Aortic arch reoperation in a single centre: early and late results in 57 consecutive patients†

Moz, Monica; Misfeld, Martín; Leontyev, Sergey; Borger, Michael A.; Davierwala, Piroze; Mohr, Friedrich–Wilhelm

doi:10.1093/ejcts/ezt205

Cited by 30 publications

(31 citation statements)

References 13 publications

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“…The second-stage operation in these cases is performed using FET and is associated with perioperative neurological comorbidity and 30-day mortality. 8 The REAAD registry including 117 patients showed an in-hospital mortality of 19.6% for patients who required reoperation after type A dissection because of a relevant proximal (aortic root) or distal (aortic arch) pathology. Distal pathology was even associated with a higher mortality of 26%.…”

Section: Frozen Elephant Trunkmentioning

confidence: 99%

Hybrid Off-pump Second-Stage Aortic Arch Repair after Type A Dissection

Lescan

Anđić

Krüger

et al. 2018

Thorac cardiovasc Surg

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Background Ascending aorta or hemi-arch repair are common in the acute phase of type A dissection. Postdissection aneurysms can develop with antegrade perfusion of the false lumen in the dissected aortic arch and require reoperation. Methods From 2012 to 2018, we reoperated nine patients with postdissection aneurysms using a hybrid technique without cardiopulmonary bypass. The patients had a EuroSCORE II of 13% and a logistic EuroSCORE I of 45% and were not candidates for frozen elephant trunk surgery. The median interval since the acute ascending repair was 184 (92; 528) days. All patients were treated by median resternotomy, ascending to carotid bypass on a partially clamped ascending graft, and transfemoral endovascular repair with a Relay NBS (nonbare stent) or conformable Gore C-TAG stent graft. Results Technical success was achieved in all cases. Mean follow-up was 405 (220; 672) days. There was no disabling stroke, endoleak, paraplegia, in-hospital, or late mortality. In all patients, the false lumen was completely thrombosed at the aortic arch level with a median aneurysm shrinkage of 13 mm in the distal arch. There was no bird beak or stent graft migration. Distal stent-induced new entry was observed in one case. Reinterventions were not necessary due to diameter stability. Conclusion Complete debranching with transfemoral thoracic endovascular aneurysm repair showed encouraging results in patients with relevant comorbidities. The used stent grafts performed well in the mid-term follow-up period with no endoleaks or migration.

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Section: Frozen Elephant Trunkmentioning

confidence: 99%

Hybrid Off-pump Second-Stage Aortic Arch Repair after Type A Dissection

Lescan

Anđić

Krüger

et al. 2018

Thorac cardiovasc Surg

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“…While redo aortic arch surgery can be done safely, it is still a second significant procedure with risks of a second procedure that can carry a mortality in the 20% range. [10][11][12][13] Moreover, there are actually decently validated anatomic characteristics of the dissection that predict aneurysmal degeneration.…”

Section: Extending the Repair In Type A Dissectionmentioning

confidence: 99%

“…20 All of these potentially amplified complications can be even worse in a redo setting, so while they are to be considered for all patients the patients at particular risk for reintervention will most likely experience this in a second operation anyway. [11][12][13] In summary, as the understanding of late intervention improves, the patients at risk for second arch procedures may warrant consideration for more extensive arch operations at the index operation for type A dissection. Aortic centers around the world are adopting aggressive algorithms to arch replacement in these acute pathologies.…”

Section: Extending the Repair In Type A Dissectionmentioning

confidence: 99%

Noteworthy Literature Published in 2016 for Cardiac Surgery

Aftab

Cleveland

Reece

2017

Semin Cardiothorac Vasc Anesth

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Cardiac surgical care of patients continued to evolve rapidly in 2016. In this article, 3 topics of considerable change are discussed based on recent publications. The first topic reviews the potential risks and benefits of newly instituted low-risk percutaneous aortic valve replacement. The second topic reviews the increasing utilization of more extensive arch replacements in acute type A dissection. The final topic reviews current trends and justification for changes in patterns of use of cardioplegia options. The topics discussed are contemporary issues facing cardiac surgery, so they should serve to address the reasoning for changes in contemporary practice in 2016.

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“…These techniques typically employ cardiopulmonary bypass and deep hypothermic circulatory arrest, with mortality rates in contemporary series approaching 16.5%. [1][2][3][4][5][6] Neurological complications remain relatively common in these procedures, with the major stroke rate reported as high as 10% and paraparesis/ paraplegia rates up to 5% for open repair. 5,7 The treatment of aortic arch pathology in a reoperative setting is a particularly challenging endeavor, most notably in patients who have previously undergone type A aortic dissection repair.…”

Section: Introductionmentioning

confidence: 99%

“…Upward of 40% of these patients require future aortic intervention. 6,8 Endovascular treatment of descending thoracic and abdominal aortic aneurysms is well described, with perioperative outcomes surpassing open repair. 9,10 However, the aortic arch has historically presented a challenge with regard to endovascular therapy, in part due to the unique curved anatomy of the arch, the high force of antegrade blood flow in the ascending aorta, the motion in the distal ascending aorta, and the presence of 3 supra-aortic branch vessels.…”

Section: Introductionmentioning

confidence: 99%

Applicability of the Zenith Inner Branched Arch Endograft

et al. 2020

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Purpose: To evaluate the clinical and anatomical features of patients with arch pathology to better understand the applicability of the Zenith inner branched arch endograft (IBAE). Materials and Methods: A retrospective review was performed of 60 consecutive patients (mean age 62.5 years; 42 men) who presented with nonruptured aortic arch pathology at a single institution between 2009 and 2016. Patients were stratified into standard (no previous cardiac surgery, <80 years old, and no significant medical comorbidity), high (previous cardiac surgery or significant comorbidity), or prohibitive risk (turned down for operative intervention) for operative intervention. Anatomical measurements of the aorta were obtained on computed tomography scans; anatomical suitability was based on the device’s instructions for use. Results: Overall, 27 (45%) patients had anatomy amenable to treatment with the existing IBAE. Inadequate proximal seal length and large ascending aortic diameters were the primary reasons for anatomical unsuitability. Shortening the inner curve seal zone from 25 to 15 mm and increasing the proximal seal zone diameter from 38 to 42 mm increased anatomical suitability to include 49 (82%) patients. Of these, 31 were in the high-risk cohort and 7 were deemed prohibitive risk; therefore, IBAE would have been strongly considered in these 38 patients. Conclusion: Based on anatomical criteria alone, nearly half of patients with aortic arch pathology have anatomy suitable to the Zenith IBAE in its current design. Arch branch vessel anatomy was not a limitation of the device. From a clinical standpoint, if endovascular repair were reserved for those at high or prohibitive risk for open repair, approximately 30% of patients would likely benefit from the IBAE in its current form.

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Aortic arch reoperation in a single centre: early and late results in 57 consecutive patients†

Cited by 30 publications

References 13 publications

Hybrid Off-pump Second-Stage Aortic Arch Repair after Type A Dissection

Hybrid Off-pump Second-Stage Aortic Arch Repair after Type A Dissection

Noteworthy Literature Published in 2016 for Cardiac Surgery

Applicability of the Zenith Inner Branched Arch Endograft

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