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Aneurysm management involves either conservative medical therapy or surgical intervention, depending on the size and symptoms of the aneurysm. Conservative management is generally reserved for smaller, asymptomatic aneurysms, while larger or symptomatic aneurysms often necessitate surgical repair.Conservative Medical TherapyFor small, asymptomatic aneurysms, particularly abdominal aortic aneurysms (AAA) less than 5.5 centimeters in diameter, conservative medical therapy is recommended. This...
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Novel and Innovative Hybrid Technique for Type A Aortic Dissection
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Elephant Trunk Stent Fenestration for Acute Type A Aortic Dissection.

Anfeng Yu1, Min Zhang1, Zhiwei Wang1

  • 1Department of Cardiovascular Surgery, Renmin Hospital of Wuhan University, Hubei, China; Cardiovascular Surgery Laboratory, Renmin Hospital of Wuhan University, Hubei, China; Central Laboratory, Renmin Hospital of Wuhan University, Hubei, China.

The Annals of Thoracic Surgery
|January 1, 2021
PubMed
Summary

Elephant trunk stent fenestration offers a simplified approach for acute type A aortic dissection (ATAAD) repair. This technique demonstrates favorable early and long-term outcomes, suggesting its wider adoption for ATAAD patients.

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Area of Science:

  • Cardiovascular Surgery
  • Thoracic Surgery
  • Medical Devices

Background:

  • Acute type A aortic dissection (ATAAD) presents significant surgical challenges.
  • Reconstruction of the aortic arch and branch vessels is critical for patient survival.
  • Traditional methods for ATAAD repair can be complex and carry substantial risks.

Purpose of the Study:

  • To evaluate the clinical outcomes of elephant trunk stent fenestration in ATAAD patients.
  • To assess the safety and efficacy of this technique in a large cohort.
  • To determine the long-term survival rates and complications associated with the procedure.

Main Methods:

  • Retrospective analysis of 271 ATAAD patients treated between January 2009 and December 2019.
  • All patients underwent total arch replacement with deep hypothermia circulatory arrest and elephant trunk stent fenestration.
  • Data collected included patient characteristics, perioperative findings, and long-term follow-up results.

Main Results:

  • Average in-hospital mortality was 4.1%.
  • Low rates of reoperation for bleeding (1.5%) and endoleaks (2 patients at 3 years).
  • Excellent long-term survival: 93.0% at 1 year, 89.3% at 5 years, and 81.7% at 10 years.

Conclusions:

  • Elephant trunk stent fenestration simplifies left subclavian artery reconstruction in ATAAD.
  • The technique is associated with reduced surgical difficulty and satisfactory early and long-term outcomes.
  • This method is recommended for promotion in select ATAAD patients.