Early and Midterm Outcomes of Open Surgical Correction After Thoracic Endovascular Aortic Repair

Miyahara, Shunsuke; Nomura, Yoshikatsu; Shirasaka, Tomonori; Taketoshi, Hideto; Yamanaka, Katsuhiro; Omura, Atsushi; Sakamoto, Toshihito; Inoue, Takeshi; Minami, Hiroya; Okada, Kenji; Okita, Yutaka

doi:10.1016/j.athoracsur.2013.02.027

Cited by 22 publications

(16 citation statements)

References 24 publications

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“…A flowchart of the literature search and selection process is available in Figure . Finally, the 15 articles listed in Table were deemed suitable to be included in our qualitative and quantitative analysis …”

Section: Resultsmentioning

confidence: 99%

“…Adequate data on this variable were available from 11 studies, including 212 patients (Table ). Patients were on average in their sixth decade of life (62.13, 51.7–77.0 years), and were of male sex in 61.3% of cases (95% CI, 0.541–0.680).…”

Section: Resultsmentioning

confidence: 99%

“…Adequate data on this variable were available from all of the 15 studies, including 330 patients . These data are expressed alphanumerically in Table ; a graphic representation of the distributions of aortic procedures and circulatory support is provided in Figure .…”

Section: Resultsmentioning

confidence: 99%

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Secondary Open Aortic Procedure Following Thoracic Endovascular Aortic Repair: Meta‐Analytic State of the Art

Gambardella

Antoniou

Torella

et al. 2017

JAHA

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BackgroundThoracic endovascular aortic repair is characterized by a substantial need for reintervention. Secondary open aortic procedure becomes necessary when further endoluminal options are exhausted. This synopsis and quantitative analysis of available evidence aims to overcome the limitations of institutional cohort reports on secondary open aortic procedure.Methods and ResultsElectronic databases were searched from 1994 to the present date with a prospectively registered protocol. Pooled quantification of pre/intraoperative variables, and proportional meta‐analysis with random effect model of early and midterm outcomes were performed. Subgroup analysis was conducted for patients who had early mortality. Fifteen studies were elected for final analysis, encompassing 330 patients. The following values are expressed as “pooled mean, 95% confidence interval.” Type B dissection was the most common pathology at index thoracic endovascular aortic repair (51.2%, 44.4–57.9). The most frequent indication for secondary open aortic procedure was endoleak (39.7%, 34.6–45.1). More than half of patients had surgery on the descending aorta (51.2%, 45.8–56.6), and one fourth on the arch (25.2%, 20.8–30.1). Operative mortality was 10.6% (7.4–14.9). Neurological morbidity was substantial between stroke (5.1%, 2.8–9.1) and paraplegia (8.3%, 5.2–13.1). At 2‐year follow‐up, mortality (20.4%, 11.5–33.5) and aortic adverse event (aortic death 7.7%, 4.3–13.3, tertiary aortic open procedure 7.4%, 4.0–13.2) were not negligible.ConclusionsIn the secondary open aortic procedure population, type B dissection was both the most common pathology and the one associated with the lowest early mortality, whereas aortic infection and extra‐anatomical bypass were associated with the most ominous prognosis.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Secondary Open Aortic Procedure Following Thoracic Endovascular Aortic Repair: Meta‐Analytic State of the Art

Gambardella

Antoniou

Torella

et al. 2017

JAHA

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“…7,8 Although the mortality and morbidity rates of TEVAR are lower than those of open surgery, 1,4 the rate of open surgical conversion after failed TEVAR has been reported to range from 4% to 10%. [9][10][11] A type I endoleak is one of the most common causes of secondary surgical intervention in addition to retrograde dissection. Despite improvements in TEVAR techniques, the rate of failed TEVAR has been reported to be 11.3% and endovascular or surgical reintervention is required in 7.7% of cases.…”

Section: Discussionmentioning

confidence: 99%

Explantation of a failed endovascular stent graft in a patient with a type B dissection

et al. 2018

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“…In their report regarding 16 open repairs after TEVAR, Miyahara et al [25] at Kobe University describe a case of endograft collapse in 1 patient who had originally been treated for a ruptured degenerative aneurysm. During emergent repair of the descending thoracic aorta, the device was completely removed.…”

Section: Device-specific Mechanical Failurementioning

confidence: 97%

Open aortic surgery after thoracic endovascular aortic repair

Coselli

Spiliotopoulos

Preventza

et al. 2016

Gen Thorac Cardiovasc Surg

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In the last decade, thoracic endovascular aortic aneurysm repair (TEVAR) has emerged as an appealing alternative to the traditional open aortic aneurysm repair. This is largely due to generally improved early outcomes associated with TEVAR, including lower perioperative mortality and morbidity. However, it is relatively common for patients who undergo TEVAR to need a secondary intervention. In select circumstances, these secondary interventions are performed as an open procedure. Although it is difficult to assess the rate of open repairs after TEVAR, the rates in large series of TEVAR cases (>300) have ranged from 0.4 to 7.9 %. Major complications of TEVAR that typically necessitates open distal aortic repair (i.e., repair of the descending thoracic or thoracoabdominal aorta) include endoleak (especially type I), aortic fistula, endograft infection, device collapse or migration, and continued expansion of the aneurysm sac. Conversion to open repair of the distal aorta may be either elective (as for many endoleaks) or emergent (as for rupture, retrograde complicated dissection, malperfusion, and endograft infection). In addition, in select patients (e.g., those with a chronic aortic dissection), unrepaired sections of the aorta may progressively dilate, resulting in the need for multiple distal aortic repairs. Open repairs after TEVAR can be broadly classified as full extraction, partial extraction, or full salvage of the stent-graft. Although full and partial stent-graft extraction imply failure of TEVAR, such failure is generally absent in cases where the stent-graft can be fully salvaged. We review the literature regarding open repair after TEVAR and highlight operative strategies.

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Early and Midterm Outcomes of Open Surgical Correction After Thoracic Endovascular Aortic Repair

Cited by 22 publications

References 24 publications

Secondary Open Aortic Procedure Following Thoracic Endovascular Aortic Repair: Meta‐Analytic State of the Art

Secondary Open Aortic Procedure Following Thoracic Endovascular Aortic Repair: Meta‐Analytic State of the Art

Explantation of a failed endovascular stent graft in a patient with a type B dissection

Open aortic surgery after thoracic endovascular aortic repair

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