TY - JOUR
T1 - Global experience with an inner branched arch endograft
AU - Haulon, Stéphan
AU - Greenberg, Roy K.
AU - Spear, Rafaëlle
AU - Eagleton, Matt
AU - Abraham, Cherrie
AU - Lioupis, Christos
AU - Verhoeven, Eric
AU - Ivancev, Krassi
AU - Kölbel, Tilo
AU - Stanley, Brendan
AU - Resch, Timothy
AU - Desgranges, Pascal
AU - Maurel, Blandine
AU - Roeder, Blayne
AU - Chuter, Timothy
AU - Mastracci, Tara
N1 - Publisher Copyright:
© 2014 The American Association for Thoracic Surgery.
PY - 2014/10/1
Y1 - 2014/10/1
N2 - Background: Branched endografts are a new option to treat arch aneurysm in high-risk patients.Methods and results: We performed a retrospective multicenter analysis of all patients with arch aneurysms treated with a new branched endograft designed with 2 inner branches to perfuse the supra aortic trunks. Thirty-eight patients were included. The median age was 71 years (range, 64-74 years). An American Society of Anesthesiologists score of 3 or 4 was reported in 89.5%(95%confidence interval [CI], 79.7-99.3) of patients. The 30-day mortality rate was 13.2%(95%CI, 2.2-24.2). Technical success was obtained in 32 patients (84.2% [95% CI, 72.4-95.9]). Early secondary procedures were performed in 4 patients (10.5% [95% CI, 0.7-20.3]). Early cerebrovascular complications were diagnosed in 6 patients (15.8% [95% CI, 4.0-27.6]), including 4 transient ischemic attacks, 1 stroke, and 1 subarachnoid hemorrhage. The median follow-up was 12 months (range, 6-12 months). During follow-up, no aneurysm-related death was detected. Secondary procedures during follow-up were performed in 3 patients (9.1% [95% CI, 0.0-19.1]), including 1 conversion to open surgery. We compared the first 10 patients (early experience group) with the subsequent 28 patients. Intraoperative complications and secondary procedures were significantly higher in the early experience group. Although not statistically significant, the early mortality was higher in the early experience group (30% [95% CI, 0.0-60.0]) versus the remainder (7.1% [95% CI, 0.0-16.9]; P = .066). Being part of the early experience group and ascending aortic diameter 38 mm were found to be associated to higher rates of combined early mortality and neurologic complications.Conclusions: Our preliminary study confirms the feasibility and safety of the endovascular repair of arch aneurysms in selected patients who may not have other conventional options. Clinical trial registration information: Thoracic IDE NCT00583817, FDA IDE# 000101.
AB - Background: Branched endografts are a new option to treat arch aneurysm in high-risk patients.Methods and results: We performed a retrospective multicenter analysis of all patients with arch aneurysms treated with a new branched endograft designed with 2 inner branches to perfuse the supra aortic trunks. Thirty-eight patients were included. The median age was 71 years (range, 64-74 years). An American Society of Anesthesiologists score of 3 or 4 was reported in 89.5%(95%confidence interval [CI], 79.7-99.3) of patients. The 30-day mortality rate was 13.2%(95%CI, 2.2-24.2). Technical success was obtained in 32 patients (84.2% [95% CI, 72.4-95.9]). Early secondary procedures were performed in 4 patients (10.5% [95% CI, 0.7-20.3]). Early cerebrovascular complications were diagnosed in 6 patients (15.8% [95% CI, 4.0-27.6]), including 4 transient ischemic attacks, 1 stroke, and 1 subarachnoid hemorrhage. The median follow-up was 12 months (range, 6-12 months). During follow-up, no aneurysm-related death was detected. Secondary procedures during follow-up were performed in 3 patients (9.1% [95% CI, 0.0-19.1]), including 1 conversion to open surgery. We compared the first 10 patients (early experience group) with the subsequent 28 patients. Intraoperative complications and secondary procedures were significantly higher in the early experience group. Although not statistically significant, the early mortality was higher in the early experience group (30% [95% CI, 0.0-60.0]) versus the remainder (7.1% [95% CI, 0.0-16.9]; P = .066). Being part of the early experience group and ascending aortic diameter 38 mm were found to be associated to higher rates of combined early mortality and neurologic complications.Conclusions: Our preliminary study confirms the feasibility and safety of the endovascular repair of arch aneurysms in selected patients who may not have other conventional options. Clinical trial registration information: Thoracic IDE NCT00583817, FDA IDE# 000101.
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U2 - 10.1016/j.jtcvs.2014.02.072
DO - 10.1016/j.jtcvs.2014.02.072
M3 - Article
C2 - 24685375
AN - SCOPUS:84908240883
SN - 0022-5223
VL - 148
SP - 1709
EP - 1716
JO - Journal of Thoracic and Cardiovascular Surgery
JF - Journal of Thoracic and Cardiovascular Surgery
IS - 4
ER -