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
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)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: May 07, 2021
Footnotes
Funding: This research was supported by the KIAT (Korea Institute for Advancement of Technology) grant funded by the Korea Government (MOTIE: Ministry of Trade Industry and Energy). (P0008801)
Conflict of Interest: None
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- Commentary: 3D Aortic Grafts, Evolving Sci-Fi?Seminars in Thoracic and Cardiovascular SurgeryVol. 34Issue 3
- PreviewThoracoabdominal 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 AortaSeminars in Thoracic and Cardiovascular SurgeryVol. 34Issue 3
- PreviewThe 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.
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