Elephant Trunk Stent Fenestration for Acute Type A Aortic Dissection

BACKGROUND This study investigated the clinical outcomes of elephant trunk stent fenestration in patients with acute type A aortic dissection (ATAAD). METHODS From January 2009 to December 2019, 271 ATAAD patients were treated in the Department of Cardiovascular Surgery, Renmin Hospital of Wuhan University. Patients underwent deep hypothermia circulatory arrest with bilateral antegrade cerebral perfusion with total arch replacement and elephant trunk stent fenestration. Patient characteristics, perioperative findings, and follow-up results were analyzed retrospectively. RESULTS The average in-hospital mortality rate was 4.1%, the cardiopulmonary bypass time was 160.8 +/- 60.4 minutes, the cross-clamp time was 91.1 +/- 24.5 minutes, and the circulatory arrest time was 22.8 +/- 5.5 minutes. The rate of reoperation for bleeding was 1.5%, and the pericardial mediastinal drainage volume was 312.0 +/- 159.2 mL 24 hours after surgery. Follow-up data were available for 95.4% of patients. Endoleaks developed in 2 patients 3 years after surgery. The postoperative survival rate was 93.0% at 1 year, 89.3% at 5 years, and 81.7% at 10 years. CONCLUSIONS Elephant trunk stent fenestration can simplify reconstruction of the left subclavian artery in ATAAD patients and reduce surgical difficulty. Because the early postoperative outcomes and long-term results were satisfactory in our sample, this technique should be promoted for some patients with ATAAD. (Ann Thorac Surg 2021;112:747-55) (c) 2021 by The Society of Thoracic Surgeons