Author + information
- Received September 29, 2012
- Accepted October 11, 2012
- Published online April 1, 2013.
- Eric E. Roselli, MD⁎ (, )
- Nicholas Brozzi, MD,
- Turki Albacker, MD and
- Bruce W. Lytle, MD
- ↵⁎Reprint requests and correspondence:
Dr. Eric E. Roselli, Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, 9500 Euclid Avenue, Desk J4-1, Cleveland, Ohio 44195-5108
Acute aortic dissection remains a surgical emergency. The conventional approach involves graft replacement of the ascending aorta under circulatory arrest with variable extension into the root or arch depending on morphology at presentation. A significant proportion of patients are deemed too high-risk for surgery and are managed medically, but the 30-day mortality is over 58% (1).
A 55-year-old woman had previously undergone emergency open repair of a descending aortic dissection complicated by aorto-esophageal fistula. Multiple reoperations included re-replacement of the descending aorta, esophagectomy, delayed reconstruction with a substernal colon interposition, and hybrid thoracoabdominal repair with visceral debranching and stent grafting. She presented, eight years since the initial type B dissection, with an acute type A dissection with moderately severe aortic insufficiency (Fig. 1, Online Videos 1 and 2). Given her exceptional risk for open repair, she consented to stent grafting of the ascending aorta (2).
Left ventricular apex and left subclavian artery were accessed through small incisions. Through and through wire access was obtained, and a 32 × 58 mm aortic extension cuff (Cook, Bloomington, Indiana) was advanced through the apex into the ascending aorta and deployed during rapid pacing (Fig. 2A, Online Video 3). Fluoroscopy and transesophageal echocardiography were used to guide delivery and for post-procedure assessment (Figs. 2B and 2C, Online Videos 4, 5, and 6).
Transapical delivery with through and through wire access allows for accurate delivery of a commercially available stent graft into acutely dissected ascending aorta with resolution of severe aortic insufficiency.
Dr. Roselli reports receiving honorarium for training from Cook. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received September 29, 2012.
- Accepted October 11, 2012.
- American College of Cardiology Foundation