A new minimal invasive technique with in-situ stent-graft fenestration for type A aortic dissection

Sanjiu Yu; Deqing Lin; Jianguang Yi; Xianpu Zhang; Yongbo Cheng; Chaojun Yan; Huajie Zheng; Lingfeng Tang; Mei Guo; Ping He; Jun Li; Wei Cheng

doi:10.1016/j.heliyon.2024.e29106

A new minimal invasive technique with in-situ stent-graft fenestration for type A aortic dissection

Heliyon. 2024 Apr 3;10(7):e29106. doi: 10.1016/j.heliyon.2024.e29106. eCollection 2024 Apr 15.

Authors

Sanjiu Yu¹, Deqing Lin¹, Jianguang Yi¹, Xianpu Zhang¹, Yongbo Cheng¹, Chaojun Yan¹, Huajie Zheng¹, Lingfeng Tang¹, Mei Guo¹, Ping He¹, Jun Li¹, Wei Cheng¹

Affiliation

¹ Department of Cardiac Surgery, The First Hospital Affiliated to Army Medical University (Third Military Medical University), Chongqing, 400038, PR China.

Abstract

Background: Aortic surgery successfully improves the prognosis of patients with type A aortic dissection. However, total arch replacement and reconstruction remain challenging. This study presents a new surgical modality, the in-situ stent-graft fenestration (ISSF) technique, for simplifying aortic arch reconstruction and assesses its short-term efficacy and safety in patients with type A aortic dissection.

Methods: Data from 177 patients with type A aortic dissection who underwent aortic arch reconstruction were retrospectively analyzed. Sun's procedure was performed in 90 patients and ISSF was performed in the other 87.

Results: The in-hospital mortality rate was 7.8% in the Sun's procedure group and 3.4% in the ISSF group (p = 0.357). Compared to the Sun's procedure group, the ISSF group had significantly shorter surgical duration, cardiopulmonary bypass time, circulatory arrest time, mechanical ventilation time, and aortic cross-clamp time (p < 0.05). Additionally, intraoperative blood loss was lower in the ISSF group than in the Sun's procedure group (p < 0.05). Patients who underwent ISSF also had a lower incidence of postoperative complications, including lung injury, renal failure, peripheral nerve injury, and chylothorax, than those who underwent Sun's procedure (p < 0.05). During the 6-month follow-up period after surgery, both groups showed significant improvements in the true lumen diameter of the descending thoracic aorta post-operation compared with the pre-operation measurements; meanwhile, the false lumen diameter decreased (p < 0.05).

Conclusions: The ISSF technique appears to be an effective and safe alternative to conventional surgical procedures for patients with type A aortic dissection, with the potential to simplify the procedure, shorten the operation time, and yield satisfactory operative results. However, further investigation is needed to determine its long-term benefits.

Keywords: Aortic arch reconstruction; In-situ stent-graft fenestration technique; Sun's procedure; Type A aortic dissection.