DEFINITION OF AORTIC ARCH SERIES
In ARSA, the subclavian artery arises directly from the descending aorta after the left subclavian artery branching and reaches the right arm passing behind the trachea, esophagus, and other vascular structures.ĪA anomalies are frequent in pediatric series but prenatal reports are scarce, because obtaining the required view and diagnosing requires training. RAA anomaly consists of an abnormal aortic course in which the ascending aorta surrounds the trachea by its right side (instead of by the left). 10.Most frequent AA anomalies include right aortic arch (RAA) anomaly and aberrant right subclavian artery (ARSA ). Safety and durability of single-stage type I hybrid total aortic arch repair for extensive aortic arch disease: early- and long-term clinical outcomes from a single center and our 10-year of experience. Management of Ascending Aorta and Aortic Arch: Similarities and Differences Among Cardiovascular Guidelines. Spanos K, Nana P, von Kodolitsch Y, et al. When to replace the ascending aorta? Methodist Debakey Cardiovasc J 2011 7:39-42. Surgical treatment of the dilated ascending aorta: when and how? Ann Thorac Surg 1999 67:1834-9 discussion 1853-6. Population-Based Risk Factors for Ascending, Arch, Descending, and Abdominal Aortic Dilations for 60-74-Year-Old Individuals. Obel LM, Diederichsen AC, Steffensen FH, et al. s-TAR, simplified total arch reconstruction. (A2–F2) Schematic of each step of the procedure. (F1) End-to-end anastomosis between the proximal aortic arch containing the intraluminal stented graft and the distal ascending aortic prosthesis. In addition, the proximal end of the stent-free graft is sutured to the native aortic arch wall. (E1) Stent-free sewing Dacron edge at the base of the modification is sutured to the base of the respective branch vessels. (D1) Three elliptical holes on the polyester fabric of the stent graft are separately removed using surgical scissors under direct vision (blue arrow) to modify the stent graft around each arch branch origin. (C1) Stent graft implanted anterogradely into the aortic arch and descending aorta through a transverse incision of the distal ascending aorta, and the proximal end of the stented graft positioned just proximal to the origin of the innominate artery. (B1) Replacement of ascending aorta with a suitable prosthesis. (A1) concomitant aortic root or valve surgery being performed. Procedure of the ascending aorta replacement and aortic arch reconstruction with the s-TAR technique. The s-TAR technique is a safe and effective alternative for total arch reconstruction with shorter operation time, lower rate of postoperative complications and lower total hospitalization costs compared with c-TAR.Ĭonventional total arch replacement extended aortic arch dilatation stented graft total arch reconstruction.Ģ023 Journal of Thoracic Disease. The s-TAR group had significantly shorter intensive care unit (ICU) stay and lower total hospitalization costs. The in-hospital mortality rate was 0% in the s-TAR group and 4.9% in the c-TAR group. Both perioperative blood loss and the incidence of reoperation for bleeding were significantly lower in the s-TAR group.
The incidence of recurrent laryngeal nerve injury and paraplegia was markedly increased in the c-TAR group however, no such events were observed in the s-TAR group. No patient in either group experienced permanent neurologic dysfunction. Cardiopulmonary bypass, selective cerebral perfusion, and lower-body circulatory arrest time were significantly shorter in the s-TAR group, which also had a lower incidence of prolonged ventilation and transient neurologic dysfunction. All patients were successfully treated with s-TAR or c-TAR, and none died intraoperatively. No inter-group differences were found for sex, age, comorbidities, or EuroSCORE II results. The indication for intervention was maximum diameter of ascending aorta >55 mm and aortic arch in zone II >35 mm.Ī total of 84 patients were analyzed: 43 in the s-TAR group and 41 in the c-TAR group. This retrospective analysis of prospectively collected data from all consecutive patients who had ascending aortic aneurysm with extended aortic arch dilation and underwent simultaneous ascending aorta replacement and aortic arch reconstruction with the s-TAR or c-TAR between 20. We present a simplified total arch reconstruction with a modified stent graft (s-TAR) and compared its operative outcomes with conventional total arch replacement (c-TAR). Reconstruction of the aortic arch and its three supra-aortic vessels remains a great surgical challenge with postoperative complications.
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