Novel Surgical Treatments Of Aortic Arch,Aortic Root And Descending Aorta In Acute Aortic Dissection

The article is divided into five sections.The first chapter introduces the developments in the diagnosis and treatment of aortic dissection.The second chapter is the clinical application of a novel arch fenestrated stent graft for acute Stanford type A aortic dissection.The third chapter is the aortic root management strategy in Stanford type A aortic dissection.The fourth chapter is the influence of different management of aortic arch and proximal descending aorta.The fifth chapter is the clinical application of the novel flow modulator.1.The developments in the diagnosis and treatment of aortic dissection.In this chapter,firstly we will review the epidemiology,predisposition,genetic risk,predictors of outcome and the biomarkers.Secondly,We demonstrate the indications,technical details,short-term results,long-term prognosis,advantages and disadvantages of three different repair of distal aorta,which are hemiarch replacement,hemiarch replacement with stent elephant trunk and triple-branched stent graft.Thirdly,We show the three repair techniques of the aortic root,including the reconstruction,glue adhesion and the root replacement,and compare the characters and the outcomes of these techniques.Finally,We elaborate the endovascular repair and revascularization of aortic branch vessels.2.The clinical application of a novel arch fenestrated stent graft for acute Stanford type A aortic dissection.We designed the arch fenestrated stent graft according to the aortic arch anatomy of Chinese people.A retrospective case review has been used to investigate the feasibility,effectiveness and safety of the arch fenestrated stent graft.We have found that the insertion of arch fenestrated stent graft is simple and quick,which simplified the repair of distal aorta.The arch fenestrated stent could seal off the primary intimal tear,expand the true lumen,promote quick thrombosis of the false lumen and remodeled the aorta.This simple technique may improve short-term and long-term outcomes of patients who require conventional ascending aorta replacement due to acute type A aortic dissection.3.The aortic root management strategy in Stanford type A aortic dissection.We compare the advantages and disadvantages of different aortic root managements,put forward a new idea of aortic root management and designed a new technique for aortic root reconstruction.The Dacron patch has been trimmed to match the entire dissected area,is then placed in the false lumen.The other Dacron felt is placed inner the endothelium to reinforce the intima.A retrospective clinical analysis is used to evaluate the short and middle term outcome of this technique.The technique is feasible,safe and has acceptable durability as indicated by relatively low mortality and high survival rate.There is no case died of aortic root event during the following up.Seven patients had developed aortic insufficiency(grade>2)and/or dilation of the sinus(the diameter>45mm).One patient had reoperation for severe aortic regurgitation and the diameter of sinus greater than 50mm.We concluded that this reconstruction is a simple and reliable technique with satisfied short-term result.4.The influence of different management of aortic arch and proximal descending aorta.We evaluated the Cronus stent,Triple-branched Stent Graft and arch fenestrated stent by comparing the state of distal false lumen and the distal diameter of the aorta and investigated the effect of the stent size on the remodeling of the distal aorta.We have reported that these three surgery approaches have similar false lumen closing rate and achieved satisfied long-term result.The lager stent could reduce the patent rate of residual dissection and the optimal size of stent was the 90-100%of the total aorta size.5.The clinical application of the novel flow modulator.We report the clinical outcome of novel flow modulator.The flow modulator is a self-expandable vascular prosthesis,which was covered by Dacron with lmm2 hole.We observe the results of the flow modulator in the aortic dissection and aneurysm.Twenty-two ostia of branched vessels were covered by the flow modulator in 14 patients.The patent rate of branch vessels is 95.5%without paraplegia.The isolation rate of aortic dissection and/or aneurysm was 84.6%.The implantation technique flow modulator is simple,can apply in the case with the demand of branch vessels reservation.