Reoperation after Implanting a Triple-Branched Stent Graft: Case Report

Acute type A aortic dissection (ATAAD) is an aortic catastrophe with high mortality, requiring immediate surgical intervention. Recently, placement of a triple-branch stent graft has emerged as an effective technique for total arch reconstruction. Indications for this approach, however, are limited by various complications, such as endoleak, stent graft migration or kinking, and spontaneous thrombosis. Here, we report a case of Marfan syndrome in which the patient underwent a reoperation owing to frame fractures (or degradation of graft material) in a triple-branched stent graft implanted 5 years earlier.

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Faculty Opinions recommendation of Total arch repair for acute type A aortic dissection with 2 modified techniques: open single-branched stent graft placement and reinforcement of the dissected arch vessel stump with stent graft.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.12215956.13383054 ◽

2011 ◽

Author(s):

John Augoustides ◽

Michael Andritsos

Keyword(s):

Aortic Dissection ◽

Stent Graft ◽

Type A ◽

Acute Type ◽

Type A Aortic Dissection ◽

Graft Placement

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Acute Type A Aortic Dissection Treated Using a Tubular Stent-Graft in the Ascending Aorta and a Multibranched Stent-Graft in the Aortic Arch

Journal of Endovascular Therapy ◽

10.1177/1526602816680089 ◽

2016 ◽

Vol 24 (1) ◽

pp. 75-80 ◽

Cited By ~ 17

Author(s):

Tilo Kölbel ◽

Christian Detter ◽

Sebastian W. Carpenter ◽

Fiona Rohlffs ◽

Yskert von Kodolitsch ◽

...

Keyword(s):

Aortic Dissection ◽

Stent Graft ◽

Open Surgery ◽

Type A ◽

Ascending Aorta ◽

Type I ◽

Acute Type ◽

Stent Grafts ◽

Type A Aortic Dissection ◽

Custom Made

Purpose: To describe the combined use of a tubular stent-graft for the ascending aorta and an inner-branched arch stent-graft for patients with acute type A aortic dissection. Technique: The technique to deploy these modular, custom-made stent-grafts is demonstrated in 2 patients with acute DeBakey type I aortic dissections and significant comorbidities precluding open surgery. Both emergent procedures were made possible by the availability of suitable devices manufactured for elective repair in other patients. After preliminary carotid-subclavian bypass, a long Lunderquist guidewire was introduced from the right femoral artery to the left ventricle for delivery of the Zenith Ascend and Zenith Branched Arch Endovascular Grafts under inflow occlusion. Bridging stent-grafts were delivered to the innominate and left common carotid arteries to connect to the 2 inner branches; the left subclavian artery was occluded. Both cases were technically successful and resulted in exclusion of the false lumen in the ascending aorta. The operating and fluoroscopy times did not exceed those of comparable elective procedures. The patients were rapidly extubated shortly after the procedure and without serious immediate complications. One patient survived 11 months with a satisfactory repair; the other succumbed to complications of recurrent pneumonia after 23 days. Conclusion: Endovascular treatment of patients with acute type A aortic dissection using a combination of tubular and branched stent-grafts in the ascending aorta is feasible and offers an alternative strategy to open surgery.

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Predictors of return to work after open triple-branched stent graft placement for acute type A aortic dissection

Interactive CardioVascular and Thoracic Surgery ◽

10.1093/icvts/ivz236 ◽

2019 ◽

Vol 30 (1) ◽

pp. 99-106 ◽

Cited By ~ 1

Author(s):

Yanjuan Lin ◽

Yiping Chen ◽

Haoruo Zhang ◽

Yanchun Peng ◽

Sailan Li ◽

...

Keyword(s):

Aortic Dissection ◽

Return To Work ◽

Stent Graft ◽

Operating Time ◽

Acute Type ◽

Aortic Cross Clamp Time ◽

Aortic Cross Clamp ◽

Type A Aortic Dissection ◽

Graft Placement ◽

Returning To Work

Abstract OBJECTIVES To investigate the rate of returning to work within 12 months after open triple-branched stent graft placement in acute type A aortic dissection (AAAD) patients and the reasons why patients did not return to work. METHODS We conducted this cohort study of AAAD patients who were discharged alive from the hospital at Fujian Cardiac Center during the period 2013–2018. The collected data included the patients’ baseline characteristics, employment status at 12 months after AAAD and variables classifying the potential reasons for those who did not return to work at 12 months. We applied logistic regression to estimate the factors associated with returning to work at 12 months. RESULTS One year after AAAD hospitalization, of the 326 AAAD patients, 81 (24.8%) returned to work, 231 (70.9%) did not and 14 (4.3%) died. Among the 231 patients who did not return to work, 105 (45.5%) were unable to work because of AAAD and 36 (15.6%) lost job owing to AAAD. After adjustment for other risk factors, age, female sex, type of work, operating time, aortic cross-clamp time and length of intensive care unit (ICU) stay were still significantly associated with a lower chance of returning to work. CONCLUSIONS Less than 25% of the previously employed patients returned to work at 12 months after AAAD. Older age, female sex, manual or semi-skilled professional work, a longer operating time, a longer aortic cross-clamp time and a longer length of ICU stay were associated with a lower likelihood of returning to work.

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