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Giampiero Esposito MD 2010-A- 10 -AATS Cardiovascular Surgery Unit CITTA’ DI LECCE HOSPITAL - ITALY GVM Hospitals of Ca

Hybrid Approach to Type A acute aortic dissection: the Lupiae technique. . Giampiero Esposito MD 2010-A- 10 -AATS Cardiovascular Surgery Unit CITTA’ DI LECCE HOSPITAL - ITALY GVM Hospitals of Care and Research. HYBRID TWO-STAGE “LUPIAE TECHNIQUE”. Visceral vessels CT & SMA.

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Giampiero Esposito MD 2010-A- 10 -AATS Cardiovascular Surgery Unit CITTA’ DI LECCE HOSPITAL - ITALY GVM Hospitals of Ca

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  1. Hybrid Approach to Type A acute aortic dissection: the Lupiae technique. Giampiero Esposito MD 2010-A-10-AATS Cardiovascular Surgery Unit CITTA’ DI LECCE HOSPITAL - ITALY GVM Hospitals of Care and Research

  2. HYBRID TWO-STAGE “LUPIAE TECHNIQUE” Visceral vessels CT & SMA

  3. Conception of HYBRID Two-Stage Strategy “LUPIAE TECHNIQUE” in Type A A.D.(De Bakey I) Intended two stage repair of Type A Aortic Dissection with “complicated” residual false lumen by combining ascending aorta, arch replacement and debranching of epiaortic vessels using a New Multibranched Dacron Prosthesis with subsequent retrograde transfemoral Stent grafting

  4. HYBRID Two-Stage Strategy “LUPIAE TECHNIQUE” in Extensive Type A A.D. OBJECTIVES • “Easy” surgical procedure • Easy distal OPEN anastomosis • Short circulatory arrest time • Easy debranching of BCT, LCA, LSA • “Ideal” proximal landing zone • Safe, Long, Stable • “Easy” subsequent endovascular • procedure • Optimized sealing • Minimized risk of Type I endoleak • False lume exclusion

  5. OPERATIVE METHODSin Type A Aortic DissectionLUPIAE Technique • Rapid transfer to the operating room after diagnosis (TTE, CT-scan) • Intraoperative TEE to confirm diagnosis and plane type of surgery • Arterial cannulation by right axillary artery, brachiocephalic trunk • or left ventricular apex • LSA debranching and perfusion • Cooling at 28°C, ascending aortic clamp, myocardial protection (Custodiol) • AVA resuspension, proximal aortic reconstruction • Circulatory arrest with cerebral anterograde perfusion and distal aortic • reconstruction (20-25 min) • Distal aortic riperfusion, LCA and BCT reimplantation, off-ECC, • LSA reimplantation

  6. LUPIAE Technique in TYPE A A.D.first surgical stage RESULTS May 2005 – April 2009 • Number of patients: 38 (26 males and 12 females, mean age 64,7± 8,9 yrs) • Intraoperative data: • - ECC 103,2± 17,0 min • - Xclamp 44,8 ± 9,2 min • - CA 20 ± 2,5 min • Mortality: 2/38 • Morbidity: • - 3 temporary neurological dysfunction • - 2 temporary renal failure requiring dialysis • - 4 temporary respiratory failure (2 requiring tracheo) • - 3 reexplorations for bleeding

  7. “LUPIAE TECHNIQUE” “Fixed” Elephant Trunk Ideal Proximal Aortic Landing Zone

  8. LUPIAE Technique: Second Endovascular Stage

  9. 3D CT-scan follow-up in Type A Aortic Dissection

  10. LUPIAE Technique in TYPE A A.D.hybrid two stage RESULTS May 2005 – April 2009 • Number of patients: 27 (19 males and 8 females, mean age 64,7± 8,9 yrs) • Devices: Vascutek® Lupiae dacron & Medtronic® Valiant • Approach: • - general/local anesthesia • - surgical exposure of femoral artery • Mortality: 1/27 • Morbidity: • - 1 femoral artery dissection

  11. CONCLUSIONS • The Lupiae Technique in Type A aortic dissection with • complicated false lumen achieves 2 important targets: • “Easy” replacement of dissected ascending aorta • and arch with epiaortic vessels debranching using Vascutek® • “Lupiae graft”. • 2. A “safe, long and stable” proximal landing zone created by • the “fixed” Elephant Trunk is ready to be used for • second endovascular stage in which stent graft deployment • is performed in the residual dissected thoracic aorta.

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