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Pre-sewn Multi-branched Aortic Graft and 3D-Printing Guidance for Crawford Extent II or III Thoracoabdominal Aortic Aneurysm Repair

  • Author Footnotes
    1 Drs. Rhee and Park contributed equally as the first authors to this work.
    Younju Rhee
    Footnotes
    1 Drs. Rhee and Park contributed equally as the first authors to this work.
    Affiliations
    Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
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  • Author Footnotes
    1 Drs. Rhee and Park contributed equally as the first authors to this work.
    Sung Jun Park
    Footnotes
    1 Drs. Rhee and Park contributed equally as the first authors to this work.
    Affiliations
    Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
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  • Taehun Kim
    Affiliations
    Department of Convergence Medicine, Asan Medical Institute of Convergence Science and Technology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
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  • Namkug Kim
    Affiliations
    Department of Convergence Medicine, Asan Medical Institute of Convergence Science and Technology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
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  • Dong Hyun Yang
    Affiliations
    Department of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
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  • Joon Bum Kim
    Correspondence
    Address reprint requests to Joon Bum Kim, MD, PhD, Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-Ro- 43-Gil, Songpa-Gu, Seoul, Korea 05505
    Affiliations
    Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
    Search for articles by this author
  • Author Footnotes
    1 Drs. Rhee and Park contributed equally as the first authors to this work.
      Reconstruction of the visceral and segmental arteries is a challenging part of open surgical repair of extensive thoracoabdominal aortic aneurysm (TAAA). For more efficient reconstruction of these branching vessels, a technique of using pre-hand-sewn multi-branched aortic graft (octopod technique) has been adopted with the aid of 3D-printing-guidance in latest cases. The octopod graft has been employed for the extent II or III TAAA repair, in which the commercially available two 4-branched aortic grafts were interconnected before surgery. Since January 2017, 3D-printed-aortic model has been used to efficiently replicate the projected aorta shape fitted to patient's anatomy. From May 2015 through Oct 2019, 20 patients (median age, 40years; range, 23-65; 5 females) underwent extent II or III TAAA repair using the octopod technique with (n = 9) or without (n=11) 3D-printing-guidance. Thirteen patients (65%) were diagnosed as Marfan syndrome. Eighteen patients (90%) had undergone prior aorta repair including 4 patients (20%) undergoing redo-thoracotomy. Revascularization of segmental arteries was conducted in 19 patients (95%, median, N = 2; range, 1-4). Median pump and entire procedural times were 173.5 minutes (interquartile range [IQR], 136.8-187.8) and 441 minutes (IQR, 392.8-492.3), respectively. There was no operative mortality or stroke, however, permanent paraplegia occurred in one patient (5%). During follow-up (median 35months, range 1-56 months), all of reconstructed branched vessels remained wide patent on CT. The octopod technique for open TAAA repair showed favorable early and mid-term results with high feasibility of procedural efficiency. 3D-printing guidance is expected to improve the flow of surgical procedures especially in challenging anatomy.

      Graphical abstract

      Keywords

      Abbreviations:

      BT (body temperature), CAD (computer-aided design), CPB (cardiopulmonary bypass), CSF (cerebrospinal fluid), CT (computed tomography), ECG (electrocardiography), HCA (hypothermic circulatory arrest), LCOS (low cardiac output syndrome), SMA (superior mesenteric artery), TAA (thoracoabdominal aorta), TAAA (thoracoabdominal aortic aneurysm), TEVAR (thoracic endovascular aortic repair), V-A ECMO (veno-arterial extracorporeal membrane oxygenation)
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      Linked Article

      • Commentary: 3D Aortic Grafts, Evolving Sci-Fi?
        Seminars in Thoracic and Cardiovascular SurgeryVol. 34Issue 3
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          Thoracoabdominal aortic aneurysm (TAAA) repair is challenging and requires deep understanding of the aortic anatomy based on preoperative computed tomography (CT) imaging. However, both CT scans and CT three-dimensional (3D) reconstruction can be difficult to interpret. Also, there is often minimal—but critical—differences in CT measurements that make successful repair even more challenging.
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      • Commentary: 3-D Printing: Taming the Aorta
        Seminars in Thoracic and Cardiovascular SurgeryVol. 34Issue 3
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          The phrase “to break the ice” is one of the most commonly used phrases in the English language. It first appeared in Shakespeare's comedy The Taming of the Shrew; as a metaphor, it implies that making a small effort or action will dispel the awkwardness of a problematic situation and allow the real business of developing solutions to begin. In this context, it refers to laying the groundwork for greater things to come. Dr. Rhee and his colleagues at the University of Ulsan College of Medicine in Seoul, Korea outline an approach to improve the treatment of extensive thoracoabdominal aortic aneurysms (TAAAs), those classified as Crawford extent II and extent III TAAA repairs.
        • Full-Text
        • PDF