Advertisement

Replacement of the descending thoracic aortic aneurysm with partial cardiopulmonary bypass in the era of endovascular repair

  • Kyokun Uehara
  • Hitoshi MatsudaEmail author
  • Jiro Matsuo
  • Yosuke Inoue
  • Takayuki Shijo
  • Atsushi Omura
  • Yoshimasa Seike
  • Hiroaki Sasaki
  • Junjiro Kobayashi
Original Article
  • 34 Downloads

Abstract

Objectives

Although the advent of thoracic endovascular aortic repair (TEVAR) has provided an alternative treatment option for descending thoracic aortic aneurysm (DTAA), open repair still plays a crucial role in DTAA repair. The purpose of this study was to re-evaluate the operative and long-term outcomes of open repair with partial cardiopulmonary bypass, compared to the results of TEVAR with a proximal landing zone of 3 or 4.

Methods

Between 2007 and 2017, open repair was performed for 44 patients and TEVAR for 282 patients. Acute aortic dissection and open proximal anastomosis under circulatory arrest were excluded. Perioperative and long-term follow-up data were analyzed.

Results

In-hospital mortality rate (4.5% vs 3.2%, p = 0.42), and frequencies of spinal cord injury and neurological deficit showed no significant differences between the open repair and TEVAR groups (p = 0.41, 0.25, respectively). The propensity score-matched analysis showed similar cumulative survival (p = 0.23), but significantly higher reintervention rates for the repaired segment in the TEVAR group than in the open repair group (p = 0.0054). Twenty-two (7.8%) TEVAR patients required re-interventions for the repaired segment. Of those, 17 patients underwent additional TEVAR and 5 patients needed open conversion surgery with partial cardiopulmonary bypass. Reintervention rates for the repaired segment were significantly higher in the TEVAR group than in the open repair group (p = 0.012).

Conclusions

Open repair DTAA using partial cardiopulmonary bypass showed operative outcomes comparable to TEVAR and lower reintervention rates, and thus remains an acceptable procedure for selected patients in this era of endovascular repair.

Keywords

Descending thoracic aortic aneurysm Open repair Partial cardiopulmonary bypass Thoracic endovascular aneurysm repair 

Notes

Funding

None.

Compliance with ethical standards

Conflict of interest

All authors declare that they have no conflict of interest.

References

  1. 1.
    Ranney DN, Cox ML, Yerokun BA, Benrashid E, McCann RL, Hughes GC. Long-term results of endovascular repair for descending thoracic aortic aneurysms. J Vasc Surg. 2018;67:363–8.CrossRefGoogle Scholar
  2. 2.
    Bavaria JE, Appoo JJ, Makaroun MS, Verter J, Yu ZF, Mitchell RS. Endovascular stent grafting versus open surgi-cal repair of descending thoracic aortic aneurysms in low-risk patients: a multicenter comparative trial. J Thorac Cardiovasc Surg. 2007;133:369–77.CrossRefGoogle Scholar
  3. 3.
    Shah AA, Barfield ME, Andersen ND, Williams JB, Shah JA, Hanna JM, et al. Results of thoracic endovascular aortic repair 6 years after United States Food and Drug Adminis-tration approval. Ann Thorac Surg. 2012;94:1394–9.CrossRefGoogle Scholar
  4. 4.
    Czerny M, Funovics M, Sodeck G, Dumfarth J, Schoder M, Juraszek A, et al. Long-term results of thoracic endovascular aortic repair in atherosclerotic aneurysms involving the descending aorta. J Thorac Cardiovasc Surg. 2010;140:S179–184.CrossRefGoogle Scholar
  5. 5.
    Lee WA, Daniels MJ, Beaver TM, Klodell CT, Raghinaru DE, Hess PJ Jr. Late outcomes of a single-center experience of 400 consecutive thoracic endovascular aortic repairs. Circulation. 2011;123:2938–45.CrossRefGoogle Scholar
  6. 6.
    Desai ND, Burtch K, Moser W, Moeller P, Szeto WY, Pochettino A, et al. Long-term comparison of thoracic endovascular aortic repair (TEVAR) to open surgery for the treatment of thoracic aortic aneurysms. J Thorac Cardiovasc Surg. 2012;144:604–9.CrossRefGoogle Scholar
  7. 7.
    Minatoya K, Ogino H, Matsuda H, Sasaki H, Yagihara T, Kitamura S. Replacement of the descending aorta: recent outcomes of open surgery performed with partial cardiopulmonary bypass. J Thorac Cardiovasc Surg. 2008;136:431–5.CrossRefGoogle Scholar
  8. 8.
    Tanaka A, Sandhu HK, Pratt WB, Afifi R, Miller CC 3rd, Charlton-Ouw K, et al. Risk modeling to optimize patient selection for management of the descending thoracic aortic aneurysm. Ann Thorac Surg. 2018;105:724–30.CrossRefGoogle Scholar
  9. 9.
    Estrera AL, Jan A, Sandhu H, Shalhub S, Medina-Castro M, Nguyen TC, et al. Outcomes of open repair for chronic descending thoracic aortic dissection. Ann Thorac Surg. 2015;99:786–93.CrossRefGoogle Scholar
  10. 10.
    Sadek M, Abjigitova D, Pellet Y, Rachakonda A, Panagopoulos G, Plestis K. Operative outcomes after open repair of descending thoracic aortic aneurysms in the era of endovascular surgery. Ann Thorac Surg. 2014;97:1562–7.CrossRefGoogle Scholar
  11. 11.
    Davidovic L, Sladojevic M, Koncar I, Markovic M, Ulus T, Ilic N, et al. Late complication after thoracic endovascular aortic repair: what is the role of an open surgical conversion? Ann Vasc Surg. 2018;47:238–46.CrossRefGoogle Scholar
  12. 12.
    Tanaka H, Ogino H, Matsui Y, Higami T, Okabayashi H, Saiki Y, et al. The impact of preoperative identification of the Adamkiewicz artery on descending and thoracoabdominal aortic repair. J Thorac Cardiovasc Surg. 2016;151:122–8.CrossRefGoogle Scholar
  13. 13.
    Uehara K, Matsuda H, Inoue Y, Omura A, Seike Y, Sasaki H, et al. Simple identification of the adamkiewicz artery in extended thoracoabdominal aortic aneurysm repair. Ann Thorac Surg. 2017;103:e567–e569569.CrossRefGoogle Scholar
  14. 14.
    Czerny M, Reser D, Eggebrecht H, Janata K, Sodeck G, Etz C, et al. Aorto-bronchial and aorto-pulmonary fistulation after thoracic endovascular aortic repair: an analysis from the European Registry of Endovascular Aortic Repair Complications. Eur J Cardiothorac Surg. 2015;48:252–7.CrossRefGoogle Scholar
  15. 15.
    Sladojevic M, Bjelovic M, Ilic N, Mutavdzic P, Koncar I, Dragas M, et al. Open surgical treatment of secondary aortoesophageal and aortobronchial fistula after thoracic endovascular aortic repair and esophagocoloplasty in a second procedure. Ann Vasc Surg. 2017;44:417.e11–e16.CrossRefGoogle Scholar

Copyright information

© The Japanese Association for Thoracic Surgery 2019

Authors and Affiliations

  1. 1.Department of Cardiovascular SurgeryNational Cerebral and Cardiovascular CenterSuitaJapan

Personalised recommendations