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.