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Published on: May 21, 2017
Stent-grafting of the thoracic aorta by the cardiothoracic surgeon
Burkhart Zipfel1, Robert Hammerschmidt, Thomas Krabatsch
1Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, Berlin, Germany. zipfel@dhzb.de
Insights
Endovascular stent-grafting shows promising results for thoracic aortic surgery, even in complex emergency cases. Cardiothoracic surgeons can perform this procedure with adequate training, offering a viable alternative to open repair.
Area of Science:
- Cardiovascular Surgery
- Endovascular Techniques
- Thoracic Aorta Interventions
Background:
- Endovascular stent-grafting is an emerging technique for aortic surgery.
- This study evaluates its application in thoracic aortic interventions.
Purpose of the Study:
- To assess the efficacy and safety of endovascular stent-grafting in thoracic aortic surgery.
- To determine outcomes in a large patient cohort, including emergency procedures.
Main Methods:
- 196 stent-grafts were implanted in 172 patients, with 57% of operations being emergencies.
- Procedures were performed in the operating room, with 12% reoperations for endoleaks.
- Access methods included femoral cut-down and conduit approaches, with 10 cases requiring surgical reconstruction of access vessels.
Main Results:
- Thirty-day mortality was 9.7%, and paraplegia occurred in 1.0% of patients.
- Primary technical success was 85.2%, with secondary success at 91.8%.
- Actuarial survival rates were 79% at 1 year, 67% at 3 years, and 55% at 5 years.
Conclusions:
- Endovascular stent-grafting provides excellent results for thoracic aortic disease, especially in emergency settings.
- Cardiothoracic surgeons can perform this procedure after training, but surgical skills are essential for access vessel management and potential conversions.
- The operating room is the recommended setting for these interventions.
Background:
We evaluated endovascular stent-grafting as a new technique in aortic surgery.
Methods:
One hundred ninety-six stent-grafts were implanted in the thoracic aorta in 172 patients. All procedures but one were performed in the operating room by a team of cardiothoracic surgeons; 112 operations (57%) were emergency procedures. Twenty-four procedures (12%) were reoperations for endoleaks. The left subclavian artery origin was covered in 46 cases and the left common carotid artery in 2 cases. Access was by femoral cut-down in 174 procedures, percutaneous femoral approach in 1, and by conduit to the iliac arteries or infrarenal aorta in 17. Surgical reconstruction of damaged access vessels became necessary in 10 cases.
Results:
Thirty-day mortality was 9.7% (19 patients). Paraplegia occurred in 1.0% (2 patients). Primary technical success was 85.2%, secondary 91.8%. Six conversions to open repair were necessary, 3 during the procedures and 3 secondarily before discharge. Actuarial survival was 79% at 1 year, 67% at 3 years, and 55% at 5 years.
Conclusions:
The results are excellent, taking into account the high incidence of emergency procedures and that open surgery is not promising in many patients. The cardiothoracic surgeon can perform the procedure after adequate training in endovascular techniques. Surgical skills are mandatory because of the potential need for extended surgical approach to the access vessels or immediate conversion to open surgery. Therefore, the operating room is the preferred site for this procedure.
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