Combined Treatment of Aortic Type A Dissection: Ascending Aorta Repair and Placement of a Stent in the Descending Aorta
Background: The established treatment modality of acute Stanford type A dissection includes repairing the ascending aorta and a variable part of the aortic arch and leaving the descending aorta untreated. We report a simultaneous approach of open repair of the ascending aorta with the transluminal placement of a stent in the descending aorta to minimize the consequences of an untreated descending aorta.
Methods: Two cases of type A aortic dissection are described, one case with the entry port in the descending aorta and the second case with the entry port in the aortic arch. Both patients were treated by the replacement of the ascending aorta (and the aortic arch in the second case) and the placement of a stent in the descending aorta with a new device as the patients were under circulatory arrest and deep hypothermia. The device consists of a Djumbodis stent mounted on a compliant balloon. This stent is made of 316L stainless steel and can be adapted to the shape of the aortic arch or descending aorta. Three different lengths are available: 4 cm, 9 cm, and 14 cm. The device used in these patients has a diameter of 9 mm.
Results: The early results were satisfactory with a completely thrombosed false lumen in one case and a partially thrombosed false lumen in the other, according to immediate postoperative transesophageal echocardiography control. A follow-up computed tomographic chest scan was done at 12 months in the first case and at 7 months in the second case and confirmed the good surgical results.
Conclusions: This preliminary study shows that combined surgical and endovascular treatment of acute type A dissection is feasible and that at least partial thrombosis of the false lumen can be achieved, potentially minimizing the risk of further dilatation or rupture. The early results are encouraging, but more cases and long-term results are required to demonstrate the effectiveness of this new combined treatment modality.
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