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J Thorac Cardiovasc Surg 2008;135:1261-1269
© 2008 The American Association for Thoracic Surgery

Surgery for Acquired Cardiovascular Disease

Long-term results of the open stent-grafting technique for extended aortic arch disease

^a Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
^b Department of Anesthesiology, Osaka University Graduate School of Medicine, Osaka, Japan
^c Department of Cardiovascular Surgery, Osaka General Medical Center, Osaka, Japan
^d Department of Cardiovascular Surgery, Morinomiya Hospital, Osaka, Japan

Received for publication May 3, 2007; revisions received September 27, 2007; accepted for publication October 31, 2007.

^_* Address for reprints: Yoshiki Sawa, MD, PhD, Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan. (Email: sawa{at}surg1.med.osaka-u.ac.jp).

Objective: This report elucidates the long-term safety and effectiveness of extended aortic arch replacement with an open stent-grafting technique from our 12 years of experience.

Methods: From 1994 to 2004, 126 patients (mean age 67.8 years) with different pathologic conditions of the aortic arch with extension to the descending aorta (57 dissections [acute/chronic = 31/26] and 69 aneurysms) were operated on with an open stent-grafting technique. During deep hypothermic circulatory arrest with selective cerebral perfusion, the stent graft was delivered through the transected proximal aortic arch, and arch replacement with a 4-branched prosthesis was performed.

Results: Operative mortality within 30 days was 3.2%. Perioperative morbidity included 7 (5.6%) strokes and 8 (6.3%) spinal injuries (paraplegia in 3, transient paraparesis in 5). Sixty-three percent of the patients were extubated within 24 hours. In long-term follow-up (mean 60.4 ± 36.5 months, maximum 153 months), survival was 81.1%, 63.3%, and 53.7% at 1, 5, and 8 years. Five (3.9%) late endoleaks were observed but treated with successful additional endovascular repair. Freedom from endoleaks was 98.0%, 91.1%, and 91.1% for 1, 5, and 8 years, respectively.

Conclusion: Long-term observation showed safety and good durability of the open stent-grafting technique for aortic arch disease. This technique could be an attractive treatment option for aortic arch aneurysm with distal extension and aortic dissection requiring aortic arch replacement.

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Discussion
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