Total Arch Replacement through Left Thoracotomy for Residual Aortic Dissection after Repair of Type A Aortic Dissection

P0350 

Abstract Submission 

Aya Tanaka (1), Yutaka Okita (2), Kenji Okada (3), takanori Oka (1), Kotaro Tsunemi (1), Atsushi Omura (4), Hiroyuki Hayashi (1)

(1) Takatsuki General Hospital, Takatsuki, Osaka, (2) Takatsuki General Hospital, Kobe, Hyogo, (3) Kobe University Hospital, Kobe, Hyogo, (4) N/A, Kobe, Japan

Aya Tanaka    -  Contact Me
Takatsuki General Hospital

*Yutaka Okita    -  Contact Me
Takatsuki General Hospital

Kenji Okada    -  Contact Me
Kobe University Hospital

takanori Oka    -  Contact Me
Takatsuki General Hospital

Kotaro Tsunemi    -  Contact Me
Takatsuki General Hospital

Atsushi Omura    -  Contact Me
N/A

Hiroyuki Hayashi    -  Contact Me
Takatsuki General Hospital

Aya Tanaka    -  Contact Me
N/A

Objective:
After hemi-arch replacement for acute type A aortic dissection (ATAAD), enlargement of the residual aneurysm sometimes requires surgery. We investigated the long-term outcomes of total arch replacement through left thoracotomy in such cases.
Methods:
From October 1999 to September 2023, 445 patients underwent surgery because of ATAAD. Two hundreds patients had total arch replacement (TAR), 33 patients had semi-arch replacement（1-2 branch）, and 212 patients had hemi-arch replacement (ascending aorta). Nineteen patients (18 patients have had hemi-arch replacement, 1 patient have had semi-arch replacement) required redo TAR because of residual distal dissection. Fourteen patients had median sternotomy and TAR+ Free Elephant Trunk or Frozen Elephant Trunk installation (ET) as a redo surgery, while 5 patients (4 post hemi-arch replacement, 1 post semi-arch replacement) underwent left thoracotomy and TAR. Including these 4 patients, we had in total of 34 patients (30 patients have undergone hemi-arch replacement for ATAAD at other hospitals) undergoing extensive（aortic arch to descending aorta）arch replacement after previous surgery for ATAAD, using the left thoracotomy. The mean age of the patients was 62.1 ± 10.6 years (42-80 years), and the most enlarged aortic site was the aortic arch in 19 patients, descending aorta above the Th 6 level in 4 patients, and descending aorta below Th 6 in 11 patients. Three symptomatic patients were operated urgently, while the others underwent elective surgery. Left posterolateral thoracotomy approach was used in 31 patients, clam-shell approach was used in 1 patient, antero-lateral thoracotomy with partial sternotomy (ALPS) was used in 1 patient, and straight incision with rib cross approach was used in 1 patient. All patients underwent total arch replacement and replacement of descending aorta. As an additional procedure, 2 patients underwent aortic root replacement, 10 patients underwent thoracoabdominal aorta replacement, and 1 patient underwent CABG. The mean cardiopulmonary bypass time was 229 ± 60.1 minutes, cardiac ischemia time was 74.5 ± 33.5 minutes. Antegrade cerebral perfusion was used in all patients, and the cerebral perfusion time was 79.9 ± 23.8 minutes. The minimum tympanic temperature was 24.5 ± 2.67 ℃, the minimum rectal temperature was 26.1 ± 2.96 ℃.
Results:
There was one early death because of coronary embolism and multiple stroke 5 days after the surgery. The follow-up period varies from 2 months to 16.5 years. Kaplan-Meier survival at 5, 10 year was 89.7 ± 5.65 %, 64.2 ± 10.6 % respectively. Freedom from cardio-aortic event at 5, 10 year was 85.4 ± 6.82 %, 76.1 ± 8.67 %, and reoperation freedom at 5, 10 year was 92.0 ± 5.44 %. Of the 8 patients who died within 10 years, 3 died of cardiovascular events (2 for aortic aneurysm rupture, 1 for renal and heart failure).
Conclusion:
The early results of total arch replacement through left thoracotomy for residual aortic dissection after ATAAD repair were satisfactory. However, there have been some patients who had events in the distal aorta after reoperation.

Dissection