1 / 12

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

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.

Audrey
Download Presentation

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

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. 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

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

  3. 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

  4. 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

  5. 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

  6. 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

  7. “LUPIAE TECHNIQUE” “Fixed” Elephant Trunk Ideal Proximal Aortic Landing Zone

  8. LUPIAE Technique: Second Endovascular Stage

  9. 3D CT-scan follow-up in Type A Aortic Dissection

  10. 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

  11. 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.

More Related