A new minimal invasive technique with in-situ stent-graft fenestration for type A aortic dissection
Sanjiu Yu,
Deqing Lin,
Jianguang Yi,
Xianpu Zhang,
Yongbo Cheng,
Chaojun Yan,
Huajie Zheng,
Lingfeng Tang,
Mei Guo,
Ping He,
Jun Li,
Wei Cheng
Affiliations
Sanjiu Yu
Department of Cardiac Surgery, The First Hospital Affiliated to Army Medical University (Third Military Medical University), Chongqing, 400038, PR China
Deqing Lin
Department of Cardiac Surgery, The First Hospital Affiliated to Army Medical University (Third Military Medical University), Chongqing, 400038, PR China
Jianguang Yi
Department of Cardiac Surgery, The First Hospital Affiliated to Army Medical University (Third Military Medical University), Chongqing, 400038, PR China
Xianpu Zhang
Department of Cardiac Surgery, The First Hospital Affiliated to Army Medical University (Third Military Medical University), Chongqing, 400038, PR China
Yongbo Cheng
Department of Cardiac Surgery, The First Hospital Affiliated to Army Medical University (Third Military Medical University), Chongqing, 400038, PR China
Chaojun Yan
Department of Cardiac Surgery, The First Hospital Affiliated to Army Medical University (Third Military Medical University), Chongqing, 400038, PR China
Huajie Zheng
Department of Cardiac Surgery, The First Hospital Affiliated to Army Medical University (Third Military Medical University), Chongqing, 400038, PR China
Lingfeng Tang
Department of Cardiac Surgery, The First Hospital Affiliated to Army Medical University (Third Military Medical University), Chongqing, 400038, PR China
Mei Guo
Department of Cardiac Surgery, The First Hospital Affiliated to Army Medical University (Third Military Medical University), Chongqing, 400038, PR China
Ping He
Department of Cardiac Surgery, The First Hospital Affiliated to Army Medical University (Third Military Medical University), Chongqing, 400038, PR China
Jun Li
Corresponding author.; Department of Cardiac Surgery, The First Hospital Affiliated to Army Medical University (Third Military Medical University), Chongqing, 400038, PR China
Wei Cheng
Corresponding author.; Department of Cardiac Surgery, The First Hospital Affiliated to Army Medical University (Third Military Medical University), Chongqing, 400038, PR China
Background: Aortic surgery successfully improves the prognosis of patients with type A aortic dissection. However, total arch replacement and reconstruction remain challenging. This study presents a new surgical modality, the in-situ stent-graft fenestration (ISSF) technique, for simplifying aortic arch reconstruction and assesses its short-term efficacy and safety in patients with type A aortic dissection. Methods: Data from 177 patients with type A aortic dissection who underwent aortic arch reconstruction were retrospectively analyzed. Sun's procedure was performed in 90 patients and ISSF was performed in the other 87. Results: The in-hospital mortality rate was 7.8% in the Sun's procedure group and 3.4% in the ISSF group (p = 0.357). Compared to the Sun's procedure group, the ISSF group had significantly shorter surgical duration, cardiopulmonary bypass time, circulatory arrest time, mechanical ventilation time, and aortic cross-clamp time (p < 0.05). Additionally, intraoperative blood loss was lower in the ISSF group than in the Sun's procedure group (p < 0.05). Patients who underwent ISSF also had a lower incidence of postoperative complications, including lung injury, renal failure, peripheral nerve injury, and chylothorax, than those who underwent Sun's procedure (p < 0.05). During the 6-month follow-up period after surgery, both groups showed significant improvements in the true lumen diameter of the descending thoracic aorta post-operation compared with the pre-operation measurements; meanwhile, the false lumen diameter decreased (p < 0.05). Conclusions: The ISSF technique appears to be an effective and safe alternative to conventional surgical procedures for patients with type A aortic dissection, with the potential to simplify the procedure, shorten the operation time, and yield satisfactory operative results. However, further investigation is needed to determine its long-term benefits.
