Outcomes of secondary procedures after primary thoracic endovascular aortic repair†.

Autor:	Nozdrzykowski M; Department of Cardiac Surgery, Leipzig Heart Centre - University of Leipzig, Leipzig, Germany mnozdrzykowski@yahoo.de., Luehr M; Department of Cardiac Surgery, Leipzig Heart Centre - University of Leipzig, Leipzig, Germany., Garbade J; Department of Cardiac Surgery, Leipzig Heart Centre - University of Leipzig, Leipzig, Germany., Schmidt A; Department for Interventional Angiology, University Hospital Leipzig, Leipzig, Germany., Leontyev S; Department of Cardiac Surgery, Leipzig Heart Centre - University of Leipzig, Leipzig, Germany., Misfeld M; Department of Cardiac Surgery, Leipzig Heart Centre - University of Leipzig, Leipzig, Germany., Mohr FW; Department of Cardiac Surgery, Leipzig Heart Centre - University of Leipzig, Leipzig, Germany., Etz CD; Department of Cardiac Surgery, Leipzig Heart Centre - University of Leipzig, Leipzig, Germany.
Jazyk:	angličtina
Zdroj:	European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery [Eur J Cardiothorac Surg] 2016 Mar; Vol. 49 (3), pp. 770-7. Date of Electronic Publication: 2015 Sep 04.
DOI:	10.1093/ejcts/ezv279
Abstrakt:	Objectives: The purpose of this study is to retrospectively evaluate, with an 'all-comers' approach, the survival and outcome of patients following secondary surgical or interventional procedures after thoracic endovascular aortic repair (TEVAR). Methods: Between October 2002 and December 2013, 371 patients with different aortic pathologies underwent primary TEVAR at our institution. Fifty-six out of the 371 patients (15.1%, 18 females, mean age 62.3 ± 13.7 years) required secondary procedures, either interventionally (N = 31; 55.4%) or surgically (N = 25; 44.6%), due to stent graft-related complications. After TEVAR complications comprised endoleaks (N = 28; 7.5%), organ malperfusion (N = 9; 2.4%), aorto-oesophageal/-bronchial fistulae (N = 9; 2.4%), stent graft infections (N = 4; 1.1%), aneurysm progression (N = 3; 0.8%), retrograde type A aortic dissection (N = 2; 0.5%) and aortic regurgitation (N = 1; 0.3%). Results: The overall in-hospital mortality rate was 10.7% (N = 5): open surgery (N = 1; 4%) versus reintervention (N = 5; 16%; P = 0.14). The cumulative survival rates after secondary procedures at 6 months, 1 year and 3 years were 80.4, 73.5 and 69.3%, respectively. Postoperative complications either for open surgery or reintervention comprised stroke (8 vs 9.6%; P = 0.82), paraplegia (4 vs 6.4%; P = 0.68), renal failure (16 vs 3.2%; P = 0.09), respiratory failure (12 vs 0%; P = 0.04), sepsis (16 vs 3.2%; P = 0.87), organ malperfusion (4 vs 3.2%; P = 0.87) and need for a tertiary procedure (8 vs 6.4%; P = 0.82). Conclusions: Stent graft complications after primary TEVAR were not infrequent and often required secondary procedures for definite treatment. Endoleaks (type Ia), organ malperfusion, stent graft infections, fistula formation and expanding aneurysm occurred predominantly during early and mid-term follow-up. Despite the high-risk nature of the complications, secondary open surgical or interventional procedures may be successfully performed with an acceptable outcome. (© The Author 2015. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.)
Databáze:	MEDLINE
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