Clinical Study of the First-Stage Antegrade Thoracic Endovascular Aortic Repair after Total Arch Replacement

Taisuke Nakayama, Shingo Isshiki, Mayuko Nakayama, Takashi Harada, Hideki Sasaki, Hiroshi Ishitoya

Ehime prefectural central hospital, Matsuyama city, Japan

Date, time and location: 2018.05.26 15:30, Exhibition area, 1st Floor. Zone – A

Abstract

Objective

We aimed to determine the outcomes of first-stage antegrade thoracic endovascular aneurysm repair (TEVAR) via a median sternotomy using an elephant trunk graft after total arch replacement (TAR) to treat extensive thoracic aortic lesions.

Methods

Among 28 patients who underwent aortic repair between 2014 and 2017, eight who were at high risk consented to the procedure under emergency circumstances. We compared outcomes between patients with poor and good outcomes.

Results

Outcomes were poor (hospital death, major complications, hospitalization for >50 days) and good for nine and 19 patients, respectively.The patients with poor outcomes were older (age: 78±6 vs. 69±11 years, P=0.016) and had worse renal function (eGFR 44±21 vs. 68±19, P=0.007) and higher EURO Score IIvalues (13±10.2 vs. 6±7.2, P=0.047) than those with good outcomes. Rates of emergencies and concomitant operations were similar between the groups, but the durations of surgery and of cardiopulmonary bypass were longer (595±122 vs. 486±106 minutes, P=0.023, and 269±79 vs. 190±34 minutes, P=0.001, respectively) for those with poor outcomes. However, these differences did not reach significance in multivariate analyses. Therefore, risk scores of 1 point were assigned to the following factors: age >75 years, eGFR <50, EURO Score II >8, and surgical duration >540 minutes. The risk score was significantly higher in patients with poor outcomes (2.55±1.03 vs. 0.79±1.03, P<0.0001). Two cut-offs were identified in ROC curves, indicating that outcomes were poorer for patients with more than two risk factors.

Conclusions

The outcomes of first-stage TEVAR using the elephant trunk graft after TAR are acceptable.  However, second-stage retrograde TEVAR might be advisable instead of one-stage repair considering the possibility of poor outcomes.