ORIGINAL ARTICLES  VASCULAR SECTION RECENT ADVANCES IN THE MANAGEMENT OF THORACIC DISSECTIONS 

The Journal of Cardiovascular Surgery 2010 October;51(5):633-40

Copyright © 2010 EDIZIONI MINERVA MEDICA

language: English

DeBakey type I dissection: when hybrid stent-grafting is indicated?

Jakob H., Tsagakis K. ✉

Department of Thoracic and Cardiovascular Surgery, West-German Heart Center Essen, University Hospital Essen, Essen, Germany

AIM: For avoidance of late downstream complications after classic DeBakey type I aortic dissection repair, replacement of the arch with simultaneous antegrade descending stent-grafting using a hybrid prosthesis was applied in acute and chronic aortic dissection. Indication and results were studied.
METHODS: Between January 2001 and January 2010, 168 patients were operated for acute and chronic aortic dissection (AD). Forty-five patients received an E-vita open stent-graft prosthesis, 29 for acute aortic dissection (AAD) (28 for DeBakey type I, 1 for type III) and 16 for chronic aortic dissection (CAD) (13 type I, 3 type III). Indication was full circular arch dissection, an entry or re-entry tear distal to the left subclavian artery in AAD, and new abdominal malperfusion, rapid growth of the false lumen (FL), impending or contained rupture in CAD.
RESULTS: Hospital mortality was 10% in AAD and 0 in CAD. Complications like new stroke occurred in 7% versus 6%, temporary dialysis in 55% versus 19%, and false lumen obliteration was observed in 93% versus 63% in AAD versus CAD, respectively. Follow-up was 100% at a mean of 19 months. Overall survival at four years was 72% in AAD versus 94% in CAD. FL thrombosis was stable in AAD (92%) and increased to 93% in CAD over time. Freedom from secondary aortic intervention was 90% in AAD and 75% in CAD.
CONCLUSION: This hybrid approach in patients with AAD and CAD type I is safe when indicated and renders stable results over time down to the stent-graft end. Secondary TEVAR can be easily performed downstream when necessary. The international E-vita open registry data supports this single center results.