Surgery for marfan patients with acute type a dissection using a stented elephant trunk procedure

Area of Science:

• Cardiovascular Surgery
• Thoracic Surgery
• Vascular Surgery

Background:

• Marfan syndrome patients with acute type A aortic dissection involving the aortic arch present complex surgical challenges.
• Traditional surgical approaches may not adequately address the extent of aortic involvement in these patients.

Purpose of the Study:

• To evaluate the efficacy of total arch replacement combined with stented elephant trunk implantation.
• To assess outcomes in Marfan patients experiencing acute type A aortic dissection involving the aortic arch.

Main Methods:

• A cohort of 13 consecutive Marfan patients underwent total arch replacement and stented elephant trunk implantation between 2004 and 2006.
• Patient demographics, dissection extent, and postoperative imaging (computed tomography) were analyzed.
• Follow-up included assessment of residual false lumen, thrombus formation, and clinical outcomes.

Main Results:

• All 13 patients survived the initial procedure and were discharged.
• Complete thrombus formation around the stented elephant trunk was observed in 84.6% of patients.
• The mean follow-up was 27 months, with one late death and manageable complications including cerebral infarction and limb ischemia.

Conclusions:

• Total arch replacement with stented elephant trunk implantation is a viable option for Marfan patients with acute type A aortic dissection.
• The procedure demonstrates a potential to reduce late descending aorta dilatation, possibly extending reoperation intervals.
• Successful thrombus formation around the stent is crucial for long-term outcomes, preventing false lumen patency.