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Updated: Mar 8, 2026
Novel and Innovative Hybrid Technique for Type A Aortic Dissection
Published on: March 28, 2025
Long-term experience with the E-vita Open hybrid graft in complex thoracic aortic disease†
Heinz Jakob1, Daniel Dohle1, Jaroslav Benedik1
1Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Centre, University Hospital Essen, Essen, Germany.
Insights
The E-vita Open hybrid stent graft offers durable long-term treatment for acute aortic dissection, chronic aortic dissection, and thoracic aortic aneurysms. It provides a reliable solution for complex aortic conditions with a low reintervention rate.
Area of Science:
- Cardiovascular Surgery
- Medical Devices
- Aortic Disease Management
Background:
- The E-vita Open hybrid stent graft is designed for one-stage treatment of proximal and distal thoracic aorta pathologies.
- It addresses acute aortic dissection (AAD), chronic aortic dissection (CAD), and complex thoracic aortic aneurysms (TAA).
Purpose of the Study:
- To evaluate the long-term (up to 10 years) outcomes of the E-vita Open hybrid stent graft.
- To assess its efficacy in treating AAD, CAD, and TAA.
Main Methods:
- A consecutive series of 178 patients treated with the E-vita Open hybrid graft between February 2005 and March 2015.
- Data collection included pre-, intra-, and postoperative variables, procedural improvements, and long-term follow-up with aortic remodelling analyses.
Main Results:
- 30-day mortality was 10% overall. Significant risk factors for in-hospital death included low ejection fraction and compromised hemodynamics.
- Seven-year survival rates were 55% (AAD), 74% (CAD), and 73% (TAA). Freedom from aorta-related late death was high (91-100%).
- Positive aortic remodeling was observed in 82-92% of patients, with low rates of downstream endovascular intervention (74-96%) and thoraco-abdominal surgery (65-97%).
Conclusions:
- The E-vita Open hybrid stent graft demonstrates durable long-term performance with no proximal endoleaks or graft failures.
- It serves as an effective landing zone for subsequent thoracic endovascular repair or thoraco-abdominal surgery if needed.
- The graft effectively manages aortic disease down to the mid-thoracic level, minimizing the need for reinterventions.
Objectives:
The E-vita Open hybrid stent graft is intended to achieve one-stage treatment of the proximal and distal thoracic aorta down to the mid-thoracic level in cases of acute (AAD) or chronic (CAD) type I aortic dissection and complex thoracic aortic aneurysm (TAA). We report our long-term results up to 10-year experience.
Methods:
From February 2005 until March 2015, 178 consecutive patients (mean age 59 ± 11 years) underwent surgery using the E-vita Open hybrid graft for AAD ( n = 96), CAD ( n = 43) or TAA ( n = 39). Pre-, intra- and postoperative variables, influential procedural improvements and follow-up data including aortic remodelling analyses are presented.
Results:
Overall 30-day mortality was 10%, 10% for AAD, 7% for CAD and 13% for TAA. Univariable analysis identified low left ventricular ejection fraction, peripheral arterial disease, chronic obstructive pulmonary disease and severely compromised haemodynamics as risk factors for in-hospital death. Logistic regression analysis defined compromised haemodynamics and duration of cardiopulmonary bypass as significant. After 7 years, estimated survival was 55% for AAD, 74% for CAD and 73% for TAA patients. Freedom from aorta-related late death was 94%, 91% in AAD, 100% in CAD and 97% in TAA. Positive or stable aortic remodelling down to the stent graft end was achieved in 92% AAD, 82% in CAD and full aneurysmal exclusion in 88%. Further downstream, negative remodelling was observed in 27% of the AAD, 41% of the CAD and 22% of the TAA patients. Freedom from endovascular intervention downstream was 96% in AAD, 75% in CAD and 74% in TAA patients. Freedom from thoraco-abdominal surgery was 97%, 65% and 93%, respectively.
Conclusions:
The E-vita Open hybrid stent graft renders durable long-term performance without any proximal endoleakage or graft failure over time and represents the ideal landing or docking zone for either thoracic endovascular thoracic repair or thoraco-abdominal surgery, if required. No reinterventions were necessary down to the end of the stent graft, proving that the disease is overcome along the hybrid graft down to mid-thoracic level.
