Surgical treatment of acute type B aortic dissection using an endoprosthesis (elephant trunk)

被引:46
作者
Palma, JH
Almeida, DR
Carvalho, AC
Andrade, JCS
Buffolo, E
机构
[1] ESCOLA PAULISTA MED,DIV CARDIOVASC SURG,SAO PAULO,BRAZIL
[2] ESCOLA PAULISTA MED,DIV CARDIOL,SAO PAULO,BRAZIL
关键词
D O I
10.1016/S0003-4975(97)00052-0
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background. The surgical treatment of acute complicated type B aortic dissection continues to be a challenge and is still associated with high morbidity and mortality rates. Methods. Seventy consecutive patients with an acute type B aortic dissection underwent an elephant trunk procedure through a median sternotomy during deep hypothermic circulatory arrest. An endoprosthesis that was 22 to 24 mm in diameter was inserted through an incision in the arch and held in place with only proximal sutures. Results. The mean arrest time was 31.4 +/- 8.7 minutes, and it was possible to adequately position the endoluminal graft in every patient. The procedure was done in association with other procedures in 13 patients. There were six in-hospital deaths not related to the endoprosthesis, and four late deaths. Late reoperation was necessary in 6 patients to manage leakage at the proximal suture line. Conclusions. The insertion of an endoprosthesis through the arch for the management of a complicated acute type B dissection has several advantages over the conventional thoracotomy approach. The hospital mortality rate in this series of 70 patients was 20%, and the actuarial 5-year survival rate was 62.5%. We consider the elephant trunk procedure the treatment of choice in patients with type B acute dissections, regardless of whether the dissection is complicated or not. (C) 1997 by The Society of Thoracic Surgeons.
引用
收藏
页码:1081 / 1084
页数:4
相关论文
共 14 条
[1]  
BORST HG, 1988, J THORAC CARDIOV SUR, V95, P11
[2]  
CARPENTIER A, 1981, J THORAC CARDIOV SUR, V81, P659
[3]  
CRAWFORD EF, 1981, SURGERY, V89, P743
[4]  
Daily P O, 1970, Ann Thorac Surg, V10, P237
[5]   TRANSLUMINAL PLACEMENT OF ENDOVASCULAR STENT-GRAFTS FOR THE TREATMENT OF DESCENDING THORACIC AORTIC-ANEURYSMS [J].
DAKE, MD ;
MILLER, DC ;
SEMBA, CP ;
MITCHELL, RS ;
WALKER, PJ ;
LIDDELL, RP .
NEW ENGLAND JOURNAL OF MEDICINE, 1994, 331 (26) :1729-1734
[6]  
Dalen J E, 1974, Am J Cardiol, V34, P803, DOI 10.1016/0002-9149(74)90700-0
[7]   SURGICAL CONSIDERATIONS OF DISSECTING ANEURYSM OF THE AORTA [J].
DEBAKEY, ME ;
COOLEY, DA ;
CREECH, O .
ANNALS OF SURGERY, 1955, 142 (04) :586-612
[8]   LONG-TERM SURVIVAL OF PATIENTS WITH TREATED AORTIC DISSECTION [J].
DOROGHAZI, RM ;
SLATER, EE ;
DESANCTIS, RW ;
BUCKLEY, MJ ;
AUSTEN, WG ;
ROSENTHAL, S .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 1984, 3 (04) :1026-1034
[9]   LONG-TERM EXPERIENCE WITH DESCENDING AORTIC DISSECTION - THE COMPLICATION-SPECIFIC APPROACH [J].
ELEFTERIADES, JA ;
HARTLEROAD, J ;
GUSBERG, RJ ;
SALAZAR, AM ;
BLACK, HR ;
KOPF, GS ;
BALDWIN, JC ;
HAMMOND, GL .
ANNALS OF THORACIC SURGERY, 1992, 53 (01) :11-21
[10]  
GURIN D, 1935, NY STATE J MED, V34, P1200