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Procedure for extensive thoracic aortic aneurysm

The assessment of the new hybrid procedure for extensive aortic aneurysms compared with the conventional open surgery. Department of Cardiovascular surgery , Osaka University Graduate School of Medicine, Osaka,Japan #1 Department of Cardiovascular surgery, Osaka General Medical Center #2

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Procedure for extensive thoracic aortic aneurysm

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  1. Theassessmentofthenewhybridprocedureforextensiveaorticaneurysmscomparedwiththeconventional open surgery Department of Cardiovascular surgery , Osaka University Graduate School of Medicine, Osaka,Japan#1 Department of Cardiovascular surgery, Osaka General Medical Center#2 Depertment of Cardiovascular Surgery, Higashi Takarazuka Satoh Hospital#3 Keiwa Kin#1, Toru Kuratani#1, Yukitoshi Shirakawa#1, Kei Torikai#1, KazuoShimamura#1, Hiroshi Takano#2 , Hisashi Satoh#3 , Yoshiki Sawa#1

  2. Procedure for extensive thoracic aortic aneurysm Second stage repairwith left thoracotomy Bilateral anterior thoracotomy • Second stage repair was not done in 43 (35.9%) of 117 • patients who completed first-stage elephant trunk procedures • Among these patients, within an average period of 3.4 years , 13 of 43 (30.2%) died, 4 of 13 (30.8%) as the result of rupture. • Mechanical ventilator support for more than 72h was required in 50% of the operative survivors, and 13% a tracheostomy was necessary. Kouchoukos.J.et.al Ann Thorac Surg. 2007 83;811-4. Safi.H.J.et.al Circulation. 2001 Dec 11;104(24):2938-42. Our result with elephant trunk procedure (~2000) 11 cases Trying forless invasive procedure Two-stage repairwith TEVAR (~2002) Three cases died from aneurysm rupture during the interval between operation

  3. New hybrid procedure for extensive aortic arch aneurysm Stent graft 1 days after Two-stage TEVAR (minimum overlap length 5cm) • Under DHCA • Insertion of stent graft to the descending aorta • Open distal anastomosis

  4. Objective We elucidate the efficacy of this “hybrid procedure”to compare with a conventional single-stage repair.

  5. Patient s 131cases 2000.1~2011.10　 Elective patients with extended aortic arch aneurysm

  6. Patient s 131cases 2000.1~2011.10　 Elective patients with extended aortic arch aneurysm • Hybrid procedure with TEVAR • (H-group) 63 cases • Single-stage procedure with cram-shell approach • (S-group) 68 cases

  7. Patient s Demographics

  8. Short-term RESULTS H-group N=63 1 (1.6%) 2 (3.2%) 1 (1.6%) 1 (1.6%) 3 (4.8%) S-group N=68 10 (15%) 3 (4.4%) 2 (2.9%) 2 (2.9%) 14 (21%) Hospital mortality Complication Stroke Paraplesia Acute renal failure Tracheostomy 0.0068 0.7119 0.6048 0.6048 0.0071

  9. Mid-term RESULT ~mortality~ Follow-up: 32.0month (1-121) Follow-up completion: 97.1% 1 .8 .6 .4 Free from aneurysm-related mortality (4 years; 86% H-group vs 71% S-group P= .0262) .2 0 Number at risk Over-all 131 57 23 11 5 H-group 63 36 13 7 3 S-group 68 21 10 4 2 0 20 40 60 80 100 120 140

  10. Conclusion Hybrid procedure with frozen elephant trunk and TEVAR gave excellent early and long-term results compared with a conventional single-stage repair. This hybrid procedure may be alternative to the conventional sigle-stage.

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