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New 3-zone hybrid graft: First-in-man experience in acute type I dissection.

Authors
  • Jakob, Heinz1
  • Shehada, Sharaf-Eldin2
  • Dohle, Daniel3
  • Wendt, Daniel4
  • El Gabry, Mohamed4
  • Schlosser, Thomas5
  • Tsagakis, Konstantinos4
  • 1 Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital Essen, Essen, Germany. Electronic address: [email protected] , (Germany)
  • 2 Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital Essen, Essen, Germany. Electronic address: [email protected] , (Germany)
  • 3 Department of Cardiothoracic and Vascular Surgery, Johannes-Gutenberg University, Mainz, Germany. , (Germany)
  • 4 Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital Essen, Essen, Germany. , (Germany)
  • 5 Institute for Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany. , (Germany)
Type
Published Article
Journal
The Journal of thoracic and cardiovascular surgery
Publication Date
May 06, 2020
Identifiers
DOI: 10.1016/j.jtcvs.2020.04.113
PMID: 32653283
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

Acute type I aortic dissection (AAD) represents a surgical emergency with time-dependent evolving complications. Frozen elephant trunk (FET) enables false lumen exclusion downstream but is still debated in AAD due to its greater dimension of surgery. To combine the benefits of fast proximal repair with the FET benefits, a 3-zone hybrid graft was developed consisting of an ascending polyester portion, an arch noncovered stent, and a descending stent graft. Mid-term results of this new technique are presented. A total of 6 patients (age mean 69 years) with type I AAD in critical status (Penn classification B n = 5, BC n = 1) were operated between July 2016 and April 2018 using the 3-zone hybrid graft. The device was implanted on the basis of strict compassionate use. Operations were performed under distal hypothermic circulatory arrest and selective antegrade cerebral perfusion (SACP). Operative mortality was 17% (n = 1). Mean crossclamp and SACP time were 92 and 34 minutes, respectively, but came down in the last 2 cases to 75/65 crossclamp and 23/24 SACP minutes each. During follow up, mean 19 ± 12 months, one endovascular extension downstream was performed. Imaging control demonstrated no anastomotic-related proximal entry and no true lumen collapse downstream. The goal to achieve fast and reliable repair of complicated type I AAD down to midthoracic level seems to be achievable. Noncovered stenting of the head vessel's origin does not cause stenosis or obstruction. A multicenter studying of this concept is next. Copyright © 2020 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

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