Giampiero Esposito MD
2010-A10 -AATS
Cardiovascular Surgery Unit
CITTA’ DI LECCE HOSPITAL - ITALY
GVM Hospitals of Care and Research

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

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

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

in Type A Aortic Dissection
LUPIAE 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

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

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

LUPIAE Technique:
Second Endovascular Stage

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

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

The Lupiae Technique in Type A aortic dissection with complicated false lumen achieves 2 important targets:
1. “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.