Long Term Results of Aortic Arch Repair Using Stent Grafting Technique

Abstract

Objective: This report elucidates the long-term safety and effectiveness of aortic arch repair using stent graft from our 12 years experience.

Methods: Open stent grafting technique: From 1994 to 2004, 126 patients (mean age 67.8 years) with different aortic arch pathologies (57 dissections and 69 aneurysms) were operated with open stent grafting technique. Under deep hypothermic circulatory arrest with selective cerebral perfusion, the stent graft was delivered through the transected proximal aortic arch and arch replacement was performed with 4 branched prosthesis.

TPEG (Transluminally Placed Endovascular Grafting) with bypass to neck vessels: From1997 to 2007, 26 patients (mean age 65.3 years) with different distal arch pathologies (17 dissections and 9 aneurysms) were operated with TPEG with bypass to neck vessels. 6 aorto-carotid and/or subclavian bypass, 4 axillary-carotid and/or axillary bypass, and 16 carotid-subclavian bypass were performed prior to TPEG.

Results: Open stent grafting technique: Operative mortality was 3.2%. Perioperative morbidity included 7 (5.6%) strokes, 3 (2.4%) paraplegias, 5 (3.9%) transient para-palesis. Sixty three percent of the patients were extubated within 24 hours. In long term follow up (mean 60.4 ± 36.5 months, maximum 153 months), survival was 81.1%, 63.3% and 53.7% at 1, 5 and 8 years. Five (3.9%) late endoleaks were observed but treated with successful additional endovascular repair. Freedom from endoleaks was 98.0%, 91.1%, 91.1% for 1, 5 and 8year respectively.

TPEG with neck bypass: Operative mortality was 3.8%. Perioperative morbidity included 1 (3.8%) minor stroke, 1 (3.8%) pulmonary embolism and 3 (11.5%) endoleak (type I). In follow up, no endoleak was observed.

Conclusion: Long term observation showed safety and good durability of hybrid procedures using stent graft for aortic arch disease. These technique could be an attractive treatment option for aortic arch aneurysm with distal extension and aortic dissection requiring aortic arch repair.