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New standard surgical approach proposed for type A aortic dissection

Reuters Health • The Doctor's Channel Daily Newscast

NEW YORK (Reuters Health) – Encouraging results with total arch replacement combined with stented “elephant trunk” implantation suggest that this strategy should become a new standard of management for type A dissection involving the aortic arch, a Chinese team reports.

Dr. LiZhong Sun, currently at the Beijing Anzhen Hospital, and colleagues say the optimal procedure for managing type A dissection involving the aortic arch — an inherently lethal condition — is controversial. In the February 23 issue of Circulation, they review their experience with 411 such patients who underwent aortic arch replacement between 2003 and 2008.

In 291 of the patients, the procedure was combined with stented “elephant trunk” implantation, while 120 patients had conventional surgical repair.

In-hospital mortality was 3.09% with the stented procedure compared with 5.00% with conventional repair, according to the report.

“Obliteration of the false lumen around the stented elephant trunk occurred in 94.2% (130 of 138) of patients with acute dissection and in 92.0% (126 of 137) of patients with chronic dissection,” the team reports. The distal aorta was thus stabilized, so that the prevalence of aneurysmal dilatation of the distal aorta was reduced. “Accordingly, the need for secondary intervention of the distal aorta was greatly reduced with the stented elephant trunk technique.”

However, the authors note, injury to the spinal cord “remained a challenging problem,” occurring in 2.41% with the stented procedure compared with 0.83% with conventional repair.

Overall, “A low prevalence of morbidity and mortality was obtained in our study population,” Dr. Sun and colleagues conclude. The results and promising outcomes, they believe, could enable total arch replacement combined with stented elephant trunk implantation “to become the new ‘standard’ therapy for type A dissection involving repair of the aortic arch.”

Reference:

Total Arch Replacement Combined With Stented Elephant Trunk Implantation

Circulation 2011;123:971-978.