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Interstage mortality in two-stage elephant trunk surgery.

Ayman Saeyeldin1,2,3, Anton A Gryaznov1,4, Mohammad A Zafar1

  • 1Aortic Institute at Yale-New Haven, Yale University School of Medicine, New Haven, Connecticut, USA.

Journal of Cardiac Surgery
|February 26, 2021
PubMed
Summary
This summary is machine-generated.

The two-stage elephant trunk (ET) approach for extensive thoracic aortic aneurysm (TAA) has a cumulative mortality of 18.6%. Despite risks, this aggressive strategy is warranted due to disease severity, not interstage rupture fears.

Keywords:
aortic aneurysmaortic dissectionelephant trunkmega-aortamortality

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Area of Science:

  • Cardiovascular Surgery
  • Thoracic Surgery
  • Aortic Disease Management

Background:

  • Extensive thoracic aortic aneurysms (TAA) present significant management challenges.
  • The open two-stage elephant trunk (ET) approach is utilized for complex TAA cases.
  • Concerns exist regarding interstage mortality associated with the two-stage ET procedure.

Purpose of the Study:

  • To evaluate the safety and outcomes of the two-stage ET approach for extensive TAA.
  • To assess interstage mortality and overall cumulative mortality.
  • To determine if the benefits outweigh the risks in managing complex aortic disease.

Main Methods:

  • A retrospective review of 152 patients undergoing Stage I ET procedures between 2003 and 2018.
  • Analysis of planned versus completed Stage II ET procedures.
  • Assessment of in-hospital, interstage, and 30-day post-Stage II mortality, as well as complications like stroke and paraplegia.

Main Results:

  • In-hospital mortality for Stage I was 3.3%.
  • Interstage mortality for patients planned for Stage II was 8.3% (5/6).
  • 30-day mortality after Stage II was 10.3%, with 12% stroke and 5.1% paraplegia rates.

Conclusions:

  • The overall cumulative mortality for the two-stage ET approach was 18.6%.
  • This mortality rate is considered commensurate with the high severity of extensive TAA.
  • The study suggests that fear of interstage rupture should not deter the aggressive two-stage ET approach for extensive TAA.