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conferenceseries
.com
Volume 8, Issue 9 (Suppl)
J Clin Exp Cardiolog, an open access journal
ISSN: 2155-9880
Euro Cardiology 2017
October 16-18, 2017
October 16-18, 2017 | Budapest, Hungary
20
th
European
Cardiology
Conference
J Clin Exp Cardiolog 2017, 8:9(Suppl)
DOI: 10.4172/2155-9880-C1-078
One stage hybrid repair of Type-AAortic Dissection with integrated covered stent graft of descending
thoracic aorta-Our experience withmodified frozen elephant trunk in a low resource setting of North-
Eastern part of India
Manuj Kumar Saikia
North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, India
Statement of the Problem:
One stage repair of ascending aorta, arch and descending thoracic aorta though technically
challenging gives an advantage of complete repair. In a low resource setting a hybrid operating room (OR) is not always
available for simultaneous performance of intervention along with the operation .So we use the C-arm imaging during the
operation along with the help of interventional radiologist to perform one stage complete repair of ascending aorta , arch
debranching and covered stent graft to the descending thoracic aorta in few selected cases of Type-A aortic dissection .As
composite graft of frozen elephant trunk was not available in this part of the region so we modified the operation by use of
separate covered stent graft during the procedure.
Patients:
Ten patients were operated with one stage modified frozen elephant trunk in the year 2015 -2016. All are male patients,
age ranges from 57 yrs to 72yrs. All ten patients were referred to our institute from outside hospitals with a history of sudden
onset chest pain duration ranging from 6days to 18days. No patients had any history of cerebro vascular accidents (CVA) or
other peripheral vascular symptoms. Four patients had evidence of severe Aortic Regurgitation. After echocardiography, all
the patients were evaluated with computed tomography (CT) angiography of entire ascending aorta and follow through up to
femoral artery along with CT coronary angiography
Methods:
After general anesthesia, a guide wire is being inserted through left femoral artery by the help of C-arm imaging so
that it passes through true lumen and parked in the region of ascending aorta. This guide wire is being used to place the covered
stent graft in to the descending thoracic aorta in the later stage of operation when the entire aortic arch is being opened under
total circulatory arrest (TCA). Median sternotomy, Cardio pulmonary Bypass (CPB) established with Axillary artery & Right
Atrial cannulation except in one case where Innominate artery cannulation was done .After cross clamp, custodial cardioplegia
& Bentall procedure was performed in four cases & other two ascending aorta was replaced, after that patient cooled to 24
degree, antegrade cerebral perfusion and TCA instituted , arch excised, distal aorta prepared with teflon felt and covered stent
graft placed in to descending aorta by anchoring it to the guide wire, operation completed by debranching all three neck vessels
by placing a Plexus graft which is sutured distally to the proximal portion of covered stent graft and proximally to the ascending
aortic graft
Results:
No short-term mortality. Median hospital stays 15 days post operatively. No patient had any neurological deficit
post operatively. One patient had hoarseness of voice .Maximum follow up to 9 months. No evidence of new onset renal or
peripheral vascular diseases or other complication
Conclusion:
One stage repair with ascending aorta, arch and integrated covered stent graft to descending aorta (modified
frozen elephant trunk) is possible for Type A aortic dissection in low resource setting with the help of C-arm imaging in
routine operating room (OR). The procedure is safe with improved outcome compared with conventional elephant trunk 9
month post-operatively. Patient selection and antegrade cerebral perfusion through both innominate artery and left common
carotid artery helps in reducing the neurological events.
manuj_saikia@yahoo.com