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• W4250043532 abstract "We appreciate the insightful comments from Drs Gu and Shi regarding our article describing the initial experience with a simplified single anastomosis frozen elephant trunk repair for acute DeBakey type I dissection.1Roselli E.E. Rafael A. Soltesz E.G. Canale L. Lytle B.W. Simplified frozen elephant trunk repair for acute DeBakey type I dissection.J Thorac Cardiovasc Surg. 2013; 145: S197-S201Abstract Full Text Full Text PDF PubMed Scopus (90) Google Scholar They are concerned with the integrity of the stent-graft after modification. The device is made of 3 separate stents: one at each flared end and one continuous stent comprising the main body. Trimming flares from one end within the arch will not affect the rest of the device because it is a separate stent. Bare ends of the wire have not posed a problem because the flares are securely covered with graft material, and this portion of the device is directly sutured within the aorta. During this procedure, the device is fixed to the aortic wall not only by radial force and sutures at the base of the branch vessel but also by at least half of the circumference of the suture line between the ascending surgical graft and the aortic wall (the conventional hemiarch anastomosis). Despite no issues with the initial published experience, we have since had a patient develop a proximal type 1 endoleak. Because the device was directly sutured to the aorta, migration is not an issue. This endoleak was easily addressed with endovascular embolization, and we now place additional full-thickness tacking sutures within the arch to achieve better seal. Our hope is that in the future there will be a disease-specific device that allows for even easier performance of this simplified single anastomosis technique. The team from Shenyang also asked about indications. This technique is applicable to a wide variety of patients presenting with type I dissection. In this initial series of consecutive patients, there have been 7 entry tears extending through the arch, a patient with aneurysmal arch, 1 descending tear extending retrogradely, and several patients with dissection into the arch branches. Tears within the arch were easily covered by the stent-graft. The entry tear rarely occurs right at the base of a branch vessel. It may be necessary to reimplant that vessel separately, but only if the tear cannot be repaired by direct suturing reinforced with the stent-graft device. Finally, covering the left subclavian artery was not associated with any acute malperfusion. Admittedly, the series is small and left subclavian malperfusion can become an issue during follow-up. Delayed revascularization is a simple solution to this problem if needed. Two patients have developed type 2 endoleaks and underwent subsequent carotid to subclavian bypass with embolization at the origin. If a disease-specific device were available, it may be easier to preserve the subclavian artery during this procedure. More important, approximately half of the patients presented with malperfusion, and all were readily managed in the hybrid operating room by this technique that optimizes true lumen flow with or without additional endovascular procedures performed promptly enough to avoid permanent end-organ injury. This procedure is safe and effective, and we will continue to use commercially available stent-grafts with modification because we believe this operation represents an improvement in care, especially for those patients with malperfusion. Our hope is that a new device, specifically designed for this application, will become available to allow for more widespread adoption. The effectiveness of simplified frozen elephant trunk repair for acute Debakey type I dissectionThe Journal of Thoracic and Cardiovascular SurgeryVol. 146Issue 3PreviewWe read with great interest the recently published study by Roselli et al1 regarding the effectiveness of simplified frozen elephant trunk repair for acute DeBakey type I dissection. In this clinical study, a single, commercially available descending thoracic stent graft was delivered antegrade directly into the open descending aorta. Two of the flares on the stent graft were resected to create a fenestration around the supra-aortic branch vessel. The stent graft at the base of this fenestration then was sutured to the base of the branch artery with a pledgeted mattress suture. Full-Text PDF" @default.
• W4250043532 created "2022-05-12" @default.
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• W4250043532 date "2013-09-01" @default.
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• W4250043532 title "Reply to the Editor" @default.
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• W4250043532 doi "https://doi.org/10.1016/j.jtcvs.2013.04.018" @default.
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