Kazuo Shimamura1, Toru Kuratani1, Goro Mastumiya1, Masaaki Kato3, Hiroshi Takano2, Yoshiki Sawa1; 1Department of cardiovascular surgery, Osaka university graduate school of medecine, Osaka, Japan; 2Osaka General Medical Center, Osaka, Japan; 3Morinomiya Hispital, Osaka, Japan
Objective: For extended aortic arch repair, the distal anastomosis via median sternotomy is a critical maneuver which requires extensive exposure of distal aorta or left thoracotomy to make reliable sutures. In order to avoid this invasive maneuver, we have introduced the open stent grafting technique (OS). This technique involves stent grafting into the descending aorta through open aorta to substitute for the distal anastomosis. In this study we evaluated the efficacy of this technique and assessed the early and long term results.Methods: From 1994 to 2004, extended aortic arch repair with OS was performed in 126 patients with aortic arch disease (69 true aneurysms, 57 dissections, the average age 67.8 yrs). 37(29.3%) were in emergency status. Under deep hypothermic circulatory arrest, the stent graft was delivered through the transected proximal aortic arch and arch replacement with 4 branched graft was performed as the figure.
Results: Mean operation time was 401 min, and cardiopulmonary bypass time was 147 min. The distal end of stent graft reached just above celiac artery in 9 cases (7.1%). The mortality rate was 3.2%. The major postoperative complications were 6 cerebral infarctions (5.7%), 4 paraplegias (3.2%). Median follow up was 73.5 months (18-118 months). Two patients (1.4%) showed type I endoleak from distal end of the stent graft. In eight patients (6.3%) additional endovascular repair was performed for other aortic aneurysm or dissection. There was no delayed paraplegia. The freedom from aortic events rate was 91.4% at 5 years, and 84.2% at 8 years.
Conclusion: This study suggested that extended aortic arch repair with open stent grafting technique is a safe and effective technique with good long-term results. This novel approach could be a good alternative to conventional prosthetic replacement and might represent a significant step toward a safer method to repair extended aortic arch aneurysms.
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