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J Thorac Cardiovasc Surg 2009;138:46-53
© 2009 The American Association for Thoracic Surgery

Acquired Cardiovascular Disease

Hybrid endovascular aortic arch repair using branched endoprosthesis: The second-generation "branched" open stent-grafting technique

^a Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
^b Department of Cardiovascular Surgery, Osaka General Medical Center, Osaka, Japan

Received for publication May 2, 2008; revisions received November 18, 2008; accepted for publication March 15, 2009.

^_* 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: We advanced the open stent-grafting technique with a branched endoprosthesis, which reconstructs simultaneously the cervical branches and descending aorta within an acceptably short interval of deep hypothermic circulatory arrest. In this study, we evaluated the efficacy of this new technique and assessed the early and midterm results.

Methods: From January 2004 to September 2007, the branched open stent-grafting technique was performed in 69 cases (55 men, average age 66.2 years, 36 degenerative aneurysms and 33 aortic dissections, 13 [18.8%] in emergency, 7 [10.1%] redo cases). Under deep hypothermic circulatory arrest, the branched endoprosthesis was delivered through the opened proximal aortic arch, and total arch repair was completed. To avoid cerebral embolism, retrograde cerebral perfusion was performed at the end of deep hypothermic circulatory arrest.

Results: Average time of operation, cardiopulmonary bypass, and deep hypothermic circulatory arrest was 417, 130, and 36 minutes, respectively. A total of 124 cervical stent grafts were inserted and successfully delivered in 121 (97.6%). Operative mortality within 30 days was 3 (4.3%). The major postoperative complications involved 4 (5.8%) strokes and 2 (2.9%) spinal cord injuries. No aorta-related death was observed after discharge from hospital, and the survival was 90.9%, 88.8%, and 88.8% at 1, 2, and 3 years, respectively. Six (5.0%) cervical stent grafts showed endoleak; however, all these cases were successfully treated by additional endovascular repair.

Conclusion: Aortic arch repair with branched open stent grafting is an effective technique with satisfactory early results. In midterm analysis, cervical branch events were acceptably rare and controllable. This technique could be an attractive alternative to conventional total arch replacement.

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