Experience with aortic arch inclusion technique using artificial blood vessel for type A aortic dissection: an...

Area of Science:

• Cardiovascular Surgery
• Vascular Surgery
• Thoracic Surgery

Background:

• Acute type A aortic dissection (ATAAD) is a life-threatening condition requiring complex surgical management.
• Traditional total aortic arch replacement (TAAR) presents significant technical challenges.
• The aortic arch inclusion technique using an artificial vascular graft offers a potential solution.

Purpose of the Study:

• To elucidate the methodology of the aortic arch inclusion technique for ATAAD.
• To assess the short-term efficacy and safety of this novel technique.
• To evaluate the procedural simplification and outcomes of using a four-branch prosthetic graft.

Main Methods:

• Retrospective review of 18 ATAAD patients undergoing TAAR with an artificial vascular "inclusion" graft.
• Utilized deep hypothermic circulatory arrest (DHCA) and selective antegrade cerebral perfusion (ACP).
• Procedures included "inclusion" TAAR and stented elephant trunk (SET) surgery.

Main Results:

• Three in-hospital deaths occurred; complications included renal failure, paraplegia, and cerebral infarction.
• Postoperative computed tomography angiography (CTA) showed favorable thrombosis in the false lumen of the aortic arch and descending aorta stents in most patients.
• One patient experienced complete false lumen resolution in the thoracic and abdominal aorta after one year.

Conclusions:

• The aortic arch inclusion technique simplifies TAAR for ATAAD.
• The procedure demonstrates promising short-term outcomes with a four-branch prosthetic graft.
• Long-term efficacy necessitates extensive sampling and prolonged follow-up observations.