A 23-year experience with the reversed elephant trunk technique for staged repair of extensive thoracic aortic aneurysm
| Autor: | Matt D. Price, Ourania Preventza, Qianzi Zhang, Heidi M. Krause, Susan Y. Green, Joseph S. Coselli, Hiruni S. Amarasekara, Scott A. LeMaire |
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| Rok vydání: | 2022 |
| Předmět: |
Male
Pulmonary and Respiratory Medicine Aortic arch medicine.medical_specialty Elephant trunks 030204 cardiovascular system & hematology Thoracic aortic aneurysm Blood Vessel Prosthesis Implantation 03 medical and health sciences Aortic aneurysm 0302 clinical medicine Aneurysm Postoperative Cognitive Complications medicine.artery Ascending aorta medicine Humans Prospective Studies Aged Retrospective Studies Aortic dissection Aorta Aortic Aneurysm Thoracic business.industry Middle Aged Thoracic Surgical Procedures medicine.disease Surgery Aortic Dissection 030228 respiratory system cardiovascular system Female Cardiology and Cardiovascular Medicine business |
| Zdroj: | The Journal of Thoracic and Cardiovascular Surgery. 163:1252-1264 |
| ISSN: | 0022-5223 |
| DOI: | 10.1016/j.jtcvs.2020.09.148 |
| Popis: | Objective The reversed elephant trunk technique permits staged repair of extensive thoracic aortic aneurysm in patients whose distal (ie, descending thoracic and thoracoabdominal) aorta is symptomatic or disproportionately large compared with their proximal aorta (ie, ascending aorta and transverse aortic arch). We present our 23-year experience with the reversed elephant trunk approach. Methods Between 1994 and 2017, 94 patients (median age 62 [46-69] years) underwent stage 1 reversed elephant trunk repair of the distal aorta. Fifty-three patients (56%) had aortic dissection, and 31 patients (33%) had heritable thoracic aortic disease. Eighty-eight operations (94%) were Crawford extent I or II thoracoabdominal aortic repairs. Twenty-seven patients (29%) underwent subsequent stage 2 repair of the proximal aorta; 14 patients (52%) required redo median sternotomy. The median time between the stage 1 and 2 operations was 18.8 (4.8-69.3) months. Results The operative mortality was 10% (9/94) for stage 1 repairs and 4% (1/27) for stage 2 repairs; 1 patient with heritable thoracic aortic disease died after stage 1 repair (1/31, 3%), and 1 patient died after stage 2 repair (1/13, 8%). Two patients (2%) had ruptures after stage 1 repair; 1 resulted in death, and 1 precipitated emergency stage 2 repair. In total, 36 patients (38%) who survived stage 1 repair died before stage 2 reversed elephant trunk completion repair could be performed. Conclusions Managing extensive aortic aneurysm with the 2-stage reversed elephant trunk technique yields acceptable short-term outcomes. This technique is useful for the reversed elephant trunk in patients who require distal aortic repair before proximal repair and is particularly effective in patients with heritable thoracic aortic disease. The low number of patients returning for completion repair is concerning. Rigorous surveillance is needed. |
| Databáze: | OpenAIRE |
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