ORIGINAL ARTICLE  VASCULAR SECTION 

The Journal of Cardiovascular Surgery 2017 December;58(6):818-27

DOI: 10.23736/S0021-9509.16.09447-7

Copyright © 2016 EDIZIONI MINERVA MEDICA

lingua: Inglese

Outcomes analysis of stent-graft repair for thoracic aorta emergencies

Mourad BOUFI ^{1, 2} ✉, Florent VERNET ², Bianca DONA ², Olivier HARTUNG ², Anderson D. LOUNDOU ³, Martine HACCOUN ⁴, Marc LEONE ⁴, Yves S. ALIMI ^{1, 2}

¹ Aix-Marseille Université, IFSTTAR, UMR T24, 13916, Marseille, France; ² Department of Vascular Surgery, University Hospital Nord, Marseille, France; ³ Department of Public Health, Aix-Marseille Université, Marseille, France; ⁴ Department of Anesthesiology and Critical Care Medicine, University Hospital Nord, Marseille, France

BACKGROUND: This study aimed to identify patient, pathology and procedure-related factors affecting perioperative and mid-term mortality of thoracic aorta emergencies.
METHODS: Between 2007 and 2014, patients treated emergently with thoracic stent-graft were retrospectively reviewed. Variables analyzed were: age, renal insufficiency, shock, cardiac arrest, transfer status, pathology, debranching procedures, operation duration, vascular access and European System for Cardiac Operative Risk Evaluation (EuroSCORE). Seventy-four patients (54.5±22 years) were treated for traumatic rupture (N.=31), aneurysm (TAA) (N.=16), acute aortic syndrome (N.=18), aorto-esophageal fistula (N.=2), floating thrombus (N.=7). Thirty-four patients (46%) were in shock, including 3 suffering preoperative cardiac arrest. Proximal landing zones were: zone 0 (N.=4), zone 1 (N.=4), zone 2 (N.=37), zone 3 (N.=21) and zone 4 (N.=8). Debranching procedures were performed in 16 cases (22%).
RESULTS: Perioperative all-cause- mortality was 18.9% (N.=14). Univariable analysis identified age, renal insufficiency, shock, transfer status, cardiac arrest, debranching procedures in zones 0 or 4 and EuroSCORE as predictors of death (P=0.002, P=0.001, P=0.002, P=0.05, P=0.006, P=0.028, P<0.001 respectively). Multivariable analysis pinpointed shock and renal insufficiency as independent risk factors. Over a mean 41 months follow-up, survival was 72% at both 1 and 3 years and was impacted by pathology and debranching procedures. Aortic re-intervention rate was 12% (N.=9), significantly higher in TAA group (P=0.004).
CONCLUSIONS: Hemorrhagic shock remains highly lethal for endovascular repair. Hybrid procedures in zones 0 or 4 should be avoided to improve short and mid-term outcomes. TAA groups require close surveillance to detect late events.

KEY WORDS: Endovascular procedures - Aorta, thoracic - Emergencies - Mortality