title: Mid-term results of the Lupiae technique in patients with De Bakey Type I acute aortic dissection.
abstract: OBJECTIVE
  The late persistence of a patent and dilated false lumen into the thoracic aorta is associated to higher re-operation rates and to a worse prognosis after the surgical repair of De Bakey Type I acute aortic dissection (TIAAD). We present the mid-term results of a hybrid, two-stage technique for TIAAD aimed to reduce the risk of late expansion of the residual false lumen.
  
  
  METHODS
  From May 2005 to January 2011, 49 patients with TIAAD were treated with the Lupiae technique. During the emergency operation, a Vascutek Lupiae™, a multi-branched Dacron prosthesis, was implanted to replace the ascending aorta, the aortic arch and to reroute the origin of the epiaortic vessels. The debranching of the aortic arch creates a long and stable Dacron landing zone on the ascending aorta suitable for further endovascular interventions. Postoperatively, 34 patients with a patent or partially thrombosed false lumen > 22 mm or a diameter of the descending aorta > 46 mm underwent the implant endovascular stentgrafts into the descending aorta.
  
  
  RESULTS
  Three patients died after the first procedure. One patient died after the endovascular stage. No patient experienced paraplegia or stroke. The 6-year follow-up survival was 90 ± 4%. The obliteration of the false lumen was obtained in 94% of the patients.
  
  
  CONCLUSIONS
  In patients with TIAAD, the debranching of the aortic arch with the Lupiae technique can be safely performed. This technique creates a long and stable landing zone that can be easily used for the deployment of endovascular stentgrafts in case of distal false lumen expansion.
authors.affiliation: Cardiovascular Surgery Unit,  Santa Maria Hospital, Bari,  Italy.
authors.forename: Giampiero
authors.initials: G
authors.lastname: Esposito
authors.forename: Giangiuseppe
authors.initials: G
authors.lastname: Cappabianca
authors.forename: Michele
authors.initials: M
authors.lastname: Ciano
authors.forename: Nunzio
authors.initials: N
authors.lastname: Gallo
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Labriola
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Pestrichella
authors.forename: Gaetano
authors.initials: G
authors.lastname: Contegiacomo
authors.forename: Cataldo
authors.initials: C
authors.lastname: Labriola
mesh_terms: D000208:Acute Disease; D000368:Aged; D000784:Aortic Dissection / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods*; D057510:Endovascular Procedures / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D011093:Polyethylene Terephthalates / Q000627:therapeutic use; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D011093:Polyethylene Terephthalates