Early and long-term outcomes of open surgery after thoracic endovascular aortic repair

Secondary Open Arch Operation After Prior Thoracic Endovascular Aortic Repair

BACKGROUND

Many patients required secondary open arch operation due to new aortic pathologies or complications after thoracic endovascular aortic repair (TEVAR). In this study, we investigated the outcome of secondary open arch operation after prior TEVAR.

METHODS

Fifty-seven consecutive patients underwent secondary open arch operation after prior TEVAR. The major indications were retrograde type A aortic dissection (n = 24), proximal new aortic dissection (n = 8), and type Ⅰa endoleak (n = 16). An elective operation was performed in 35 patients and an emergent operation in 22. The survival and freedom from aortic events during the follow-up were evaluated with the Kaplan-Meier survival curve and the log-rank test. The survival was also analyzed with the Cox analysis.

RESULTS

The in-hospital mortality was 7.0% (4 of 57). The mean follow-up time was 32.2 ± 19.7 months. Five late deaths occurred. The overall survival at 1 year, 3 years, and 6 years was 89.5%, 84.6%, and 79.9%, respectively. Aortic events developed in 7 patients. Freedom from aortic events after the operation at 1 year, 3 years, and 6 years was 94.2%, 83.0%, and 77.8%, respectively. There were no differences in survival and freedom from aortic events between the elective group and the emergent group. The Cox analysis identified additional coronary artery bypass grafting and hypothermic circulatory arrest as independent factors predicting survival.

CONCLUSIONS

Secondary open arch operation could be performed to treat the arch pathologies after TEVAR with acceptable early and midterm outcomes.

Organ Protection for Radical Debridement to Prevent Recurrence of Infection after Zone 1 Thoracic Endovascular Aortic Aneurysm Repair: A Case Report

We present the case of a 73-year-old man with stent graft infection, who had undergone thoracic endovascular aortic aneurysm repair with a supra-aortic bypass from the right axillary to the left common carotid and axillary arteries. The procedure included total stent graft removal, radical debridement, and in situ graft replacement via left anterolateral thoracotomy. Cerebral perfusion from the left axillary artery and cardioplegia using an occlusion balloon with moderate hypothermia were performed to reinforce organ protection. Staged omentopexy was performed the next day after initial replacement with non-contaminated instruments. The postoperative course was uneventful. No recurrence of infection has been found for 3 years.