Six-year experience with a hybrid stent graft prosthesis for extensive thoracic aortic disease: an interim balance

• Published in: European journal of cardio-thoracic surgery 2012-12, Vol.42 (6), p.1018-1025
• Main Authors: Jakob, Heinz, Dohle, Daniel-Sebastian, Piotrowski, Jarowit, Benedik, Jaroslav, Thielmann, Matthias, Marggraf, Guenter, Erbel, Raimund, Tsagakis, Konstantinos
• Format: Article
• Language: English
• Subjects: Acute Disease; Aged; Aneurysm, Dissecting - mortality; Aneurysm, Dissecting - surgery; Aortic Aneurysm, Thoracic - mortality; Aortic Aneurysm, Thoracic - surgery; Biological and medical sciences; Blood and lymphatic vessels; Blood Vessel Prosthesis; Blood Vessel Prosthesis Implantation - instrumentation; Blood Vessel Prosthesis Implantation - methods; Blood Vessel Prosthesis Implantation - mortality; Cardiology. Vascular system; Chronic Disease; Diseases of the aorta; Female; Follow-Up Studies; Hospital Mortality; Humans; Kaplan-Meier Estimate; Male; Medical sciences; Middle Aged; Pneumology; Postoperative Complications - epidemiology; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); Reoperation - statistics & numerical data; Stents; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the heart; Treatment Outcome
• ISSN: 1010-7940; 1873-734X
• DOI: 10.1093/ejcts/ezs201

OBJECTIVES To avoid a two-stage surgical approach for complex thoracic aortic disease with its additive mortality and morbidity, a hybrid stent graft prosthesis was introduced 6 years ago for simultaneous treatment of the ascending, arch and descending aortas, relying proximally on a surgical suture line with an integrated distal stent graft for downstream splinting. We report the mid-term single-centre experience. METHODS Between January 2005 and March 2011, 77 patients (mean age 59 years, male 75%) with acute (AAD, n = 39) or chronic aortic dissection (CAD, n = 23) DeBakey type I or an extensive thoracic aortic aneurysm (TAA, n = 15) underwent one-stage repair. Periodic follow-up studies (100%, mean 29 months) included repeat aortic computed tomography imaging. Major adverse events (MAEs) were defined as permanent stroke, spinal cord injury and dialysis. RESULTS In-hospital mortality was 10% (8 of 77). The incidence of MAE in AAD, CAD and TAA was 5, 13 and 20%, respectively. At the last follow-up, the complete thrombosis of the thoracic false lumen was 92% for AAD, 91% for CAD and the full exclusion of aneurysms 100% in TAA. Throughout the follow-up, freedom from aortic disease-related death was 93% and 5-year survival 79%. Freedom from distal reoperation was 94% in AAD, 95% in CAD and 100% in TAA and the incidence of distal stent graft extension 10% (8 of 77). CONCLUSIONS The durable hybrid one-stage repair of complex thoracic aortic disease is feasible with acceptable mortality. Distal reintervention is infrequent and associated with low risk; thus, the indication for the optimization of the peripheral flow using the endovascular aortic repair techniques is gradually widened.