P188. Left Subclavian Artery Reconstruction in the Frozen Elephant Trunk Operation for Acute Type A Aortic Dissection
Presented During: POD Abstracts (Available for viewing in the exhibit hall for the duration of the meeting)
Hamamatsu University Hosipital
Hamamatsu
Japan - Contact Me
1992 Graduated with a degree in Medicine, Hamamatsu University School of Medicine
2001 Graduated from Graduate School of Medicine, Hamamatsu University School of Medicine
1992 Resident, Department of Surgery, Shizuoka General Hospital
1995 Fujinomiya City Hospital, Surgery
2001 Assistant Professor, First Dpartment of Surgery, Hamamatsu University School of Medicine
2013 Numazu City Hospital, Cardiovascular Surgery, Medical Director
2015 Assistant Professor, First Dpartment of Surgery, Hamamatsu University School of Medicine
2021 Lecturer, First Dpartment of Surgery, Hamamatsu University School of Medicine
2023 Associate Professor, First Dpartment of Surgery, Hamamatsu University School of Medicine
Thursday, April 25, 2024: 5:38 PM - 7:00 PM
Sheraton Times Square
Room: Central Park
Description
Background. The frozen elephant trunk has increasingly been used for acute type A aortic dissection. The trunk is frequently secured at zone 2, which may compromise left subclavian artery reconstruction. To facilitate reconstruction, the frozen elephant trunk may be fenestrated or bypass grafting to the left axillary artery has been employed. In the latter case, however, adhesion between the lung and the bypass graft may cause a problem during subsequent downstream aortic repair. We perform stress-free left subclavian artery reconstruction through a straight median sternotomy incision by dissecting the left common carotid artery and dividing the left anterior cervical muscles, which provides sufficient exposure of the left subclavian artery up to the vertebral artery take-off.
Objectives. We report our technique of left subclavian artery exposure and compare the outcomes between those treated by fenestrated frozen elephant trunk and those treated by anatomical left subclavian artery reconstruction.
Patients and Methods. Twenty-three patients who underwent frozen elephant trunk operation for acute type A aortic dissection between September 2019 and October 2023 were retrospectively analyzed. Patients requiring preoperative cardiopulmonary resuscitation were excluded. Anatomical reconstruction was performed in 11 patients (A group) and fenestrated frozen elephant trunk in 13 patients (F group; 8 patients with left subclavian fenestration and 5 patients with combined left carotid and subclavian fenestration). No patients underwent bypass grafting to the left axillary artery. Patient characteristics, concomitant procedures, cardiopulmonary bypass (CPB) time, aortic crossclamp (AXC) time, selective cerebral perfusion (SCP) time, circulatory arrest (CA) time of the lower torso, in-hospital death, and postoperative descending aortic false lumen status were evaluated. Data were shown as mean ±standard deviation.
Results. Patient age was 57 ± 12 (A) and 61 ± 7 years (F). Body weight was 73 ± 14 (A) and 71 ± 18 kg (F), and height was 170 ± 13 (A) and 169 ± 8 cm (F), respectively. Concomitant procedures included 3 Bentall in group T, 2 Bentall and 1 mitral valve repair in group F. CPB time was 274 ± 80 (A) and 251 ± 81 min (F), AXC time was 144 ± 48 (A) and 164 ± 73 minutes (F), SCP time was 180 ± 41 min (A) and 159 ± 65 min (F), CA time was 56 ± 15 (A) and 65 ± 8 minutes, respectively. There were no in-hospital deaths in both groups. In the A group, false lumen thrombosis was obtained around the trunk except for one case with 3-channel dissection. In the F group, there was one case with residual blood flow from the re-entry in the left subclavian artery and 1 case requiring additional TEVAR due to residual false lumen blood flow from fenestration.
Authors
Naoki Washiyama (1), Norihiko Shiiya (2), Daisuke Takahashi (3), Kazumasa Tsuda (4)
Institutions
(1) N/A, N/A, (2) Hamamatsu University Hospital, Hamamatsu, Japan, (3) MD, Hamamatsu, NA, (4) N/A, Hamamatsu, Shizuoka
Objectives. We report our technique of left subclavian artery exposure and compare the outcomes between those treated by fenestrated frozen elephant trunk and those treated by anatomical left subclavian artery reconstruction.
Patients and Methods. Twenty-three patients who underwent frozen elephant trunk operation for acute type A aortic dissection between September 2019 and October 2023 were retrospectively analyzed. Patients requiring preoperative cardiopulmonary resuscitation were excluded. Anatomical reconstruction was performed in 11 patients (A group) and fenestrated frozen elephant trunk in 13 patients (F group; 8 patients with left subclavian fenestration and 5 patients with combined left carotid and subclavian fenestration). No patients underwent bypass grafting to the left axillary artery. Patient characteristics, concomitant procedures, cardiopulmonary bypass (CPB) time, aortic crossclamp (AXC) time, selective cerebral perfusion (SCP) time, circulatory arrest (CA) time of the lower torso, in-hospital death, and postoperative descending aortic false lumen status were evaluated. Data were shown as mean ±standard deviation.
Results. Patient age was 57 ± 12 (A) and 61 ± 7 years (F). Body weight was 73 ± 14 (A) and 71 ± 18 kg (F), and height was 170 ± 13 (A) and 169 ± 8 cm (F), respectively. Concomitant procedures included 3 Bentall in group T, 2 Bentall and 1 mitral valve repair in group F. CPB time was 274 ± 80 (A) and 251 ± 81 min (F), AXC time was 144 ± 48 (A) and 164 ± 73 minutes (F), SCP time was 180 ± 41 min (A) and 159 ± 65 min (F), CA time was 56 ± 15 (A) and 65 ± 8 minutes, respectively. There were no in-hospital deaths in both groups. In the A group, false lumen thrombosis was obtained around the trunk except for one case with 3-channel dissection. In the F group, there was one case with residual blood flow from the re-entry in the left subclavian artery and 1 case requiring additional TEVAR due to residual false lumen blood flow from fenestration.
Authors
Naoki Washiyama (1), Norihiko Shiiya (2), Daisuke Takahashi (3), Kazumasa Tsuda (4)
Institutions
(1) N/A, N/A, (2) Hamamatsu University Hospital, Hamamatsu, Japan, (3) MD, Hamamatsu, NA, (4) N/A, Hamamatsu, Shizuoka
Presentation Duration
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