1. Six-year experience with a hybrid stent graft prosthesis for extensive thoracic aortic disease: an interim balance
- Author
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Heinz Jakob, Guenter Marggraf, D.-S. Dohle, Raimund Erbel, Konstantinos Tsagakis, Jaroslav Benedik, Matthias Thielmann, and Jarowit Piotrowski
- Subjects
Male ,Reoperation ,Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,medicine.medical_treatment ,Medizin ,Kaplan-Meier Estimate ,Thoracic aortic aneurysm ,Blood Vessel Prosthesis Implantation ,Aortic aneurysm ,Postoperative Complications ,Aneurysm ,Blood vessel prosthesis ,medicine.artery ,medicine ,Humans ,Hospital Mortality ,Aged ,Aortic dissection ,Aorta ,Aortic Aneurysm, Thoracic ,business.industry ,Stent ,General Medicine ,Middle Aged ,medicine.disease ,Blood Vessel Prosthesis ,Surgery ,Aortic Dissection ,Treatment Outcome ,Cardiothoracic surgery ,Acute Disease ,Chronic Disease ,Female ,Stents ,Radiology ,Cardiology and Cardiovascular Medicine ,business ,Follow-Up Studies - Abstract
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.
- Published
- 2012