JTCVS techniques · 2025
Reoperative arch-first total arch repair after previous acute type A aortic dissection repair.
СтатьяНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Ohira Suguru, Malekan Ramin, Kai Masashi, Tavolacci Sooyun Caroline, Gregory Vasiliki, Shimamura Junichi, Laskowski Igor, Lansman Steven L, Spielvogel David
Аннотация
OBJECTIVE: We sought to review the outcomes of our arch-first total aortic arch repair (TAR) using a trifurcated graft after previous acute type A aortic dissection (ATAD) repair.
METHODS: From February 2006 to June 2024, 62 patients underwent reoperative TAR after ATAD repair. The first-stage TAR includes axillary artery cannulation, minimal dissection without aortic crossclamping, myocardial protection using systemic potassium and retrograde blood cardioplegia, an arch-first technique with deep hypothermia (20 °C), and construction of a classical elephant trunk through a partial transverse incision distally or proximally to old distal aortic anastomosis.
RESULTS: The median age at reoperative TAR was 63.5 years. The median interval from initial ATAD repair to reoperative TAR was 3 years. A concomitant procedure was performed in 20 patients (32.3%). The median cardiopulmonary bypass and lower body circulatory arrest times were 227.5 and 97 minutes, respectively. Operative mortality was 1.6% (n = 1/62), as was the incidence of stroke (1.6%) and renal-replacement therapy (3.2%). Stage II repair was performed or planned in 49 patients (open repair [above the celiac axis in most patients], n = 42; endovascular, n = 3; endovascular converted to open repair, n = 2; and waiting for repair, n = 2). Median interval between staged procedures was 63 days [interquartile range, 36, 134]. Mortality of stage II procedure was 4.3% (n = 2/47) with no spinal cord injury. Kaplan-Meier analysis showed that estimated survival at 5 years was 82.7 ± 6.7%.
CONCLUSIONS: Our reoperative TAR is safe in the setting of residual dissection that minimizes dissection of the cardiac structures, simplifies the distal anastomosis, and protects vital organs.
METHODS: From February 2006 to June 2024, 62 patients underwent reoperative TAR after ATAD repair. The first-stage TAR includes axillary artery cannulation, minimal dissection without aortic crossclamping, myocardial protection using systemic potassium and retrograde blood cardioplegia, an arch-first technique with deep hypothermia (20 °C), and construction of a classical elephant trunk through a partial transverse incision distally or proximally to old distal aortic anastomosis.
RESULTS: The median age at reoperative TAR was 63.5 years. The median interval from initial ATAD repair to reoperative TAR was 3 years. A concomitant procedure was performed in 20 patients (32.3%). The median cardiopulmonary bypass and lower body circulatory arrest times were 227.5 and 97 minutes, respectively. Operative mortality was 1.6% (n = 1/62), as was the incidence of stroke (1.6%) and renal-replacement therapy (3.2%). Stage II repair was performed or planned in 49 patients (open repair [above the celiac axis in most patients], n = 42; endovascular, n = 3; endovascular converted to open repair, n = 2; and waiting for repair, n = 2). Median interval between staged procedures was 63 days [interquartile range, 36, 134]. Mortality of stage II procedure was 4.3% (n = 2/47) with no spinal cord injury. Kaplan-Meier analysis showed that estimated survival at 5 years was 82.7 ± 6.7%.
CONCLUSIONS: Our reoperative TAR is safe in the setting of residual dissection that minimizes dissection of the cardiac structures, simplifies the distal anastomosis, and protects vital organs.