Aortic arch dilation after hemiarch replacement with open stent graft for acute Stanford A aortic dissection

P0041 

Abstract Submission 

Shinichiro Ikeda (1), Tomomi Nakajima (1), Takayuki Gyoten (1), Osamu Kinoshita (1), Toshihisa Asakura (1), Akihiro Yoshitake (1)

(1) Saitama Medical University International Medical Center, Hidaka, Japan

Shinichiro Ikeda    -  Contact Me
Saitama Medical University International Medical Center

Tomomi Nakajima    -  Contact Me
Saitama Medical University International Medical Center

Takayuki Gyoten    -  Contact Me
Saitama Medical University International Medical Center

Osamu Kinoshita    -  Contact Me
Saitama Medical University International Medical Center

Toshihisa Asakura    -  Contact Me
Saitama Medical University International Medical Center

Akihiro Yoshitake    -  Contact Me
Saitama Medical University International Medical Center

Shinichiro Ikeda    -  Contact Me
N/A

Objective: Hemiarch replacement with open stent graft has been used for acute Stanford A aortic dissection could be useful for descending aorta remodeling. However, the aortic arch is left as native aorta and could dilate later. We investigated the cause and frequency of aortic arch dilation.
Methods: We analyzed the clinical data of patients who underwent hemiarch and open stent graft for acute Stanford A aortic dissection between 2008 and 2017. Results: A total of 145 patients [Male:82(57%) Femal:63(43%)] were included in this study. Median age was 68 years old. In-hospital mortality was 4 patients (3%). New stroke occurred in 10 patients (7%). Paraplegia in one patient (0.7%). During a follow-up (Median 3 years), out of 141 patients who were discharged alive, 14 patients (10%) had larger than 5 cm of aortic arch or more than 1 cm dilation compared to the one in preoperative CT scan. Out of those 14 patients, arch branch vessels were preoperatively dissected in 12 patients (86%) compared with 64 patients (50%) out of 127 patients who did not meet the criteria above (P<0.05). 7 patients required reintervention for dilated aortic arch. One patient whose arch branch vessels were dissected preoperatively had 4.4 cm of aortic ach and died due to aortic arch rupture 2.6 years after the index surgery. Complete descending aorta remodeling was accomplished in 83 patients (59%). 14 patients (10%) needed an intervention for descending aorta. Conclusions: Hemiarch replacement with open stent could rescue the patients with a low mortality rate and acceptable perioperative adverse events' rate. Some patients required aortic arch intervention later. Preoperative aortic arch branch vessels dissection could increase aortic arch adverse events such as aortic arch dilation or rupture as the residual dissection in the arch branch vessels become re-entry site.

Dissection