Type A aortic dissection involving the carotid arteries: carotid stenting during open aortic arch surgery

Abstract OBJECTIVES The aim of this study was to investigate the clinical outcomes and follow-up results among 5 main aortic arch surgery methods for type A aortic dissection in a single centre. METHODS From 2002 to 2018, 958 type A aortic dissection patients who received surgical repair were divided into 5 groups according to the arch surgery method: hemiarch replacement (n = 206), island arch replacement (n = 54), total arch replacement with frozen elephant trunk (n = 425), triple-branched stent (n = 39) and fenestrated stent (n = 234). The indications for the different arch methods were related to the patient’s preoperative status, the location and extent of the dissection and the surgical ability of the surgeons. A comparative study was performed to identify the differences in the perioperative data, and the Kaplan–Meier analysis was used to assess the long-term survival and reintervention rates. Thirty matched surviving patients that were included in each group completed Computed tomography angiography to determine long-term reshaping effect. RESULTS The 30-day mortality rate was 15.8%, and there was no difference among the 5 groups (P = 0.848). The follow-up survival rates were similar among the 5 groups (P = 0.130), and the same was true for patients without reintervention (P = 0.471). In the propensity matching study, patients with stents (frozen elephant trunk, triple-branched stent, fenestrated stent) had a slower aortic dilation rate and a higher ratio of thrombosis in the false lumen at the descending aortic and abdominal aortic levels than patients without stents. CONCLUSIONS No standard method is available for arch surgery, and indications and long-term effects should be identified with clinical data. In our experiences, simpler surgical procedures could reduce mortality in critically ill patients and stents in the distal aorta could improve long-term reshape effects.

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One more method for arterial cannulation in aortic arch surgery (“Penza cannulation”)

Asian Cardiovascular and Thoracic Annals ◽

10.1177/0218492318799901 ◽

2018 ◽

Vol 26 (7) ◽

pp. 584-586 ◽

Cited By ~ 1

Author(s):

Evgeny Rosseykin ◽

Evgeny Kobzev ◽

Vladlen Bazylev

Keyword(s):

Aortic Dissection ◽

Aortic Arch ◽

Type A ◽

New Method ◽

Arterial Cannulation ◽

Type A Aortic Dissection ◽

Aortic Arch Surgery ◽

Aortic Cannulation ◽

Brachiocephalic Arteries

Here we propose a new method of aortic cannulation in type A aortic dissection and aortic arch aneurysms. Aortic cannulation is performed through any of the ostia of brachiocephalic arteries and has been successfully used in 77 patients. This procedure is simple, safe, effective, and might be used as one of the alternatives to the classic methods of arterial cannulation.

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Analysis of early and long-term outcomes of acute type A aortic dissection according to the new international aortic arch surgery study group recommendations

Heart and Vessels ◽

10.1007/s00380-015-0770-1 ◽

2015 ◽

Vol 31 (10) ◽

pp. 1616-1624 ◽

Cited By ~ 8

Author(s):

Andrea Colli ◽

Massimiliano Carrozzini ◽

Marco Galuppo ◽

Marina Comisso ◽

Francesca Toto ◽

...

Keyword(s):

Aortic Dissection ◽

Aortic Arch ◽

Type A ◽

Study Group ◽

Acute Type ◽

Long Term Outcomes ◽

Type A Aortic Dissection ◽

Aortic Arch Surgery ◽

Group Recommendations

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Hemoperfusion in Acute Type A Aortic Dissection Patients Undergoing Aortic Arch Operation (HPAO)

Case Medical Research ◽

10.31525/ct1-nct04007484 ◽

2019 ◽

Author(s):

Keyword(s):

Aortic Dissection ◽

Aortic Arch ◽

Type A ◽

Acute Type ◽

Type A Aortic Dissection

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Aortic Aneurysm and Dissection in Pregnancy: Report of a Rare Case in a Marfan with Bicuspid Aortic Valve

Indian Journal of Cardiovascular Disease in Women WINCARS ◽

10.1055/s-0040-1722793 ◽

2020 ◽

Vol 5 (04) ◽

pp. 331-334

Author(s):

Paolo Masiello ◽

Rocco Leone ◽

Rossella Maria Benvenga ◽

Severino Iesu

Keyword(s):

Aortic Valve ◽

Aortic Dissection ◽

Aortic Arch ◽

Bicuspid Aortic Valve ◽

Rare Case ◽

Unplanned Pregnancy ◽

Type A ◽

Cardiac Biomarkers ◽

High Morbidity ◽

Type A Aortic Dissection

Abstract Background Type A aortic dissection is an emergency with high morbidity and mortality when surgery is not performed. Few cases are described in the literature about aortic dissection during pregnancy. A correlation between pregnancy and aortic dissection is mainly reported in patients with family history and connective tissue disorders, such as Marfan’s syndrome (MS), Loeys–Dietz’s syndrome, and Ehlers–Danlos’s syndromes, and patients with bicuspid aortic valve (BAV); exceptional cases are also described in patients without risk factors. Case presentation A 22-year-old young woman with MS, ascending aorta dilation, and BAV became pregnant. During labor, she experienced a short-term chest pain with spontaneous resolution. The electrocardiogram (ECG) and cardiac biomarkers were negative for acute coronary artery disease, but no transthoracic echocardiogram (TTE) was performed. A caesarean section was performed without complications. After 1 month, a routine TTE showed a chronic ascending aortic dissection involving the aortic arch and supra-aortic vessels. Due to a normally functioning aortic valve, the David operation was performed (sparing aortic valve) with the replacement of the aortic arch and supra-aortic vessels. Conclusions Aortic dissection is a rare cardiovascular complication that can occur during pregnancy and is associated with very high-risk mortality. We have reported a rare case of undiagnosed type A aortic dissection involving the aortic arch during unplanned pregnancy in patients with BAV and MS, subsequently treated with the David surgery and replacement of ascending aortic arch and supra-aortic vessels. A closer clinical and instrumental follow-up is necessary in this particular group of patients at risk. Awareness of all physicians involved is mandatory.

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Enlargement of aortic arch vessels after surgical repair of type A aortic dissection

Journal of Vascular Surgery ◽

10.1016/j.jvs.2016.09.056 ◽

2017 ◽

Vol 65 (3) ◽

pp. 669-675 ◽

Cited By ~ 3

Author(s):

Takashi Yamauchi ◽

Suguru Kubota ◽

Toshihiro Ohata ◽

Kosei Hasegawa ◽

Hideki Ueda

Keyword(s):

Aortic Dissection ◽

Aortic Arch ◽

Surgical Repair ◽

Type A ◽

Type A Aortic Dissection

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Retrograde Carotid Stenting Using Newly Released Venous Stent for Cerebral Malperfusion in Type A Aortic Dissection

Journal of Endovascular Therapy ◽

10.1177/15266028211050313 ◽

2021 ◽

pp. 152660282110503

Author(s):

Dipankar Mukherjee ◽

Elizabeth Lewis ◽

David Spinosa ◽

Daniel Tang ◽

Liam Ryan

Keyword(s):

Carotid Arteries ◽

Type A ◽

Carotid Stenting ◽

Normal Function ◽

Type A Aortic Dissection ◽

Endovascular Approach ◽

Aortic Dissections ◽

Cerebral Malperfusion ◽

Common Carotid Arteries ◽

The Brain

Stanford Type A aortic dissections (TAAD) should be considered for repair, given the involvement of branch vessels which can result in malperfusion, specifically cerebral malperfusion secondary to dissection of the innominate and carotid arteries. This is a case report with a focus on four patients presenting with both acute and chronic symptomatic TAAD, with extension into the innominate and common carotid arteries. In all four cases, the decision to intervene utilizing a hybrid endovascular approach was made to increase perfusion to the brain and alleviate symptoms. Through the use of retrograde carotid stenting utilizing both the VICI venous stent (Boston Scientific, Marlborough, MA) and Abre self-expanding Nitinol stent (Medtronic, Minneapolis, MN) we obtained good results, specifically absence of symptoms and return to normal function of the patients.

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Limited versus extended repair for type A aortic dissection involving the aortic arch

Journal of Cardiac Surgery ◽

10.1111/jocs.15097 ◽

2020 ◽

Author(s):

Matthew C. Henn ◽

Marc R. Moon

Keyword(s):

Aortic Dissection ◽

Aortic Arch ◽

Type A ◽

Type A Aortic Dissection

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Stroke in acute type A aortic dissection: the Nordic Consortium for Acute Type A Aortic Dissection (NORCAAD)

European Journal of Cardio-Thoracic Surgery ◽

10.1093/ejcts/ezaa197 ◽

2020 ◽

Vol 58 (5) ◽

pp. 1027-1034 ◽

Cited By ~ 1

Author(s):

Raphaelle A Chemtob ◽

Simon Fuglsang ◽

Arnar Geirsson ◽

Anders Ahlsson ◽

Christian Olsson ◽

...

Keyword(s):

Aortic Dissection ◽

Aortic Arch ◽

Type A ◽

Pericardial Tamponade ◽

Acute Type ◽

Aortic Arch Replacement ◽

Type A Aortic Dissection ◽

Total Aortic Arch Replacement ◽

Cerebral Malperfusion ◽

Mortality Hazard Ratio

Abstract OBJECTIVES Stroke is a serious complication in patients with acute type A aortic dissection (ATAAD). Previous studies investigating stroke in ATAAD patients have been limited by small cohorts and have shown diverging results. We sought to identify risk factors for stroke and to evaluate the effect of stroke on outcomes in surgical ATAAD patients. METHODS The Nordic Consortium for Acute Type A Aortic Dissection database included patients operated for ATAAD at 8 Scandinavian Hospitals between 2005 and 2014. RESULTS Stroke occurred in 177 (15.7%) out of 1128 patients. Patients with stroke presented more frequently with cerebral malperfusion (20.6% vs 6.3%, P < 0.001), syncope (30.6% vs 17.6%, P < 0.001), cardiogenic shock (33.1% vs 20.7%, P < 0.001) and pericardial tamponade (25.9% vs 14.7%, P < 0.001) and more often underwent total aortic arch replacement (10.7% vs 4.7%, P = 0.016), compared to patients without stroke. In the 86 patients presenting with cerebral malperfusion, 38.4% developed stroke. Thirty-day and 5-year mortality in patients with and without stroke were 27.1% vs 13.6% and 42.9% vs 25.6%, respectively. Stroke was an independent predictor of early- [odds ratio 2.02, 95% confidence interval (CI) 1.34–3.05; P < 0.001] and midterm mortality (hazard ratio 1.68, 95% CI 1.27–2.23; P < 0.001). CONCLUSIONS Stroke in ATAAD patients is associated with increased early- and midterm mortality. Preoperative cerebral malperfusion and impaired haemodynamics, as well as total aortic arch replacement, were more frequent among patients who developed stroke. Importantly, a large proportion of patients presenting with cerebral malperfusion did not develop a permanent stroke, indicating that signs of cerebral malperfusion should not be considered a contraindication for surgery.

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