Surgical treatment of retrograde type A aortic dissection after thoracic endovascular aortic repair for Stanford type B aortic dissection_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

LU Jie , TANG Yangfeng , TAN Mengwei ,  HAN Lin

Department of Cardiovascular Surgery, Changhai Hospital, Naval Medical University, Shanghai, 200433, P. R. China;

Corresponding author：

HAN Lin, Email: sh_hanlin@163.com

Keywords：

Thoracic endovascular aortic repair; retrograde type A aortic dissection; total arch replacement; frozen elephant trunk technique

DOI：

10.7507/1007-4848.202111017

Video：

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Objective To analyze the etiologies, surgical treatment and outcomes of retrograde type A aortic dissection (RTAD) after thoracic endovascular aortic repair (TEVAR) for Stanford type B aortic dissection. Methods The clinical data of patients with RTAD after TEVAR for Stanford type B aortic dissection receiving operations in Changhai Hospital from March 2014 to August 2018 were analyzed. All patients were followed-up by clinic interview or telephone. Results A total of 16 patients were enrolled, including 13 males and 3 females with a mean age of 49.1±12.2 years. The main symptoms of RTAD were chest pain in 12 patients, headache in 1 patient, conscious disturbance in 1 patient, and asymptomatic in 2 patients. All the 16 patients received total arch replacement with the frozen elephant trunk technique. Bentall procedure was used in 2 patients, aortic root plasticity in 10 patients and aortic valve replacement in 1 patient. The primary tear in 10 patients was located in the area which were anchored by bare mental stent, and in the other 6 patients it was located in the anterior part of ascending aorta. The mean cardiopulmonary bypass time was 152.2±29.4 min, aortic cross-clamping time was 93.6±27.8 min and selective cerebral perfusion time was 29.8±8.3 min. There was no death in hospital or within postoperative 30 days. The follow-up period was 32-85 (57.4±18.3) months. No death occurred during the follow-up period. One patient underwent TEVAR again 3 years after this operation and had an uneventful survival. Conclusion Total arch replacement with the frozen elephant trunk technique is a suitable strategy for the management of RTAD after TEVAR for Stanford type B aortic dissection.

Citation： LU Jie, TANG Yangfeng, TAN Mengwei, HAN Lin. Surgical treatment of retrograde type A aortic dissection after thoracic endovascular aortic repair for Stanford type B aortic dissection. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2023, 30(10): 1440-1445. doi: 10.7507/1007-4848.202111017 Copy

1.	Nienaber CA, Clough RE. Management of acute aortic dissection. Lancet, 2015, 385(9970): 800-811.
2.	Kpodonu J, Preventza O, Ramaiah VG, et al. Retrograde type A dissection after endovascular stenting of the descending thoracic aorta. Is the risk real? Eur J Cardiothorac Surg, 2008, 33(6): 1014-1018.
3.	Eggebrecht H, Thompson M, Rousseau H, et al. Retrograde ascending aortic dissection during or after thoracic aortic stent graft placement: Insight from the European registry on endovascular aortic repair complications. Circulation, 2009, 120(11 Suppl): S276-S281.
4.	Estrera AL, Shah P, Lee TY, et al. Repair of retrograde type a aortic dissection after thoracic endovascular aortic aneurysm repair using the modified elephant trunk technique. Vascular, 2009, 17(2): 116-120.
5.	Li B, Pan XD, Ma WG, et al. Stented elephant trunk technique for retrograde type A aortic dissection after endovascular stent graft repair. Ann Thorac Surg, 2014, 97(2): 596-602.
6.	Canaud L, Ozdemir BA, Patterson BO, et al. Retrograde aortic dissection after thoracic endovascular aortic repair. Ann Surg, 2014, 260(2): 389-395.
7.	Chen Y, Zhang S, Liu L, et al. Retrograde type A aortic dissection after thoracic endovascular aortic repair: A systematic review and meta-analysis. J Am Heart Assoc, 2017, 6(9): e004649.
8.	Dong ZH, Fu WG, Wang YQ, et al. Retrograde type A aortic dissection after endovascular stent graft placement for treatment of type B dissection. Circulation, 2009, 119(5): 735-741.
9.	Khoynezhad A, Donayre CE, OMARI BO, et al. Midterm results of endovascular treatment of complicated acute type B aortic dissection. J Thorac Cardiovasc Surg, 2009, 138(3): 625-631.
10.	Ma T, Dong ZH, Fu WG, et al. Incidence and risk factors for retrograde type A dissection and stent graft-induced new entry after thoracic endovascular aortic repair. J Vasc Surg, 2018, 67(4): 1026-1033 e1022.
11.	Khoynezhad A, White RA. Pathogenesis and management of retrograde type A aortic dissection after thoracic endovascular aortic repair. Ann Vasc Surg, 2013, 27(8): 1201-1206.
12.	Wang G, Zhai S, Li T, et al. Mechanism and management of retrograde type A aortic dissection complicating TEVAR for type B aortic dissection. Ann Vasc Surg, 2016, 32: 111-118.
13.	Bellos JK, Petrosyan A, Abdulamit T, et al. Retrograde type A aortic dissections after endovascular stent-graft placement for type B dissection. J Cardiovasc Surg (Torino), 2010, 51(1): 85-93.
14.	Ma T, Dong ZH, Wang S, et al. Computational investigation of interaction between stent graft and aorta in retrograde type A dissection after thoracic endovascular aortic repair for type B aortic dissection. J Vasc Surg, 2018, 68(6S): 14S-21S.
15.	Kakafika AI, Mikhailidis DP. Smoking and aortic diseases. Circ J, 2007, 71(8): 1173-1180.
16.	An Z, Song Z, Tang H, et al. Retrograde type A dissection after thoracic endovascular aortic repair: Surgical strategy and literature review. Heart Lung Circ, 2018, 27(5): 629-634.
17.	Lu S, Lai H, Wang C, et al. Surgical treatment for retrograde type A aortic dissection after endovascular stent graft placement for type B dissection. Interact Cardiovasc Thorac Surg, 2012, 14(5): 538-542.
18.	Martens A, Beckmann E, Kaufeld T, et al. Total aortic arch repair: Risk factor analysis and follow-up in 199 patients. Eur J Cardiothorac Surg, 2016, 50(5): 940-948.
19.	Idrees J, Arafat A, Johnston DR, et al. Repair of retrograde ascending dissection after descending stent grafting. J Thorac Cardiovasc Surg, 2014, 147(1): 151-154.

1. Nienaber CA, Clough RE. Management of acute aortic dissection. Lancet, 2015, 385(9970): 800-811.
2. Kpodonu J, Preventza O, Ramaiah VG, et al. Retrograde type A dissection after endovascular stenting of the descending thoracic aorta. Is the risk real? Eur J Cardiothorac Surg, 2008, 33(6): 1014-1018.
3. Eggebrecht H, Thompson M, Rousseau H, et al. Retrograde ascending aortic dissection during or after thoracic aortic stent graft placement: Insight from the European registry on endovascular aortic repair complications. Circulation, 2009, 120(11 Suppl): S276-S281.
4. Estrera AL, Shah P, Lee TY, et al. Repair of retrograde type a aortic dissection after thoracic endovascular aortic aneurysm repair using the modified elephant trunk technique. Vascular, 2009, 17(2): 116-120.
5. Li B, Pan XD, Ma WG, et al. Stented elephant trunk technique for retrograde type A aortic dissection after endovascular stent graft repair. Ann Thorac Surg, 2014, 97(2): 596-602.
6. Canaud L, Ozdemir BA, Patterson BO, et al. Retrograde aortic dissection after thoracic endovascular aortic repair. Ann Surg, 2014, 260(2): 389-395.
7. Chen Y, Zhang S, Liu L, et al. Retrograde type A aortic dissection after thoracic endovascular aortic repair: A systematic review and meta-analysis. J Am Heart Assoc, 2017, 6(9): e004649.
8. Dong ZH, Fu WG, Wang YQ, et al. Retrograde type A aortic dissection after endovascular stent graft placement for treatment of type B dissection. Circulation, 2009, 119(5): 735-741.
9. Khoynezhad A, Donayre CE, OMARI BO, et al. Midterm results of endovascular treatment of complicated acute type B aortic dissection. J Thorac Cardiovasc Surg, 2009, 138(3): 625-631.
10. Ma T, Dong ZH, Fu WG, et al. Incidence and risk factors for retrograde type A dissection and stent graft-induced new entry after thoracic endovascular aortic repair. J Vasc Surg, 2018, 67(4): 1026-1033 e1022.
11. Khoynezhad A, White RA. Pathogenesis and management of retrograde type A aortic dissection after thoracic endovascular aortic repair. Ann Vasc Surg, 2013, 27(8): 1201-1206.
12. Wang G, Zhai S, Li T, et al. Mechanism and management of retrograde type A aortic dissection complicating TEVAR for type B aortic dissection. Ann Vasc Surg, 2016, 32: 111-118.
13. Bellos JK, Petrosyan A, Abdulamit T, et al. Retrograde type A aortic dissections after endovascular stent-graft placement for type B dissection. J Cardiovasc Surg (Torino), 2010, 51(1): 85-93.
14. Ma T, Dong ZH, Wang S, et al. Computational investigation of interaction between stent graft and aorta in retrograde type A dissection after thoracic endovascular aortic repair for type B aortic dissection. J Vasc Surg, 2018, 68(6S): 14S-21S.
15. Kakafika AI, Mikhailidis DP. Smoking and aortic diseases. Circ J, 2007, 71(8): 1173-1180.
16. An Z, Song Z, Tang H, et al. Retrograde type A dissection after thoracic endovascular aortic repair: Surgical strategy and literature review. Heart Lung Circ, 2018, 27(5): 629-634.
17. Lu S, Lai H, Wang C, et al. Surgical treatment for retrograde type A aortic dissection after endovascular stent graft placement for type B dissection. Interact Cardiovasc Thorac Surg, 2012, 14(5): 538-542.
18. Martens A, Beckmann E, Kaufeld T, et al. Total aortic arch repair: Risk factor analysis and follow-up in 199 patients. Eur J Cardiothorac Surg, 2016, 50(5): 940-948.
19. Idrees J, Arafat A, Johnston DR, et al. Repair of retrograde ascending dissection after descending stent grafting. J Thorac Cardiovasc Surg, 2014, 147(1): 151-154.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Surgical treatment of retrograde type A aortic dissection after thoracic endovascular aortic repair for Stanford type B aortic dissection

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