Aortic Arch Replacement in Patients With Chronic Dissection: Special Considerations

Area of Science:

• Cardiovascular Surgery
• Vascular Surgery
• Aortic Disease

Background:

• Chronic DeBakey type I aortic dissection can progressively expand, necessitating complex surgical repair.
• Patients often undergo reoperative aortic arch surgery after initial acute dissection repair, requiring redo median sternotomy.
• Ectasia or aneurysms in the descending thoracic aorta are common during aortic arch repair.

Purpose of the Study:

• To describe an approach for repairing chronic DeBakey type I aortic dissection involving the aortic arch and distal aorta.
• To highlight the utility of the elephant trunk extension in facilitating subsequent distal aortic repair.
• To emphasize the importance of imaging surveillance protocols for patients with chronic aortic dissection.

Main Methods:

• Total transverse aortic arch replacement, with or without an elephant trunk extension.
• Surgical repair addressing both the aortic arch and the distal aorta (descending thoracic and thoracoabdominal).
• Inclusion of patients who are survivors of prior emergent proximal aortic repair.

Main Results:

• The elephant trunk extension facilitates staged repair of the distal aorta.
• This approach addresses the common ectatic or aneurysmal changes in the proximal descending thoracic aorta.
• Redo median sternotomy is frequently required for these reoperative procedures.

Conclusions:

• Total transverse aortic arch replacement with an elephant trunk extension is a viable strategy for chronic DeBakey type I aortic dissection.
• The elephant trunk technique simplifies subsequent repairs in the descending and thoracoabdominal aorta.
• A structured imaging surveillance protocol is essential for managing patients with chronic aortic dissection.