ANTEGRADE DESCENDING STENT IMPLANTATION FOR ACUTE TYPE A AORTIC DISSECTION REPAIR IS SAFE AND IMPROVES THE OUTCOME
Peter Matt1, Prerana Banerjee1, Ulrich Schurr1, Florian Rueter1, Jens Fassl2, Martin Grapow1, Oliver Reuthebuch1, Friedrich Eckstein1.
1Division of Cardiac Surgery, Basel, Switzerland, 2Division of Anesthesia and Intensive Care Medicine, Basel, Switzerland.
OBJECTIVE: We hypothesized that antegrade stent graft implantation into the descending aorta during acute type A aortic dissection (AAAD) surgery is safe and does not increase the perioperative risk compared to standard open repair.
METHODS: All consecutive patients undergoing surgery for AAAD at our institution from 2010 to 2014. 87 patients underwent hemiarch replacement in hypothermic circulatory arrest, HCA (standard group). Since 2013, 17 patients underwent the standard procedure combined with antegrade delivery of a covered conformable stent into the descending aorta (stented group). All data were prospectively collected.
RESULTS: The logistic EuroSCORE was mean 41 (standard) vs. 36 (stented), p=0.9. Circulatory perfusion time was 147 (standard) vs. 153 (stented) min, p=0.7; aortic clamping 88 (standard) vs. 89 (stented) min, p=0.9. Lowest body temperatures was 23 degree Celsius in both groups, p=0.3. Stented patients had longer circulatory arrest times with antegrade cerebral perfusion, 29 vs. 21 min, p<0.001. Implanted stent sizes ranged from 31-37 mm, stent lengths from 10-15 cm. Stroke occurred in 16% (standard) vs. 7% (stented), p=0.4; paraplegia developed in 2% (standard) vs. 0% (stented), p=1. Maximum creatinine values were 163 µmol/l (standard) vs. 150 µmol/l (stented), p=0.3. Abdominal intervention due to intestinal ischemia was needed in 12 patients, 14% (standard) vs. 1 patient, 7% (stented), p=0.4. ICU time was 9 days (standard) vs. 8 days (stented), p=0.6. 30-day mortality was 17% (standard) vs. 0% (stented) (p=0.07). 6-month survival was better in patients with an implanted stent compared to the standard group, 100% vs. 82% (p=0.06).
CONCLUSIONS: Antegrade stent graft implantation into the descending aorta during AAAD repair is a safe procedure. It increases the HCA time little without increase in perioperative morbidity and mortality. In contrast, this technique is associated with less perioperative complications and might improve the outcome.
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