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Giampiero Esposito MD 2010-A- 10 -AATS Cardiovascular Surgery Unit CITTA’ DI LECCE HOSPITAL - ITALY GVM Hospitals of Care and Research PowerPoint PPT Presentation


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Hybrid Approach to Type A acute aortic dissection: the Lupiae technique. . Giampiero Esposito MD 2010-A- 10 -AATS Cardiovascular Surgery Unit CITTA’ DI LECCE HOSPITAL - ITALY GVM Hospitals of Care and Research. HYBRID TWO-STAGE “LUPIAE TECHNIQUE”. Visceral vessels CT & SMA.

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Giampiero Esposito MD 2010-A- 10 -AATS Cardiovascular Surgery Unit CITTA’ DI LECCE HOSPITAL - ITALY GVM Hospitals of Care and Research

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Hybrid Approach to Type A acute

aortic dissection: the Lupiae technique.

Giampiero Esposito MD

2010-A-10-AATS

Cardiovascular Surgery Unit

CITTA’ DI LECCE HOSPITAL - ITALY

GVM Hospitals of Care and Research


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HYBRID TWO-STAGE “LUPIAE TECHNIQUE”

Visceral vessels

CT & SMA


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Conception of HYBRID Two-Stage Strategy

“LUPIAE TECHNIQUE” in Type A A.D.(De Bakey I)

Intended two stage repair

of Type A Aortic

Dissection with “complicated” residual false lumen by combining

ascending aorta, arch

replacement and

debranching

of epiaortic vessels using a

New Multibranched Dacron

Prosthesis with subsequent

retrograde transfemoral

Stent grafting


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HYBRID Two-Stage Strategy

“LUPIAE TECHNIQUE” in Extensive Type A A.D.

OBJECTIVES

  • “Easy” surgical procedure

    • Easy distal OPEN anastomosis

    • Short circulatory arrest time

    • Easy debranching of BCT, LCA, LSA

  • “Ideal” proximal landing zone

    • Safe, Long, Stable

  • “Easy” subsequent endovascular

    • procedure

    • Optimized sealing

    • Minimized risk of Type I endoleak

    • False lume exclusion


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OPERATIVE METHODSin Type A Aortic DissectionLUPIAE Technique

  • Rapid transfer to the operating room after diagnosis (TTE, CT-scan)

  • Intraoperative TEE to confirm diagnosis and plane type of surgery

  • Arterial cannulation by right axillary artery, brachiocephalic trunk

  • or left ventricular apex

  • LSA debranching and perfusion

  • Cooling at 28°C, ascending aortic clamp, myocardial protection (Custodiol)

  • AVA resuspension, proximal aortic reconstruction

  • Circulatory arrest with cerebral anterograde perfusion and distal aortic

  • reconstruction (20-25 min)

  • Distal aortic riperfusion, LCA and BCT reimplantation, off-ECC,

  • LSA reimplantation


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LUPIAE Technique in TYPE A A.D.first surgical stage RESULTS May 2005 – April 2009

  • Number of patients: 38 (26 males and 12 females, mean age 64,7± 8,9 yrs)

  • Intraoperative data:

  • - ECC 103,2± 17,0 min

  • - Xclamp 44,8 ± 9,2 min

  • - CA 20 ± 2,5 min

  • Mortality: 2/38

  • Morbidity:

  • - 3 temporary neurological dysfunction

  • - 2 temporary renal failure requiring dialysis

  • - 4 temporary respiratory failure (2 requiring tracheo)

  • - 3 reexplorations for bleeding


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“LUPIAE TECHNIQUE”

“Fixed” Elephant Trunk

Ideal Proximal Aortic Landing Zone


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LUPIAE Technique:

Second Endovascular Stage


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3D CT-scan follow-up in

Type A Aortic Dissection


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LUPIAE Technique in TYPE A A.D.hybrid two stage RESULTS May 2005 – April 2009

  • Number of patients: 27 (19 males and 8 females, mean age 64,7± 8,9 yrs)

  • Devices: Vascutek® Lupiae dacron & Medtronic® Valiant

  • Approach:

  • - general/local anesthesia

  • - surgical exposure of femoral artery

  • Mortality: 1/27

  • Morbidity:

  • - 1 femoral artery dissection


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CONCLUSIONS

  • The Lupiae Technique in Type A aortic dissection with

  • complicated false lumen achieves 2 important targets:

  • “Easy” replacement of dissected ascending aorta

  • and arch with epiaortic vessels debranching using Vascutek®

  • “Lupiae graft”.

  • 2. A “safe, long and stable” proximal landing zone created by

  • the “fixed” Elephant Trunk is ready to be used for

  • second endovascular stage in which stent graft deployment

  • is performed in the residual dissected thoracic aorta.


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