Safety and arch complications after hemiarch versus total arch replacement with stented elephant trunk in acute type 1 dissection: Is a stent graft always beneficial?Central MessagePerspective
Jun Hayashi, MD, PhD,
Hiroyuki Nakajima, MD, PhD,
Toshihisa Asakura, MD, PhD,
Ri Sho, PhD,
Chiho Tokunaga, MD, PhD,
Akitoshi Takazawa, MD,
Akihiro Yoshitake, MD, PhD
Affiliations
Jun Hayashi, MD, PhD
Department of Cardiovascular Surgery, International Medical Center, Saitama Medical University, Saitama, Japan; Address for reprints: Jun Hayashi, MD, PhD, Department of Cardiovascular Surgery, International Medical Center, Saitama Medical University, 1397-1 Yamane Hidaka, Saitama 350-1298, Japan.
Hiroyuki Nakajima, MD, PhD
Department of Cardiovascular Surgery, International Medical Center, Saitama Medical University, Saitama, Japan
Toshihisa Asakura, MD, PhD
Department of Cardiovascular Surgery, International Medical Center, Saitama Medical University, Saitama, Japan
Ri Sho, PhD
Department of Public Health & Hygiene, Yamagata University Graduate School of Medical Science, Yamagata, Japan
Chiho Tokunaga, MD, PhD
Department of Cardiovascular Surgery, International Medical Center, Saitama Medical University, Saitama, Japan
Akitoshi Takazawa, MD
Department of Cardiovascular Surgery, International Medical Center, Saitama Medical University, Saitama, Japan
Akihiro Yoshitake, MD, PhD
Department of Cardiovascular Surgery, International Medical Center, Saitama Medical University, Saitama, Japan
Objective: We aimed to determine the efficacy of total arch replacement with stented elephant trunk by comparing it with hemiarch replacement with and without open stent graft for acute aortic dissection type 1. Methods: We reviewed records of 177 patients who underwent hemiarch replacement (HAR group) (concomitant open stent, 125) and 98 patients who underwent total arch replacement (TAR group) (concomitant stented elephant trunk, 91) for acute type 1 dissection. Compared with the TAR group, the HAR group was older (68.1 vs 60.9 years; P < .01) and had more thrombosed false lumen (28.8% vs 4.1%, P < .01). Results: In-hospital death occurred for 7 patients in the HAR group and 1 patient in the TAR group (P = .17). More patients in the TAR group had a postoperative thrombosed false lumen, compared with the HAR group (68% vs 54%, P = .03). In patients with preoperative nonthrombosed false lumen in the HAR group, the rate of postoperative thrombosis was significantly lower than with versus without an open stent (31% vs 65%, P = .01). The rate of freedom from an aortic arch event in the TAR group at 5 years was significantly greater than that in the HAR group (100% vs 83.7%, P = .01). Conclusions: Stented elephant trunk with TAR provided a high rate of false lumen thrombosis and a low incidence of arch events, whereas an open stent during HAR was not beneficial in terms of false lumen thrombosis and arch event prevention.
