E-Vita OPEN NEO trifurcated after failed AMDS. (A) Preoperative computed tomographic angiography (CTA) revealing an enlarged aortic arch post AMDS implantation with a patent false lumen (FL). (B) Preoperative CT 3D reconstruction of AMDS prosthesis. (C) The new E-vita OPEN NEO Trifurcated (Permission: Artivion, Inc.). (D) Implanted E-vita OPEN NEO trifurcated with debranched supra-aortic vessels via upper ministernotomy. (E) Postoperative CTA showing optimal perfusion of supra-aortic vessels and closure of the FL. (F) Postoperative CTA 3D reconstruction demonstrating excellent stent-graft implantation and diminished FL diameter
Fig. 2
Fig. 2
FET using E-Vita OPEN NEO trifurcated after failed AMDS as a redo surgery via re-sternotomy. (A) Transoesophageal echocardiography of descending aorta demonstrating a true lumen (TL) and an enlarged false lumen (FL) with maintained perfusion through re-entry (arrow). (B) Computer tomography (CT) 3D reconstruction showing aortic root pseudoaneurysm (arrow). (C) CT angiography (CTA) cross-sectional revealing pseudoaneurysm at aortic root (red circle) and subtotal true lumen collapse (arrow) at the descending aorta. (D) Intraoperative fluoroscopy displaying excellent E-Vita OPEN NEO Trifurcated implantation with stent-graft extension. (E) CTA control after 6 months showing patent aortic arch, E-Vita OPEN NEO with stent-graft extension, and obliterated FL with partial thrombosis
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References

    1. Bozso SJ, Nagendran J, Chu MWA, Kiaii B, El-Hamamsy I, Ouzounian M, et al. Three-year outcomes of the dissected aorta repair through stent implantation trial. J Thorac Cardiovasc Surg. 2024;167(5):1661–e16693. - PubMed
    1. Al-Tawil M, Jubouri M, Tan SZ, Bailey DM, Williams IM, Mariscalco G, et al. Thoraflex Hybrid vs. AMDS: to replace the arch or to stent it in type A aortic dissection? Asian Cardiovasc Thorac Ann. 2023;31(7):596–603. - PubMed
    1. Holubec T, Van Linden A, Bodelle B, Walther T. Frozen Elephant trunk: minimally invasive implantation of a New Trifurcated Hybrid aortic prosthesis. Ann Thorac Surg. 2021;112(5):e321–3. - PubMed
    1. White A, Bozso SJ, Ouzounian M, Chu MWA, Moon MC. Acute type a aortic dissection and the consequences of a patent false lumen. JTCVS Techniques. 2021;9:1–8. - PMC - PubMed
    1. Bozso SJ, White A, Nagendran J, Moon MC, Chu MWA. Hybrid aortic arch and frozen elephant trunk reconstruction: bridging the gap between conventional and total endovascular arch repair. Expert Rev Cardiovasc Ther. 2018;16(3):209–17. - PubMed

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