Single‐center experience and evolution of technique with the E‐vita Open prosthesis

Abstract

Background We report our experience in aortic arch repair with the E‐vita Open hybrid prosthesis and describe the changes in our technique over time. Methods Between October 2013 and December 2019, 56 patients underwent a total aortic arch replacement with the E‐vita Open hybrid prosthesis. The main indications were thoracic aorta aneurysm (n = 27) and acute type A aortic dissection (n = 18). We analyze the technique and results in the overall series, and compare both between our early (group I, 25 patients) and late experience (group II, 31 patients). Results Overall in‐hospital mortality was 7.1% (n = 4), and permanent stroke and spinal cord injury were 3.6% and 1.8%, respectively. Fifteen patients (26.8%) underwent a planned second procedure on the distal aorta: 13 endovascular, 1 open, and 1 hybrid. Survival at 1 and 3 years was 90.7% and 80.7%, respectively. Group II included more patients with acute dissection (45.2% vs 16%, P = .02), higher rates of bilateral cerebral perfusion (100% vs 64%, P < .001), left subclavian artery perfusion during lower body circulatory arrest (87.1% vs 0%, P < .001), early reperfusion (96.8% vs 40%, P < .001), and zone 0 to 2 distal anastomosis (100% vs 72%, P = .02). In‐hospital mortality (3.2% vs 12%) and permanent stroke (0% vs 8%) tended to be lower in group II. Conclusions Total arch replacement with E‐vita Open hybrid prosthesis in complex thoracic aorta disease is safe. One‐stage treatment is feasible when pathology does not extend beyond the proximal descending thoracic aorta. In any case, it facilitates subsequent procedures on distal aorta if needed.