Surgical treatment of distal aortic arch lesions using stented elephant trunk implantation combined with transposition of left subclavian artery to left common carotid artery_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

QI Ruidong ,  ZHU Junming , CHEN Lei , LI Chengnan , QIAO Zhiyu , CHEN Lijian , GE Yipeng , HU Haiou , XIA Yu , XING Xiaoyan , ZHENG Tie ,  SUN Lizhong

Beijing Aortic Disease Center, Beijing Institute of Heart, Lung and Blood Vessel Diseases & Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, P.R.China;

Corresponding author：

ZHU Junming, Email: anzhenzjm@163.com; SUN Lizhong, Email: lizhongsun@outlook.com

Keywords：

Distal aortic arch lesions; stented elephant trunk procedure; left subclavain artery transposition

DOI：

10.7507/1007-4848.201702009

Video：

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Objective To evaluate the short- and middle-term outcomes of surgical treatment for distal aortic arch lesions using stented elephant trunk implantation combined with transposition of left subclavian artery to left common carotid artery. Methods The clinical data of 14 patients with distal aortic arch lesions undergoing stented elephant trunk procedure with left subclavain artery transposition under hypothermic cardiopulmonary bypass (CPB) with antegrade selective cerebral perfusion from May 2009 to November 2015 in our hospital were retrospectively reviewed. All of them were males with a mean age of 52±14 years ranging from 20 to 69 years. Hypertension was observed in nine patients, coronary artery disease in five and prior cerebral infarction in one. History of percutaneous coronary intervention was noted in one patient, history of Bentall operation in one, ligation of patent ductus arteriosus in one and endovascular aneurysm repair in one. Results There was no hospital death. Concomitant procedures included coronary artery bypass grafting in two patients and plasty of the ascending aorta replacement in one. Mean duration of mechanical ventilation and ICU stay was 21±7 h and 43±19 h, respectively. All patients survived and were discharged. One patient was lost to follow-up and no patient died during the follow-up. Postoperative computed tomography revealed good patency of the anastomotic site between the left subclavian artery and the left common carotid artery. Conclusion Stented elephant trunk procedure with left subclavain artery transposition obtains satisfactory surgical results in patients with distal aortic arch lesions.

Citation： QI Ruidong, ZHU Junming, CHEN Lei, LI Chengnan, QIAO Zhiyu, CHEN Lijian, GE Yipeng, HU Haiou, XIA Yu, XING Xiaoyan, ZHENG Tie, SUN Lizhong. Surgical treatment of distal aortic arch lesions using stented elephant trunk implantation combined with transposition of left subclavian artery to left common carotid artery. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2018, 25(1): 49-53. doi: 10.7507/1007-4848.201702009 Copy

1.	Cazavet A, Alacoque X, Marcheix B, et al. Aortic arch aneurysm: short- and mid-term results comparing open arch surgery and the hybrid procedure. Eur J Cardiothorac Surg, 2016, 49(1): 134-140.
2.	Zhu JM, Qi RD, Chen L, et al. Stented elephant trunk procedure with left subclavian artery transposition for acute type B dissection with distal arch involvement. J Thorac Cardiovasc Surg, 2015, 150(5): 1160-1165.
3.	Mieno S, Ozawa H, Daimon M, et al. Minimizing cerebral embolism in resection of distal aortic arch aneurysm through a left thoracotomy. Ann Thorac Surg, 2011, 91(2): 472-477.
4.	Quiñones-Baldrich WJ, Marelli D, Esmailian F. Distal aortic arch replacement for aneurysmal disease: the value of preparatory carotid subclavian reconstruction. Ann Vasc Surg, 2003, 17(2): 148-151.
5.	Samura M, Zempo N, Ikeda Y, et al. Endovascular repair of distal arch aneurysm with double-chimney technique. Ann Thorac Surg, 2013, 95(5): 1778-1780.
6.	Moriyama Y, Iguro Y, Hisatomi K, et al. Distal arch aneurysm repair using stent-grafting and ascending aorto-left axillary bypass. Ann Thorac Surg, 2000, 70(6): 1974-1976.
7.	Orihashi K, Sueda T, Watari M, et al. Endovascular stent-grafting via the aortic arch for distal aortic arch aneurysm: an alternative to endovascular stent-grafting. Eur J Cardiothorac Surg, 2001, 20(5): 973-978.
8.	Sueda T, Orihashi K, Okada K, et al. Fate of aneurysms of the distal arch and proximal descending thoracic aorta after transaortic endovascular Stent-Grafting. Ann Thorac Surg, 2003, 76(1): 84-89.
9.	Hata M, Orime Y, Wakui S, et al. Efficacy of a newly modified technique for distal limited open stenting in octogenarians with aortic arch aneurysm. J Thorac Cardiovasc Surg, 2017, 153(3): 530-535.
10.	Jim J, Moon MR, Rubin BG, et al. Hybrid repair of distal arch aortic aneurysms: endovascular elephant trunk completion. Ann Vasc Surg, 2011, 25(5): 598-604.
11.	Patel HJ, Dake MD, Bavaria JE, et al. Branched endovascular therapy of the distal aortic arch: preliminary results of the feasibility multicenter trial of the Gore thoracic branch endoprosthesis. Ann Thorac Surg, 2016, 102(4): 1190-1198.
12.	Czerny M, Gottardi R, Zimpfer D, et al. Mid-term results of supraaortic transpositions for extended endovascular repair of aortic arch pathologies. Eur J Cardiothorac Surg, 2007, 31(4): 623-627.
13.	Yoshitake A, Hachiya T, Okamoto K, et al. Postoperative Stroke after debranching with thoracic endovascular aortic repair. Ann Vasc Surg, 2016, 36: 132-138.
14.	Ockert S, Eckstein G, Lutz B, et al. Aortic hemiarch hybrid repair. J Vasc Surg, 2015, 62(4): 907-913.
15.	Zhu J, Cheng L, Liu Y, et al. One-stage repair for stanford type B aortic dissection concomitant with cardiac diseases: open stented elephant trunk technique combined with cardiac operation. Thorac Cardiovasc Surg, 2012, 60(1): 11-16.
16.	Di Eusanio M, Pantaleo A, Cefarelli M, et al. Frozen elephant trunk surgery in type B aortic dissection. Ann Cardiothorac Surg, 2014, 3(4): 400-402.
17.	Chen L, Qi RD, Liu W, et al. Repair of complicated chronic type B dissection with distal aortic arch involvement using left subclavian artery transposition with implantation of a stented elephant trunk. Thorac Cardiovasc Surg, 2017, 65(2): 99-104.
18.	Lotfi S, Clough RE, Ali T, et al. Hybrid repair of complex thoracic aortic arch pathology: long-term outcomes of extra-anatomic bypass grafting of the supra-aortic trunk. Cardiovasc Intervent Radiol, 2013, 36(1): 46-55.
19.	Fadda GF, Marino M, Kasemi H, et al. Hybrid endovascular solutions for supra-aortic vessels extra-anatomic bypass infection. Ann Vasc Surg, 2015, 29(8): 1662.
20.	Uchida N, Kodama H, Katayama K, et al. Endovascular aortic repair as second-stage surgery after hybrid open arch repair by the frozen elephant trunk technique for extended thoracic aneurysm. Ann Thorac Cardiovasc Surg, 2013, 19(3): 257-261.

1. Cazavet A, Alacoque X, Marcheix B, et al. Aortic arch aneurysm: short- and mid-term results comparing open arch surgery and the hybrid procedure. Eur J Cardiothorac Surg, 2016, 49(1): 134-140.
2. Zhu JM, Qi RD, Chen L, et al. Stented elephant trunk procedure with left subclavian artery transposition for acute type B dissection with distal arch involvement. J Thorac Cardiovasc Surg, 2015, 150(5): 1160-1165.
3. Mieno S, Ozawa H, Daimon M, et al. Minimizing cerebral embolism in resection of distal aortic arch aneurysm through a left thoracotomy. Ann Thorac Surg, 2011, 91(2): 472-477.
4. Quiñones-Baldrich WJ, Marelli D, Esmailian F. Distal aortic arch replacement for aneurysmal disease: the value of preparatory carotid subclavian reconstruction. Ann Vasc Surg, 2003, 17(2): 148-151.
5. Samura M, Zempo N, Ikeda Y, et al. Endovascular repair of distal arch aneurysm with double-chimney technique. Ann Thorac Surg, 2013, 95(5): 1778-1780.
6. Moriyama Y, Iguro Y, Hisatomi K, et al. Distal arch aneurysm repair using stent-grafting and ascending aorto-left axillary bypass. Ann Thorac Surg, 2000, 70(6): 1974-1976.
7. Orihashi K, Sueda T, Watari M, et al. Endovascular stent-grafting via the aortic arch for distal aortic arch aneurysm: an alternative to endovascular stent-grafting. Eur J Cardiothorac Surg, 2001, 20(5): 973-978.
8. Sueda T, Orihashi K, Okada K, et al. Fate of aneurysms of the distal arch and proximal descending thoracic aorta after transaortic endovascular Stent-Grafting. Ann Thorac Surg, 2003, 76(1): 84-89.
9. Hata M, Orime Y, Wakui S, et al. Efficacy of a newly modified technique for distal limited open stenting in octogenarians with aortic arch aneurysm. J Thorac Cardiovasc Surg, 2017, 153(3): 530-535.
10. Jim J, Moon MR, Rubin BG, et al. Hybrid repair of distal arch aortic aneurysms: endovascular elephant trunk completion. Ann Vasc Surg, 2011, 25(5): 598-604.
11. Patel HJ, Dake MD, Bavaria JE, et al. Branched endovascular therapy of the distal aortic arch: preliminary results of the feasibility multicenter trial of the Gore thoracic branch endoprosthesis. Ann Thorac Surg, 2016, 102(4): 1190-1198.
12. Czerny M, Gottardi R, Zimpfer D, et al. Mid-term results of supraaortic transpositions for extended endovascular repair of aortic arch pathologies. Eur J Cardiothorac Surg, 2007, 31(4): 623-627.
13. Yoshitake A, Hachiya T, Okamoto K, et al. Postoperative Stroke after debranching with thoracic endovascular aortic repair. Ann Vasc Surg, 2016, 36: 132-138.
14. Ockert S, Eckstein G, Lutz B, et al. Aortic hemiarch hybrid repair. J Vasc Surg, 2015, 62(4): 907-913.
15. Zhu J, Cheng L, Liu Y, et al. One-stage repair for stanford type B aortic dissection concomitant with cardiac diseases: open stented elephant trunk technique combined with cardiac operation. Thorac Cardiovasc Surg, 2012, 60(1): 11-16.
16. Di Eusanio M, Pantaleo A, Cefarelli M, et al. Frozen elephant trunk surgery in type B aortic dissection. Ann Cardiothorac Surg, 2014, 3(4): 400-402.
17. Chen L, Qi RD, Liu W, et al. Repair of complicated chronic type B dissection with distal aortic arch involvement using left subclavian artery transposition with implantation of a stented elephant trunk. Thorac Cardiovasc Surg, 2017, 65(2): 99-104.
18. Lotfi S, Clough RE, Ali T, et al. Hybrid repair of complex thoracic aortic arch pathology: long-term outcomes of extra-anatomic bypass grafting of the supra-aortic trunk. Cardiovasc Intervent Radiol, 2013, 36(1): 46-55.
19. Fadda GF, Marino M, Kasemi H, et al. Hybrid endovascular solutions for supra-aortic vessels extra-anatomic bypass infection. Ann Vasc Surg, 2015, 29(8): 1662.
20. Uchida N, Kodama H, Katayama K, et al. Endovascular aortic repair as second-stage surgery after hybrid open arch repair by the frozen elephant trunk technique for extended thoracic aneurysm. Ann Thorac Cardiovasc Surg, 2013, 19(3): 257-261.

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Surgical treatment of distal aortic arch lesions using stented elephant trunk implantation combined with transposition of left subclavian artery to left common carotid artery

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