Status Of Aortic Wrapping For Ascending Aortic Aneurysms ...
The assessment of the new hybrid procedure for extensive aortic aneurysms compared with the...
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TheThe assessmentassessment ofof thethe newnew hybridhybrid procedureprocedure forfor extensiveextensive aorticaortic aneurysmsaneurysms comparedcompared withwith thethe conventional open surgeryconventional open surgery
Department of Cardiovascular surgery , Osaka University Graduate School of Medicine, Osaka,Japan#1
Department of Cardiovascular surgery, Osaka General Medical Center#2
Depertment of Cardiovascular Surgery, Higashi Takarazuka Satoh Hospital#3
Keiwa Kin#1, Toru Kuratani#1, Yukitoshi Shirakawa#1, Kei Torikai#1, Kazuo Shimamura#1, Hiroshi Takano#2 , Hisashi Satoh#3 , Yoshiki Sawa#1
Procedure for extensive thoracic aortic Procedure for extensive thoracic aortic aneurysmaneurysm
Second stage repairSecond stage repair with left thoracotomy with left thoracotomy
•Second stage repair was not done in 43 (35.9%) of 117 patients who completed first-stage elephant trunk procedures
•Among these patients, within an average period of 3.4 years , 13 of 43 (30.2%) died, 4 of 13 (30.8%) as the result of rupture.
Safi.H.J.et.al Circulation. 2001 Dec 11;104(24):2938-42.
Our result with elephant trunk procedure (~2000)
11 cases
Three cases died from Three cases died from aneurysm rupture aneurysm rupture during the interval between operationduring the interval between operation
Two-stage repairTwo-stage repair with TEVAR (~2002)with TEVAR (~2002)
Trying for less invasive procedureless invasive procedure
Bilateral anterior thoracotomy Bilateral anterior thoracotomy
•Mechanical ventilator support for more than 72h was required in 50% of the operative survivors, and 13% a tracheostomy was necessary.
Kouchoukos.J.et.al Ann Thorac Surg. 2007 83;811-4.
1 days after1 days afterTwo-stage TEVAR(minimum overlap length 5cm)
New hybrid procedure for extensive aortic arch aneurysmNew hybrid procedure for extensive aortic arch aneurysm
Stent graftStent graft
Under DHCAUnder DHCA•Insertion of stent graft to the descending aortaInsertion of stent graft to the descending aorta•Open distal anastomosisOpen distal anastomosis
ObjectiveObjective
W e elucidate the efficacy of this “ hybrid procedure” to compare with a conventional single-stage repair.
n %
Age (y) 66.9± 12.2Male/female 96/35Pathology degenerative / dissection 77/54ComorbidityHypertension 86 61Ischemic heart disease 27 21Diabetes 27 21Renal dysfunction (Cr>1.5) 13 10Pulmonary dysfunction 17 13
2000.1~2011.10 Elective patients with extended aortic arch aneurysm
131cases
Patient sPatient s
2000.1~2011.10 Elective patients with extended aortic arch aneurysm
131cases
Patient sPatient s
Hybrid procedure with TEVAR
(H-group)
Single-stage procedure with cram-shell approach
(S-group)
63 cases
68 cases
H-group S-group
Number 63 68 n.s.
Age (y) 66.7±10.4 70.5±10.4 n.s.
Male/female 50/13 46/22 n.s.
Pathology
degenerative / dissection 37/26 40/28 n.s.
Comorbidity
Hypertension 42 44 n.s.
Ischemic heart disease 13 14 n.s.
Diabetes 12 15 n.s.
Renal dysfunction (Cr>1.5) 7 6 n.s.
Pulmonary dysfunction 10 7 n.s.
Patient s Patient s DemographicsDemographics
Hospital mortality Complication Stroke Paraplesia Acute renal failure Tracheostomy
H-groupN=63
1 (1.6%)
2 (3.2%)1 (1.6%)1 (1.6%)3 (4.8%)
S-groupN=68
10 (15%)
3 (4.4%)2 (2.9%)2 (2.9%)14 (21%)
Short-term RESULTSShort-term RESULTS
0.0068
0.71190.60480.60480.0071
Mid-term RESULTMid-term RESULT~mortality~~mortality~Mid-term RESULTMid-term RESULT~mortality~~mortality~ Follow-up: 32.0month (1-
121) Follow-up completion: 97.1%
0
.2
.4
.6
.8
1
0 20 40 60 80 100 120 140Number at riskOver-all 131 57 23 11 5H-group 63 36 13 7 3S-group 68 21 10 4 2
Free from aneurysm-related mortality(4 years; 86% H-group vs 71% S-group P= .0262)
ConclusionConclusion
Hybrid procedure with frozen elephant trunk and TEVAR gave excellent early and long-term results compared with a conventional single-stage repair.
This hybrid procedure may be alternative to the conventional sigle-stage.