Thorac Cardiovasc Surg 2013; 61(07): 590-593
DOI: 10.1055/s-0032-1331894
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Georg Thieme Verlag KG Stuttgart · New York

Alternative Surgical Approach to Treat Aortic Arch Aneurysm after Ascending Aortic Replacement with Hybrid Prosthesis

Jacob Zeitani
1   Department of Cardiac Surgery Unit, University Tor Vergata, Policlinico Tor Vergata, Rome, Italy
,
Paolo Nardi
1   Department of Cardiac Surgery Unit, University Tor Vergata, Policlinico Tor Vergata, Rome, Italy
,
Kyriakos Bellos
1   Department of Cardiac Surgery Unit, University Tor Vergata, Policlinico Tor Vergata, Rome, Italy
,
Silvia De Propris
1   Department of Cardiac Surgery Unit, University Tor Vergata, Policlinico Tor Vergata, Rome, Italy
,
Luigi Chiariello
1   Department of Cardiac Surgery Unit, University Tor Vergata, Policlinico Tor Vergata, Rome, Italy
› Author Affiliations
Further Information

Publication History

10 October 2012

22 October 2012

Publication Date:
22 February 2013 (online)

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Abstract

We present a surgical technique to treat the distal aortic arch in patients who previously underwent ascending aortic replacement using the frozen elephant trunk. After debranching of the epiaortic vessels using a custom-made four-branch graft and systemic cooling, the extracorporeal circulation is interrupted, maintaining antegrade cerebral perfusion through the four-branch prosthesis. Then the “old” Dacron prosthesis, previously implanted for the ascending aortic replacement, is partially incised at its distal end, leaving a margin of prosthesis anastomosed to the native distal aorta, and the E-vita stent-graft is deployed under direct vision. Then the two margins of the “old” Dacron and the new Dacron E-vita prosthesis (Jotec Inc., Hechingen, Germany) are sutured together with one suture line to guarantee sealing and reconstruction of the aorta. This technique presents several advantages: the discrepancy between the graft size and the native aortic diameter is avoided, performing the anastomosis between two prosthetic materials with similar diameters is easier; there is no risk of tears in the diseased native aortic wall and related bleeding; and finally, it is easier to perform the anastomosis at the level of the ascending aorta rather than at the distal arch, especially when the disease of the aorta is extended to the descending segment.