Arch replacement and downstream stent grafting in complex aortic dissection: first results of an international registry

• Published in: European journal of cardio-thoracic surgery Vol. 39; no. 1; pp. 87 - 94
• Main Authors: Tsagakis, Konstantinos, Pacini, Davide, Di Bartolomeo, Roberto, Benedik, Jaroslav, Cerny, Stepan, Gorlitzer, Michael, Grabenwoger, Martin, Mestres, Carlos A., Jakob, Heinz
• Format: Journal Article Conference Proceeding
• Language: English
• Published: Oxford Elsevier Science B.V 01.01.2011; Oxford University Press
• Subjects: Acute Disease; Adult; Aged; Aneurysm, Dissecting - surgery; Aorta - surgery; Aortic Aneurysm, Thoracic - surgery; Aortic Valve - surgery; Biological and medical sciences; Blood and lymphatic vessels; Blood Vessel Prosthesis; Blood Vessel Prosthesis Implantation - methods; Cardiology. Vascular system; Chronic Disease; Diseases of the aorta; Epidemiologic Methods; Female; Humans; International Cooperation; Male; Medical sciences; Middle Aged; Pneumology; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); Stents; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the heart; Treatment Outcome; Aortic dissection; Aortic arch; Aortic operation; Endoprosthesis; Instrumentation therapy; Cardiovascular disease; Replacement; Operation; Complexes; Stent; Result; Arterial disease; Vascular disease; Surgery; Aorta; Circulatory system; Cardiology; Aortic disease; International; Pneumology
• ISSN: 1010-7940; 1873-734X
• DOI: 10.1016/j.ejcts.2010.03.070

Abstract Objectives: Arch replacement combined with antegrade stent grafting of the descending aorta represents a hybrid surgical approach for extensive thoracic aortic disease. This multicentre study evaluates the early results of this method in complex aortic dissection (AD). Methods: Retrospective data acquisition was achieved by institution of an international registry. A hybrid stent graft with integrated vascular prosthesis for arch replacement (E-vita open®) was used. From January 2005 to March 2009, 106 patients (mean age 57; 77% male) with complex AD (55 acute, 51 chronic) were studied. Results: As many as 49/106 (46%) patients underwent emergency surgery. Stent-graft deployment and arch replacement (95 total, 11 subtotal) were performed under hypothermic circulatory arrest (HCA (8 ± 6 min) and selective antegrade cerebral perfusion (SACP) (74 ± 23 min). Stent-graft placement into the true lumen was successful in all but one case (99%). Ascending aortic replacement was performed in 91/106 (86%), aortic valve repair/replacement in 49/106 (46%), coronary artery bypass grafting (CABG) in 17/106 (16%) and mitral valve repair in 2/106 (2%). Cardiopulmonary bypass (CPB) and cardiac arrest times were 242 ± 64 and 144 ± 44 min, respectively. In-hospital mortality was 12% (13/106; six acute, seven chronic AD) and new strokes observed in 5/106 (5%). The false lumen (FL) was evaluated in 96/106 (91%) patients postoperatively. At first follow-up computed tomography (CT)-examination, thoracic FL thrombosis was 93% (76 complete, 13 partial) and 58% (31 complete, 25 partial) in the thoraco-abdominal aorta. Conclusions: By combining arch replacement with downstream stent grafting, one-stage repair of complex aortic dissection with almost unanimous thoracic FL thrombosis can be achieved at acceptable perioperative risk.