One-stage repair in complex multisegmental thoracic aneurysmal disease: results of a multicentre study.

OBJECTIVES Patients with thoracic aneurysmal disease involving the arch and the descending or thoracoabdominal aorta may require more than one surgical intervention. The results of one-stage repair using a hybrid stent-graft in the frozen elephant trunk manner are presented. METHODS Between January 2005 and March 2012, 113 (age 67 ± 10 years) of 358 registered patients in the International E-Vita Open Registry were operated on for combined arch and descending and thoracoabdominal aortic aneurysm. Thirty-one (27%) patients had a previous cardiothoracic, abdominal aortic surgery or endovascular repair. The E-Vita Open hybrid stent-graft was used in all cases. Postoperatively and during the follow-up (100%), aortic image examinations were performed. RESULTS Combined arch replacement and antegrade stent-grafting distally (graft diameter 34 ± 4 mm) were performed under selective cerebral perfusion (72 ± 27 min) and hypothermic visceral ischaemia (65 ± 27 min). Postoperatively, aneurysm exclusion was completely and partially achieved in 80% and 20%, respectively. In-hospital mortality and survival rate after 5 years were 12% (13 of 113) and 78%, respectively. Latest aortic imaging demonstrated 93% complete aneurysm exclusion. Freedom from secondary endovascular intervention and open surgery were 88 and 90%, respectively. CONCLUSIONS In multisegmental thoracic aneurysmal disease, combined arch replacement with distal repair by a hybrid stent-graft enables one-stage treatment with acceptable mortality. Aneurysm exclusion by the stent-graft seems to be primarily curative and allows easier access for distal open or endovascular reintervention.

[1]  R. Erbel,et al.  Six-year experience with a hybrid stent graft prosthesis for extensive thoracic aortic disease: an interim balance. , 2012, European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery.

[2]  F. Mohr,et al.  The frozen elephant trunk for the treatment of chronic dissection of the thoracic aorta: a multicenter experience. , 2011, The Annals of thoracic surgery.

[3]  Š. Černý,et al.  The International E-vita Open Registry: data sets of 274 patients. , 2011, The Journal of cardiovascular surgery.

[4]  A. Pantaleo,et al.  [Extensive disease of the thoracic aorta: hybrid treatment with the frozen elephant trunk technique]. , 2011, Giornale italiano di cardiologia.

[5]  Š. Černý,et al.  Multicenter early experience with extended aortic repair in acute aortic dissection: is simultaneous descending stent grafting justified? , 2010, The Journal of thoracic and cardiovascular surgery.

[6]  M. Luehr,et al.  Staged repair of thoracic and thoracoabdominal aortic aneurysms using the elephant trunk technique: a consecutive series of 215 first stage and 120 complete repairs. , 2008, European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery.

[7]  M. Galanski,et al.  Distal aortic surgery following arch replacement with a frozen elephant trunk. , 2008, European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery.

[8]  R. S. Mitchell,et al.  Expert consensus document on the treatment of descending thoracic aortic disease using endovascular stent-grafts. , 2008, The Annals of thoracic surgery.

[9]  J. Bavaria,et al.  Fate of the residual distal and proximal aorta after acute type a dissection repair using a contemporary surgical reconstruction algorithm. , 2007, The Annals of thoracic surgery.

[10]  M. Karck,et al.  The frozen elephant trunk technique for treatment of thoracic aortic aneurysms. , 2007, The Annals of thoracic surgery.

[11]  John A Elefteriades,et al.  Novel measurement of relative aortic size predicts rupture of thoracic aortic aneurysms. , 2006, The Annals of thoracic surgery.

[12]  T. Buck,et al.  Development of an Integrated Stent Graft-Dacron Prosthesis for Intended One-Stage Repair in Complex Thoracic Aortic Disease , 2005, Herz Kardiovaskuläre Erkrankungen.

[13]  M. Karck,et al.  Hybrid endograft for one-step treatment of multisegment disease of the thoracic aorta. , 2005, Journal of vascular and interventional radiology : JVIR.

[14]  M. Karck,et al.  The frozen elephant trunk technique for the treatment of extensive thoracic aortic aneurysms: operative results and follow-up. , 2004, European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery.

[15]  M. Karck,et al.  The frozen elephant trunk technique: a new treatment for thoracic aortic aneurysms. , 2003, The Journal of thoracic and cardiovascular surgery.

[16]  C. Miller,et al.  Staged repair of extensive aortic aneurysms. , 2002, The Annals of thoracic surgery.

[17]  J. Elefteriades Natural history of thoracic aortic aneurysms: indications for surgery, and surgical versus nonsurgical risks. , 2002, The Annals of thoracic surgery.

[18]  D. Loisance,et al.  Risk factor analysis for proximal and distal reoperations after surgery for acute type A aortic dissection. , 2002, The Journal of thoracic and cardiovascular surgery.

[19]  J. Elefteriades,et al.  Pathologic variants of thoracic aortic dissections. Penetrating atherosclerotic ulcers and intramural hematomas. , 1999, Cardiology clinics.

[20]  N. Kouchoukos,et al.  Single-stage extensive replacement of the thoracic aorta: the arch-first technique. , 1999, The Journal of thoracic and cardiovascular surgery.

[21]  Y. Matsui,et al.  Stented elephant trunk procedure for an extensive aneurysm involving distal aortic arch and descending aorta. , 1996, The Journal of thoracic and cardiovascular surgery.

[22]  T. Mizushima,et al.  New graft-implanting method for thoracic aortic aneurysm or dissection with a stented graft. , 1996, Circulation.

[23]  K Hashino,et al.  Long-term consequences of Kawasaki disease. A 10- to 21-year follow-up study of 594 patients. , 1996, Circulation.

[24]  J. Coselli,et al.  Variables predictive of outcome in 832 patients undergoing repairs of the descending thoracic aorta. , 1993, Chest.

[25]  J. Coselli,et al.  Surgical treatment of aneurysm and/or dissection of the ascending aorta, transverse aortic arch, and ascending aorta and transverse aortic arch. Factors influencing survival in 717 patients. , 1989, The Journal of thoracic and cardiovascular surgery.

[26]  H. Borst,et al.  Extensive Aortic Replacement using “Elephant Trunk” Prosthesis , 1983, The Thoracic and cardiovascular surgeon.