One-stage repair in complex multisegmental thoracic aneurysmal disease: Results of a multicentre study

Objectives: Patients with thoracic aneurysmal disease involving the arch and the descending or thoracoabdominal aorta may require more than one surgical intervention. The results of one-stage repair using a hybrid stent-graft in the frozen elephant trunk manner are presented. Methods: Between January 2005 and March 2012, 113 (age 67 \ub1 10 years) of 358 registered patients in the International E-Vita Open\uae Registry were operated on for combined arch and descending and thoracoabdominal aortic aneurysm. Thirty-one (27%) patients had a previous cardiothoracic, abdominal aortic surgery or endovascular repair. The E-Vita Open\uae hybrid stent-graft was used in all cases. Postoperatively and during the follow-up (100%), aortic image examinations were performed. Results: Combined arch replacement and antegrade stent-grafting distally (graft diameter 34 \ub1 4 mm) were performed under selective cerebral perfusion (72 \ub1 27 min) and hypothermic visceral ischaemia (65 \ub1 27 min). Postoperatively, aneurysm exclusion was completely and partially achieved in 80% and 20%, respectively. In-hospital mortality and survival rate after 5 years were 12% (13 of 113) and 78%, respectively. Latest aortic imaging demonstrated 93% complete aneurysm exclusion. Freedom from secondary endovascular intervention and open surgery were 88 and 90%, respectively. CONCLUSIONS: In multisegmental thoracic aneurysmal disease, combined arch replacement with distal repair by a hybrid stent-graft enables one-stage treatment with acceptable mortality. Aneurysm exclusion by the stent-graft seems to be primarily curative and allows easier access for distal open or endovascular reintervention. \ua9 The Author 2013. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved