Objective: The aim of this study is to report an initial experience with aortic arch stenting in type A acute dissection. Methods: Between January and December 2003 10 patients, mean age 56.8 years, were operated for type A acute aortic dissection; in 7 patients the entry tear was in ascending aorta and in 3 in aortic arch. All were submitted to ascending aortic prosthetic replacement and stenting of the aortic arch with open web Djumbodis Dissection System stent (Saint Come, Marseille, France) during hypothermic ECC. The device consists of an uncovered stent made of Steel 316 L, provided in three lengths (4, 9, and 14 cm) and mounted on a compliant balloon. The balloon is inflated to adapt the stent to the shape of the aortic arch and to coapt aortic layers. The deployed device presents a large-meshed wet and can be superimposed at the origin of epiaortic vessels without any danger of obstruction. Mean extracorporeal circulation time was 173 minutes with a total circulatory arrest time ranging from 17 to 54 minutes. Results: Three patients died within 30 days, respectively for myocardial infarction, bowel infarction and stroke. Complete thrombosis of false channel was obtained in 3 patients, incomplete deployment of distal end of the web occurred in 1 patient without symptoms and another patient required reoperation for proximal leakage. At two and nine months follow up two patients required transfemoral thoracic aorta endovascular stent-grafting for residual type B dissection. Conclusions: Initial experience attests the feasibility of aortic arch stenting with Djumbodis Dissection System. It appears a useful procedure mainly in high-risk situations such as elderly patients with comorbidities in which aortic arch replacement has a prohibitive surgical risk. Djumbodis Dissection System has also facilitated distal aortic procedures permitting a safe proximal landing zone for deployment of thoracic aortic stent grafts.
New technology in the treatment of type A acute aortic dissection. Our experience in the use of Djumbodis dissection system
BEGHI, C;
2004-01-01
Abstract
Objective: The aim of this study is to report an initial experience with aortic arch stenting in type A acute dissection. Methods: Between January and December 2003 10 patients, mean age 56.8 years, were operated for type A acute aortic dissection; in 7 patients the entry tear was in ascending aorta and in 3 in aortic arch. All were submitted to ascending aortic prosthetic replacement and stenting of the aortic arch with open web Djumbodis Dissection System stent (Saint Come, Marseille, France) during hypothermic ECC. The device consists of an uncovered stent made of Steel 316 L, provided in three lengths (4, 9, and 14 cm) and mounted on a compliant balloon. The balloon is inflated to adapt the stent to the shape of the aortic arch and to coapt aortic layers. The deployed device presents a large-meshed wet and can be superimposed at the origin of epiaortic vessels without any danger of obstruction. Mean extracorporeal circulation time was 173 minutes with a total circulatory arrest time ranging from 17 to 54 minutes. Results: Three patients died within 30 days, respectively for myocardial infarction, bowel infarction and stroke. Complete thrombosis of false channel was obtained in 3 patients, incomplete deployment of distal end of the web occurred in 1 patient without symptoms and another patient required reoperation for proximal leakage. At two and nine months follow up two patients required transfemoral thoracic aorta endovascular stent-grafting for residual type B dissection. Conclusions: Initial experience attests the feasibility of aortic arch stenting with Djumbodis Dissection System. It appears a useful procedure mainly in high-risk situations such as elderly patients with comorbidities in which aortic arch replacement has a prohibitive surgical risk. Djumbodis Dissection System has also facilitated distal aortic procedures permitting a safe proximal landing zone for deployment of thoracic aortic stent grafts.
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