Ascending aorta replacement combined to aortic arch stent positioning for type A acute aortic dissection: an endoscopic view

Objective: Surgical treatment of Type acute aortic dissection is still debated. While in
consideration of the high risks connected to emergent aortic arch replacement
traditional intervention has always been ascending aorta replacement, more recently
some authors advocate emergency total replacement of aortic arch as the best option to
prevent later complications and death.
Methods: We report two cases of Type A aortic dissection with primary entry tear
located in ascending aorta in which a traditional ascending aorta replacement was
combined to a new open web stent placement in aortic arch. Procedure was performed
during moderate hypothermic circulatory arrest and cerebral perfusion. This new
device (Djumbodis dissection system Saint Come-Chirurgie; Marseille, France),
consists of an open web stent mounted on a compliant balloon. It was inserted under
direct vision in the aortic arch and inflated till the internal and external layer of the aortic
wall well coapted. Correct opening and positioning of the stent was verified with TEE
and for the first time through a 7 mm endoscope inserted within the aortic arch.
Results: Patients were both discharged on post-operative day 7 and CT scan before
dimission showed in both cases the occlusion of the false lumen in the aortic arch.
Conclusions: In all cases of acute Type A aortic Dissection with intimal tear in
ascending aorta, replacement of the ascending aorta combined to insertion of the Djumbodis dissection system can be a valid option to extend treatment to the aortic arch
with an easily reproducible and safe procedure in order to prevent later complications.