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OBJECTIVE:
Thoracic endovascular aortic repair (TEVAR) combined with supra-aortic debranching and revascularization emerged as a promising approach for the patients with distal aortic arch disease, especially for an aged population with multiple comorbidities. We evaluate the early outcomes of debranching TEVAR without sternotomy nor thoracotomy in these high risk patients.
METHODS:
This study was a retrospective analysis of clinical records. From March 2009 to November 2011, 20 high risk patients with distal aortic arch disease underwent debranching TEVAR without sternotomy nor thoracotomy. The mean age was 76±11 years at operation, and there were 14 male and 6 female. Aortic pathology included 16 true aneurysms and 4 aortic dissections. The average size of aneurysm was 59±9 mm. As to proximal landing zone, Z0 was involved in 4, Z1 in 8 and Z2 in 8 cases. The bypass of right axillary artery-left axillary artery was performed in 9 cases, and right axillary artery-left common carotid artery and left axillary artery with bifurcated graft in 11 cases. All bypasses were placed outside the thoracic wall. Fenestrated stent graft was used in two cases. Chimney technique was applied in 5 cases. The Excluder TAG device was used in 16 cases, Najuta in 2 cases, Talent in one case, and hand-made device in one case. Urgent operation was performed in two cases. The mean logistic EuroSCORE was 26.6±19.7%. The mean follow-up period was 10.4 months.
RESULTS:
Primary technical success was achieved in all cases. There was one 30-day mortality (5%) due to low cardiac output syndrome. Perioperative morbidities were found in two cases (10%), and both are stroke caused during the procedure. No endoleak or graft migration was observed by postoperative computed tomography scans, and all bypass grafts remained patent during the follow-up period. We had no experience of paraplegia, new aortic event, or surgical site infection.
CONCLUSIONS:
The early outcomes of the debranching TEVAR without sternotomy nor thoracotomy are satisfactory and encouraging. This procedure has the advantage of simpleness, less invasiveness, and no possibility of sternal infection compared with sternotomical approach especially in high risk patients with distal aortic arch disease.