Simplified total arch repair with a stented graft for acute DeBakey type I dissection Enyi Shi, MD, PhD, Tianxiang Gu, MD, PhD, Yang Yu, MD, Chun Wang,

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Simplified total arch repair with a stented graft for acute DeBakey type I dissection Enyi Shi, MD, PhD, Tianxiang Gu, MD, PhD, Yang Yu, MD, Chun Wang, MD, PhD, Lei Yu, MD, Qin Fang, MD, Yuhai Zhang, MD, PhD The Journal of Thoracic and Cardiovascular Surgery Volume 148, Issue 5, Pages 2147-2154 (November 2014) DOI: 10.1016/j.jtcvs.2014.02.077 Copyright © 2014 The American Association for Thoracic Surgery Terms and Conditions

Figure 1 Sketch of the self-designed stented elephant graft and delivery system. A, Stented graft before delivery. B, Stented graft in expanded state. The Journal of Thoracic and Cardiovascular Surgery 2014 148, 2147-2154DOI: (10.1016/j.jtcvs.2014.02.077) Copyright © 2014 The American Association for Thoracic Surgery Terms and Conditions

Figure 2 Diagram of the simplified technique. A, The arch is transected obliquely, and almost all of the lesser curvature is resected. The distal hemiarch is reserved. B, The stented part of the graft is implanted into the descending aorta with the proximal edge of the stent just distal to the origin of left subclavian artery, and the graft free of stent is located inside the reserved arch. C, According to the arch incision, the redundant vascular graft outside the arch is pruned away. The greater curvature of the vascular graft is cut to expose the orifices of 3 vessels. D, A continuous suture is performed around the orifices of 3 branches to attach the vascular graft to the native aortic arch. E, The anastomosis of the proximal and distal vascular grafts combined with the native vessel wall of aortic arch is accomplished with a continuous suture using an open aortic technique. The Journal of Thoracic and Cardiovascular Surgery 2014 148, 2147-2154DOI: (10.1016/j.jtcvs.2014.02.077) Copyright © 2014 The American Association for Thoracic Surgery Terms and Conditions

Figure 3 CTA of a patient with acute Stanford type I dissection undergoing simplified aortic arch repair before operation (A-C) and 3 months after the surgery (D-G). Preoperative scan shows that the true lumen is compressed by a huge false lumen in the descending aorta (A-C). Postoperative scan shows that the stent graft expanded fully and that the false lumen is almost closed completely with thrombosis throughout the descending aorta. No contrast medium endoleak is detected at the greater curvature of the arch. The Journal of Thoracic and Cardiovascular Surgery 2014 148, 2147-2154DOI: (10.1016/j.jtcvs.2014.02.077) Copyright © 2014 The American Association for Thoracic Surgery Terms and Conditions

Figure 4 Postoperative CTA of a patient undergoing simplified aortic arch repair showing a small endoleak from left subclavian artery (arrows). A, Before discharge. B, Six months after operation. The Journal of Thoracic and Cardiovascular Surgery 2014 148, 2147-2154DOI: (10.1016/j.jtcvs.2014.02.077) Copyright © 2014 The American Association for Thoracic Surgery Terms and Conditions

Figure 5 Overall survival function of patients with acute DeBakey type I aortic dissection in the whole cohort. The Journal of Thoracic and Cardiovascular Surgery 2014 148, 2147-2154DOI: (10.1016/j.jtcvs.2014.02.077) Copyright © 2014 The American Association for Thoracic Surgery Terms and Conditions

Figure 6 Survival of patients with acute DeBakey type I aortic dissection in the simplified group and the total arch group during follow-up. No significant difference was found in survival between the 2 groups (P = .78). The Journal of Thoracic and Cardiovascular Surgery 2014 148, 2147-2154DOI: (10.1016/j.jtcvs.2014.02.077) Copyright © 2014 The American Association for Thoracic Surgery Terms and Conditions

Figure 7 Freedom from aortic event of patients with acute DeBakey type I aortic dissection in the simplified group and the total arch group during follow-up. The aortic event rate was not significantly different between the 2 groups (P = .84). The Journal of Thoracic and Cardiovascular Surgery 2014 148, 2147-2154DOI: (10.1016/j.jtcvs.2014.02.077) Copyright © 2014 The American Association for Thoracic Surgery Terms and Conditions