New technologies in the treatment of type A acute aortic dissection: our experience in th use of the Djumbodis dissection system

OBJECTIVES: The aim of this study is to report an initial experience with aortic arch stenting in type A acute dissection. METHODS: Between January and December 2003 10 patients, mean age 56.8 years, were operated for type A acute aortic dissection; in 7 patients the entry tear was in ascending aorta and in 3 in aortic arch. All were submitted to ascending aortic prosthetic replacement and stenting of the aortic arch with open web Djumbodis Dissection System stent ( Saint Come, Marseille, France ) during hypothermic ECC. The device consists of an uncovered stent made of Steel 316 L, provided in three lengths (4, 9, and 14 cm) and mounted on a compliant balloon. The balloon is inflated to adapt the stent to the shape of the aortic arch and to coapt aortic layers. RESULTS: Three patients died within 30 days, for myocardial infarction, bowel infarction and stroke. Complete thrombosis of false channel was obtained in 3 patients, incomplete deployment of distal end of the web occurred in 1 patient without symptoms and another patient required reoperation for proximal leakage. At two and nine months two patients required transfemoral thoracic aorta endovascular stent-grafting for residual type B dissection. CONCLUSIONS: Initial experience attests the feasibility of aortic arch stenting with Djumbodis Dissection System. It appears a useful procedure in high-risk situations such as elderly patients with comorbidities in which aortic arch replacement has a prohibitive surgical risk. Djumbodis Dissection System has also facilitated distal aortic procedures permitting a safe deployment of thoracic aortic stent grafts.