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Transaortic stented graft implantation for aortic arch aneurysm. Its benefits and risk
Tomohiro Mizuno1, Masaaki Toyama, Noriyuki Tabuchi
1Department of Thoracic and Cardiovascular Surgery, Graduate School of Medicine, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan.
Objectives:
Despite steady improvements, surgery for aortic arch disease, including the distal arch, continues to result in high rates of morbidity and mortality. We have performed aortic arch repair using a transaortic stented graft implantation into the descending aorta in 8 patients who had true aortic arch aneurysms, and here have reviewed the efficacy and problems from this procedure.
Methods:
Six patients underwent transaortic stented graft implantation into the descending aorta with bypass to the arch vessels. The other two underwent stented graft implantation into the descending aorta with replacement of the ascending aorta and aortic arch. One patient had a ruptured aneurysm.
Results:
Each operation was performed via a median sternotomy without left thoracotomy. There was no new postoperative occurrence of left recurrent laryngeal nerve palsy. All the five patients without perioperative neurological complication could be extubated within 24 h after surgery. In each case, postoperative enhanced computed tomography scans showed successful thromboexclusion of the aneurysm. There was no endoleak and no graft migration. One patient suffered cerebral injury. Spinal cord injury occurred in 2 patients, and this serious complication may have been caused by prolonged ischemia in the lower body and the long stented graft.
Conclusions:
This surgical strategy was effective for arch aneurysm and produced less damage than a conventional procedure to the postoperative respiratory function, while the operative technique need to be improved to decrease the frequency of brain and spinal cord injury.