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Postoperative results of the in situ fenestrated open stent technique for acute aortic dissection type A
OBJECTIVE: Total arch replacement is commonly used for acute aortic dissection type A at some facilities, especially since open stent grafting became commercially available in Japan. Left subclavian artery (LSCA) reconstruction involves deep view manipulation, is difficult to expose and anastomose,...
Autores principales: | , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Springer Nature Singapore
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10188390/ https://www.ncbi.nlm.nih.gov/pubmed/36255653 http://dx.doi.org/10.1007/s11748-022-01878-4 |
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author | Azuma, Shuhei Shimada, Ryo Motohashi, Yoshikazu Yoshii, Yasuyoshi |
author_facet | Azuma, Shuhei Shimada, Ryo Motohashi, Yoshikazu Yoshii, Yasuyoshi |
author_sort | Azuma, Shuhei |
collection | PubMed |
description | OBJECTIVE: Total arch replacement is commonly used for acute aortic dissection type A at some facilities, especially since open stent grafting became commercially available in Japan. Left subclavian artery (LSCA) reconstruction involves deep view manipulation, is difficult to expose and anastomose, and involves the risk of complications and surrounding vascular injury. METHODS: We evaluated 137 patients (mean age 73.8 ± 15.6 years) who underwent total arch replacement for acute aortic dissection type A, at our hospital between September 2014 and March 2022, and divided them into two groups: 70 patients for total arch replacement with fenestrated open stent technique (FeneOS), and 67 for conventional total arch replacement with the reconstruction of three-branch cerebral vessels. We performed FeneOS by deploying the graft from the entry of the left subclavian artery into the descending aorta and fenestrating the LSCA side of the stenting portion. The four-branched artificial vessel was then anastomosed between the left common carotid artery and LSCA. RESULTS: The surgical results of FeneOS were satisfactory and enabled significant reductions in operative time, selective cerebral perfusion time, cardiopulmonary bypass time, and lower body circulatory arrest time. Long-term observation (mean follow-up = 5.5 years) showed no left recurrent laryngeal nerve palsy or postoperative problems with left subclavian artery blood flow. CONCLUSIONS: FeneOS can minimize LSCA exposure because there is no need for LSCA reconstruction, reducing operation time and avoiding the risk of left recurrent laryngeal nerve injury and bleeding problems associated with LSCA exposure and anastomosis during left subclavian artery exposure. |
format | Online Article Text |
id | pubmed-10188390 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | Springer Nature Singapore |
record_format | MEDLINE/PubMed |
spelling | pubmed-101883902023-05-18 Postoperative results of the in situ fenestrated open stent technique for acute aortic dissection type A Azuma, Shuhei Shimada, Ryo Motohashi, Yoshikazu Yoshii, Yasuyoshi Gen Thorac Cardiovasc Surg Original Article OBJECTIVE: Total arch replacement is commonly used for acute aortic dissection type A at some facilities, especially since open stent grafting became commercially available in Japan. Left subclavian artery (LSCA) reconstruction involves deep view manipulation, is difficult to expose and anastomose, and involves the risk of complications and surrounding vascular injury. METHODS: We evaluated 137 patients (mean age 73.8 ± 15.6 years) who underwent total arch replacement for acute aortic dissection type A, at our hospital between September 2014 and March 2022, and divided them into two groups: 70 patients for total arch replacement with fenestrated open stent technique (FeneOS), and 67 for conventional total arch replacement with the reconstruction of three-branch cerebral vessels. We performed FeneOS by deploying the graft from the entry of the left subclavian artery into the descending aorta and fenestrating the LSCA side of the stenting portion. The four-branched artificial vessel was then anastomosed between the left common carotid artery and LSCA. RESULTS: The surgical results of FeneOS were satisfactory and enabled significant reductions in operative time, selective cerebral perfusion time, cardiopulmonary bypass time, and lower body circulatory arrest time. Long-term observation (mean follow-up = 5.5 years) showed no left recurrent laryngeal nerve palsy or postoperative problems with left subclavian artery blood flow. CONCLUSIONS: FeneOS can minimize LSCA exposure because there is no need for LSCA reconstruction, reducing operation time and avoiding the risk of left recurrent laryngeal nerve injury and bleeding problems associated with LSCA exposure and anastomosis during left subclavian artery exposure. Springer Nature Singapore 2022-10-18 2023 /pmc/articles/PMC10188390/ /pubmed/36255653 http://dx.doi.org/10.1007/s11748-022-01878-4 Text en © The Author(s) 2022 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . |
spellingShingle | Original Article Azuma, Shuhei Shimada, Ryo Motohashi, Yoshikazu Yoshii, Yasuyoshi Postoperative results of the in situ fenestrated open stent technique for acute aortic dissection type A |
title | Postoperative results of the in situ fenestrated open stent technique for acute aortic dissection type A |
title_full | Postoperative results of the in situ fenestrated open stent technique for acute aortic dissection type A |
title_fullStr | Postoperative results of the in situ fenestrated open stent technique for acute aortic dissection type A |
title_full_unstemmed | Postoperative results of the in situ fenestrated open stent technique for acute aortic dissection type A |
title_short | Postoperative results of the in situ fenestrated open stent technique for acute aortic dissection type A |
title_sort | postoperative results of the in situ fenestrated open stent technique for acute aortic dissection type a |
topic | Original Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10188390/ https://www.ncbi.nlm.nih.gov/pubmed/36255653 http://dx.doi.org/10.1007/s11748-022-01878-4 |
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