ORIGINAL ARTICLE   

Italian Journal of Vascular and Endovascular Surgery 2017 June;24(2):41-6

DOI: 10.23736/S1824-4777.17.01288-8

Copyright © 2017 EDIZIONI MINERVA MEDICA

language: English

Open aortic arch surgery following thoracic endovascular aortic repair with debranching

Tetsuro UCHIDA ✉, Azumi HAMASAKI, Yoshinori KURODA, Atsushi YAMASHITA, Jun HAYASHI, Mitsuaki SADAHIRO

Second Department of Surgery, Faculty of Medicine, Yamagata University, Yamagata, Japan

BACKGROUND: Thoracic endovascular aortic repair (TEVAR) with supra-aortic debranching is a well-known approach for treatment of aortic arch disease in high-risk patients. However, open aortic arch surgery after TEVAR is sometimes required. We aimed to evaluate our surgical results in these patients.
METHODS: Between November 2012 and June 2016, 103 patients with thoracic aorta pathologies underwent primary TEVAR at our institution; 31 patients required supra-aortic debranching for adequate proximal endograft fixation.
RESULTS: Six of 31 (19.4%) patients required secondary interventions, including open aortic arch reoperation in 4 patients (3 women, mean age 70 years). Three of the 4 patients required secondary procedures due to stent-related complications. Post-TEVAR complications comprised progressive type Ia endoleaks (N.=2), retrograde type A aortic dissection (N.=1), and an impending rupture of an aortic root pseudoaneurysm (N.=1), not associated with primary TEVAR. All 4 patients underwent total (N.=2) or partial (N.=2) aortic arch replacement via median sternotomy. The surgical technique included total cardiopulmonary bypass, moderate hypothermia, and circulatory arrest with antegrade selective cerebral perfusion (SCP). Debranching bypass grafts were divided and used as inflow tracts for bilateral antegrade SCP individually. The transected distal stump of the aortic arch was reinforced with the previously inserted stent grafts. Distal anastomosis was completed and both stumps of the divided graft were re-anastomosed before discontinuing SCP. All patients recovered.
CONCLUSIONS: Despite the high-risk of complications, open aortic arch reoperations were successfully performed. Our proposed technique is expected to make these complex surgeries safe, simple, and less invasive.

KEY WORDS: Aortic aneurysm, thoracic - Stents - Aortic diseases - Endoleak