Total Arch Replacement with Stented Elephant Trunk in DeBakey Type I Acute Aortic Dissection

Area of Science:

• Cardiovascular Surgery
• Vascular Surgery
• Thoracic Surgery

Background:

• Acute DeBakey type I aortic dissection is a life-threatening condition requiring prompt surgical intervention.
• The patient had recently undergone coronary artery stenting for myocardial infarction, complicating the management of aortic dissection.
• Conventional surgical techniques for aortic dissection can be challenging, especially in complex cases.

Observation:

• A 67-year-old female presented with acute DeBakey type I aortic dissection extending from the ascending aorta to the suprarenal artery.
• Diagnosis was confirmed via trans-esophageal echocardiography and aorta computed tomography.
• The patient had a history of recent percutaneous coronary intervention for acute myocardial infarction.

Findings:

• A hybrid surgical technique was employed, involving total arch replacement and the insertion of a stented elephant trunk (SET) graft into the descending thoracic aorta.
• The procedure was performed via median sternotomy.
• Anastomosis was successfully achieved between the proximal SET graft and the distal aortic arch.

Implications:

• This combined conventional and interventional approach may offer a viable treatment strategy for acute DeBakey type I aortic dissection.
• The SET graft facilitates a "frozen elephant trunk" in the descending aorta, potentially simplifying subsequent management.
• Further research is warranted to evaluate the long-term outcomes and efficacy of this hybrid technique in a larger patient cohort.