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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. HYBRID TWO-STAGE “LUPIAE TECHNIQUE”. Visceral vessels CT & SMA.

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slide1

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

slide4

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

slide5

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
lupiae technique in type a a d first surgical stage results may 2005 april 2009
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
slide8

“LUPIAE TECHNIQUE”

“Fixed” Elephant Trunk

Ideal Proximal Aortic Landing Zone

slide9

LUPIAE Technique:

Second Endovascular Stage

slide10

3D CT-scan follow-up in

Type A Aortic Dissection

lupiae technique in type a a d hybrid two stage results may 2005 april 2009
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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