Hybrid endovascualr aortic arch repair using branched endoprothesis: The second generation ’branched’ open stent grafting technique
Kazuo Shimamura1, Toru Kuratani2, Yukitoshi Shirakawa2, Mugiho Takeuchi1, Hiroshi Takano3, Goro Mastumiya1, Yoshiki Sawa1; 1Department of cardiovascular surgery, Osaka university graduate school of medecine, Osaka, Japan; 2Department of Advenced Cardiovascular Therapeutics,Osaka University Graduate School of medicine, Osaka, Japan; 3Department of Cardiovascular Surgery, Osaka General Medical Center, Osaka, Japan
Comment on this Abstract
Objective: Open stent grafting (OSG) is an emerging technique of aortic arch repair which involves stent grafting to the descending aorta in traditional surgical method. We advanced this technique using a branched stent graft, which reconstructs simultaneously the cervical branch and descending aorta under direct visualization (branched OSG). This procedure could complete arch replacement in single process during deep hypothermic circulatory arrest (DHCA). In this study, we evaluated the efficacy of this new technique and assessed the early and mid-term results.
Methods: From January 1994 to September 2007, aortic arch repair with OSG was performed in 195 patients. Among them, branched OSG was underwent from 2004 in 69 cases (55 male, average age 66.2 years, 36 degenerative aneurysms and 33 aortic dissections, 13(18.8%) in emergency, 7(10.1%) re-do cases). Under DHCA, the branched stent graft was delivered through the opened aorta and aortic arch repair was completed as the figure. To avoid cerebral embolism, retrograde cerebral perfusion was performed at the end of DHCA.
Results: Average time of operation / cardiopulmonary bypass / DHCA was 417 / 130 / 36 minutes respectively. Total 124 cervical stent grafts was involved, and successfully delivered in 121(97.6%). Operative mortality within 30 days was 3 (4.3%). The major postoperative complications involved 4 (5.8%) strokes, 2 (2.9%) spinal cord injuries. Median follow up was 20.3 month (1-41 months). No aortic related death was observed after discharge from hospital, and the survival rate was 90.9%, 88.8%, 88.8% at 1, 2 and 3 years respectively. Six (5.0%) cervical stent grafts showed endoleak, however all these cases were successfully treated by additional endovascular repair. Freedom from endoleak was 92.0%, 92.0% and 84.4% at 1, 2 and 3 years respectively.
Conclusion: Aortic arch repair with branched open stent grafting is an effective technique with satisfactory early and mid-term results. Although long term results would confirm its efficacy, this technique could be an attractive alternative to conventional aortic arch repair.
Back to 88th Annual Meeting
Back to Program Outline
