Suguru Ohira MD, PhD , Ramin Malekan MD , Masashi Kai MD , Sooyun Caroline Tavolacci MD, MSCR , Vasiliki Gregory BS , Junichi Shimamura MD, PhD , Igor Laskowski MD, PhD , Steven L. Lansman MD, PhD , David Spielvogel MD
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引用次数: 0
Abstract
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.