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



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.


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.


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).


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.


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




Compliance with ethical standards

Conflict of interest

All authors declare that they have no conflict of interest.


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Copyright information

© The Japanese Association for Thoracic Surgery 2019

Authors and Affiliations

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

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