Two-stage retrograde hybrid repair in the surgical treatment of acute aortic dissection complicated with distal malperfusion syndrome_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

YANG Peng ¹ , XIE Yi ¹ , LIU Yu ¹ , ZHANG Yu ¹ , LANG Qianlei ¹ , LI Wenfan ¹ , WANG Chenhao ¹ , XIAO Zhenghua ¹ ,  HU Jia ^1,2,3

1. Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, 610041, P. R. China;
2. Cardiovascular Surgery Research Laboratory, West China Hospital, Sichuan University, Chengdu, 610041, P. R. China;
3. Department of Cardiovascular Surgery, West China Guang'an Hospital, Sichuan University, Guang'an, 638001, Sichuan, P. R. China;

Corresponding author：

HU Jia, Email: Jiahu@wchscu.edu.cn

Keywords：

Two-stage retrograde hybrid repair; aortic dissection; malperfusion syndrome; intervention-first

DOI：

10.7507/1007-4848.202308031

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To evaluate the clinical efficacy of two-stage retrograde hybrid repair for acute aortic dissection involving the aortic arch complicated with distal malperfusion syndrome. Methods From May 2019 to December 2022, the patients presented with acute aortic dissection involving the aortic arch complicated with distal malperfusion syndrome treated in the Department of Cardiovascular Surgery of West China Hospital, Sichuan University were enrolled. After preoperative evaluation, all patients underwent priority emergency interventional surgery to improve distal malperfusion, and then underwent two-stage hybrid surgery to repair proximal aortic lesions. The perioperative clinical and imaging data were retrospectively analyzed. Results Five patients were collected, including 4 males and 1 female, with a median age of 58 years. The main manifestations were lower limb ischemia and renal insufficiency in 3 patients, and poor intestinal perfusion in 2 patients. All patients were given priority to interventional surgery to implant graft stents or bare stents and necessary branch artery intervention, and then successfully performed two-stage hybrid surgery, including type Ⅰhybrid surgery for 2 patients, type Ⅱ hybrid surgery for 1 patient and type Ⅲ hybrid surgery for the other 2 patients, with a success rate of 100.0%. All patients were discharged successfully, and the function of the organs with poor perfusion returned to normal. Only 1 patient recovered to grade 4 muscle strength of the diseased lower limbs upon discharge. No adverse events such as amputation, exploratory laparotomy and intestinal resection or long-term hemodialysis occurred. Conclusion The application of two-stage retrograde hybrid repair in the surgical treatment of acute aortic dissection involving the aortic arch complicated with distal malperfusion syndrome is safe and effective, and is helpful to improve the perioperative survival rate, and clinical outcomes of such patients.

Citation： YANG Peng, XIE Yi, LIU Yu, ZHANG Yu, LANG Qianlei, LI Wenfan, WANG Chenhao, XIAO Zhenghua, HU Jia. Two-stage retrograde hybrid repair in the surgical treatment of acute aortic dissection complicated with distal malperfusion syndrome. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2024, 31(4): 585-593. doi: 10.7507/1007-4848.202308031 Copy

1.	Yang B, Norton EL, Rosati CM, et al. Managing patients with acute type A aortic dissection and mesenteric malperfusion syndrome: A 20-year experience. J Thorac Cardiovasc Surg, 2019, 158(3): 675-687.
2.	Jaffar-Karballai M, Tran TT, Oremakinde O, et al. Malperfusion in acute type A aortic dissection: Management strategies. Vasc Endovascular Surg, 2021, 55(7): 721-729.
3.	Norton EL, Orelaru F, Naeem A, et al. Treating lower extremity malperfusion syndrome in acute type A aortic dissection with endovascular revascularization followed by delayed aortic repair. JTCVS Open, 2022, 10: 101-110.
4.	Norton EL, Khaja MS, Williams DM, et al. Type A aortic dissection complicated by malperfusion syndrome. Curr Opin Cardiol, 2019, 34(6): 610-615.
5.	Ahmed Y, van Bakel PAJ, Patel HJ. Addressing malperfusion first before repairing type A dissection. JTCVS Tech, 2021, 10: 1-5.
6.	Zhang HW, Huang Y, Yang P, et al. Urgent retrograde two-stage hybrid repair of a complicated blunt traumatic aortic injury. J Vasc Surg, 2019, 70(5): 1669-1672.
7.	Xiao ZH, Zhang Y, Hu J. PETTICOAT assisted two stage retrograde hybrid arch repair for type A aortic dissection with malperfusion syndrome. Eur J Vasc Endovasc Surg, 2023, 66(2): 295.
8.	国家心血管病专家委员会血管外科专业委员会. 杂交技术治疗累及弓部主动脉病变的中国专家共识. 中国循环杂志, 2020, 35(2): 124-130.
9.	Moroi MK, Hendriksen BS, Roberts SM, et al. Management of type A aortic dissection with malperfusion syndrome: A case report. Innovations (Phila), 2020, 15(4): 379-381.
10.	Moorthy PSK, Sakijan AS. Malperfusion in acute type A aortic dissection: How we handle the challenge? Indian J Thorac Cardiovasc Surg, 2022, 38(Suppl 1): 122-131.
11.	Leshnower BG, Keeling WB, Duwayri YM, et al. The "thoracic endovascular aortic repair-first" strategy for acute type A dissection with mesenteric malperfusion: Initial results compared with conventional algorithms. J Thorac Cardiovasc Surg, 2019, 158(6): 1516-1524.
12.	Bayamin K, Power A, Chu MWA, et al. Malperfusion syndrome in acute type A aortic dissection: Thinking beyond the proximal repair. J Card Surg, 2022, 37(11): 3827-3834.
13.	Acharya MN, Mariscalco G. Central aortic or mesenteric malperfusion repair first in acute type A aortic dissection: Still an unanswered question? J Card Surg, 2022, 37(12): 4434-4436.
14.	Williams IM, Idhrees M, Velayudhan B, et al. Malperfusion syndrome in acute type A aortic dissection: It's not what you know, it's what you can prove! J Card Surg, 2022, 37(11): 3835-3837.
15.	Kumagai K, Hiraoka A, Chikazawa G, et al. Preceding aortic bare stenting for visceral and limb malperfusion before proximal surgical repair of stanford type A aortic dissection. Ann Vasc Dis, 2023, 16(2): 142-145.
16.	Yang B, Rosati CM, Norton EL, et al. Endovascular fenestration/stenting first followed by delayed open aortic repair for acute type A aortic dissection with malperfusion syndrome. Circulation, 2018, 138(19): 2091-2103.
17.	Xu X, Wu Y, Wu Z. Revascularization-first strategy versus central repair-first strategy for acute type A aortic dissection complicated with mesenteric malperfusion syndrome: A meta-analysis. J Card Surg, 2022, 37(12): 4427-4433.
18.	Brown JA, Sultan I. Author reply to commentary: The Scylla and Charybdis of acute type A aortic dissection: Malperfusion and rupture. J Thorac Cardiovasc Surg, 2024, 167(3): 895-896.
19.	Ahmad RA, Orelaru F, Graham N, et al. Progression of distal aorta after endovascular fenestration/stenting in acute type A aortic dissection with malperfusion syndrome. JTCVS Open, 2023, 14: 1-13.
20.	Song S, Lu L, Peng H, et al. Management strategies for acute type A aortic dissection complicated by limb malperfusion. Heart Surg Forum, 2023, 26(1): E043-E047.
21.	Grewal S, Contrella BN, Sherk WM, et al. Endovascular management of malperfusion syndromes in aortic dissection. Tech Vasc Interv Radiol, 2021, 24(2): 100751.
22.	Chikashi N, So I, Tomonori H, et al. Impact of time from symptom onset to operation on outcome of repair of acute type A aortic dissection with malperfusion. J Thorac Cardiovasc Surg, 2023, 165(3): 984-991.
23.	Narayan P, Rogers CA, Benedetto U, et al. Malperfusion rather than merely timing of operative repair determines early and late outcome in type A aortic dissection. J Thorac Cardiovasc Surg, 2017, 154(1): 81-86.
24.	张煜, 肖正华, 张尔永, 等. 杂交技术与传统开放手术治疗主动脉弓部疾病: 孰优孰劣? 中国胸心血管外科临床杂志, 2021, 28(8): 998-1004.
25.	Liu Y, Liang S, Zhang B, et al. Early outcomes of hybrid typeⅡ arch repair versus total arch replacement with frozen elephant trunk in acute DeBakey typeⅠ aortic dissection: A propensity score-matched analysis. Interact Cardiovasc Thorac Surg, 2020, 31(4): 565-572.
26.	Zhang B, Sun X, Liu Y, et al. Hybrid technique on the total arch replacement for type A aortic dissection: 12-year clinical and radiographical outcomes from a single center. Front Cardiovasc Med, 2022, 9: 820653.
27.	Huang F, Li X, Zhang Z, et al. Comparison of two surgical approaches for acute type A aortic dissection: Hybrid debranching versus total arch replacement. J Cardiothorac Surg, 2022, 17(1): 166.
28.	Gu J, Chen Z. Clinical efficacy of hybrid surgery for stanford type A aortic dissection. Risk Manag Healthc Policy, 2021, 14: 3013-3023.

1. Yang B, Norton EL, Rosati CM, et al. Managing patients with acute type A aortic dissection and mesenteric malperfusion syndrome: A 20-year experience. J Thorac Cardiovasc Surg, 2019, 158(3): 675-687.
2. Jaffar-Karballai M, Tran TT, Oremakinde O, et al. Malperfusion in acute type A aortic dissection: Management strategies. Vasc Endovascular Surg, 2021, 55(7): 721-729.
3. Norton EL, Orelaru F, Naeem A, et al. Treating lower extremity malperfusion syndrome in acute type A aortic dissection with endovascular revascularization followed by delayed aortic repair. JTCVS Open, 2022, 10: 101-110.
4. Norton EL, Khaja MS, Williams DM, et al. Type A aortic dissection complicated by malperfusion syndrome. Curr Opin Cardiol, 2019, 34(6): 610-615.
5. Ahmed Y, van Bakel PAJ, Patel HJ. Addressing malperfusion first before repairing type A dissection. JTCVS Tech, 2021, 10: 1-5.
6. Zhang HW, Huang Y, Yang P, et al. Urgent retrograde two-stage hybrid repair of a complicated blunt traumatic aortic injury. J Vasc Surg, 2019, 70(5): 1669-1672.
7. Xiao ZH, Zhang Y, Hu J. PETTICOAT assisted two stage retrograde hybrid arch repair for type A aortic dissection with malperfusion syndrome. Eur J Vasc Endovasc Surg, 2023, 66(2): 295.
8. 国家心血管病专家委员会血管外科专业委员会. 杂交技术治疗累及弓部主动脉病变的中国专家共识. 中国循环杂志, 2020, 35(2): 124-130.
9. Moroi MK, Hendriksen BS, Roberts SM, et al. Management of type A aortic dissection with malperfusion syndrome: A case report. Innovations (Phila), 2020, 15(4): 379-381.
10. Moorthy PSK, Sakijan AS. Malperfusion in acute type A aortic dissection: How we handle the challenge? Indian J Thorac Cardiovasc Surg, 2022, 38(Suppl 1): 122-131.
11. Leshnower BG, Keeling WB, Duwayri YM, et al. The "thoracic endovascular aortic repair-first" strategy for acute type A dissection with mesenteric malperfusion: Initial results compared with conventional algorithms. J Thorac Cardiovasc Surg, 2019, 158(6): 1516-1524.
12. Bayamin K, Power A, Chu MWA, et al. Malperfusion syndrome in acute type A aortic dissection: Thinking beyond the proximal repair. J Card Surg, 2022, 37(11): 3827-3834.
13. Acharya MN, Mariscalco G. Central aortic or mesenteric malperfusion repair first in acute type A aortic dissection: Still an unanswered question? J Card Surg, 2022, 37(12): 4434-4436.
14. Williams IM, Idhrees M, Velayudhan B, et al. Malperfusion syndrome in acute type A aortic dissection: It's not what you know, it's what you can prove! J Card Surg, 2022, 37(11): 3835-3837.
15. Kumagai K, Hiraoka A, Chikazawa G, et al. Preceding aortic bare stenting for visceral and limb malperfusion before proximal surgical repair of stanford type A aortic dissection. Ann Vasc Dis, 2023, 16(2): 142-145.
16. Yang B, Rosati CM, Norton EL, et al. Endovascular fenestration/stenting first followed by delayed open aortic repair for acute type A aortic dissection with malperfusion syndrome. Circulation, 2018, 138(19): 2091-2103.
17. Xu X, Wu Y, Wu Z. Revascularization-first strategy versus central repair-first strategy for acute type A aortic dissection complicated with mesenteric malperfusion syndrome: A meta-analysis. J Card Surg, 2022, 37(12): 4427-4433.
18. Brown JA, Sultan I. Author reply to commentary: The Scylla and Charybdis of acute type A aortic dissection: Malperfusion and rupture. J Thorac Cardiovasc Surg, 2024, 167(3): 895-896.
19. Ahmad RA, Orelaru F, Graham N, et al. Progression of distal aorta after endovascular fenestration/stenting in acute type A aortic dissection with malperfusion syndrome. JTCVS Open, 2023, 14: 1-13.
20. Song S, Lu L, Peng H, et al. Management strategies for acute type A aortic dissection complicated by limb malperfusion. Heart Surg Forum, 2023, 26(1): E043-E047.
21. Grewal S, Contrella BN, Sherk WM, et al. Endovascular management of malperfusion syndromes in aortic dissection. Tech Vasc Interv Radiol, 2021, 24(2): 100751.
22. Chikashi N, So I, Tomonori H, et al. Impact of time from symptom onset to operation on outcome of repair of acute type A aortic dissection with malperfusion. J Thorac Cardiovasc Surg, 2023, 165(3): 984-991.
23. Narayan P, Rogers CA, Benedetto U, et al. Malperfusion rather than merely timing of operative repair determines early and late outcome in type A aortic dissection. J Thorac Cardiovasc Surg, 2017, 154(1): 81-86.
24. 张煜, 肖正华, 张尔永, 等. 杂交技术与传统开放手术治疗主动脉弓部疾病: 孰优孰劣? 中国胸心血管外科临床杂志, 2021, 28(8): 998-1004.
25. Liu Y, Liang S, Zhang B, et al. Early outcomes of hybrid typeⅡ arch repair versus total arch replacement with frozen elephant trunk in acute DeBakey typeⅠ aortic dissection: A propensity score-matched analysis. Interact Cardiovasc Thorac Surg, 2020, 31(4): 565-572.
26. Zhang B, Sun X, Liu Y, et al. Hybrid technique on the total arch replacement for type A aortic dissection: 12-year clinical and radiographical outcomes from a single center. Front Cardiovasc Med, 2022, 9: 820653.
27. Huang F, Li X, Zhang Z, et al. Comparison of two surgical approaches for acute type A aortic dissection: Hybrid debranching versus total arch replacement. J Cardiothorac Surg, 2022, 17(1): 166.
28. Gu J, Chen Z. Clinical efficacy of hybrid surgery for stanford type A aortic dissection. Risk Manag Healthc Policy, 2021, 14: 3013-3023.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Two-stage retrograde hybrid repair in the surgical treatment of acute aortic dissection complicated with distal malperfusion syndrome

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content