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Arch replacement with collared elephant trunks: The Siena approach
- Source :
- JTCVS Techniques
- Publication Year :
- 2020
-
Abstract
- Objective To illustrate our experience and results in patients with diffuse aneurysmal disease treated with arch replacement using the Siena collared graft, a device designed in 2002 to improve the elephant trunk technique. Results of the first step surgical implant and the subsequent treatment strategies, with extensive use of endovascular techniques, are reported. Methods All aortic arch–replacement procedures using the Siena graft between February 2002 and January 2020 were retrospectively analyzed for early and late clinical outcomes. Results Of 146 patients (54 women, 36.9%) with a median age of 69.1 years (interquartile range 58.4-75.0 years), 55 (37.6%) had acute/chronic dissection with false lumen aneurysmal dilatation, 91 (62.3%) had degenerative aneurysms, 45 (30.8%) were redo operations, and 14 (9.5%) had connective tissue disease. First-stage outcomes: 10.9% 30-day mortality (n = 16); 5.4% stroke (n = 8, 6 disabling, 2 nondisabling; 3 fatal); and 0.6% paraplegia. Outcomes for 113 second-stage procedures (77.3%, n = 97 endovascular [66.4%], n = 16 surgical [10.9%]) were 5.3% and 8.8% 30-day and 180-day mortality; no stroke; 10.6% paraplegia. Median follow-up was 5.7 years (range: 0-18.02 years) median survival was 16.65 years (95% lower confidence limit, 10.06 years) with no significant difference between aneurysm and dissection patients. Freedom from further treatment was 87.0% (95% confidence interval, 79.9%-94.7%) at 5 years and 71.4% (95% confidence interval, 71.4%-84.7%) at 10 years; median time to reintervention was 2.59 years (interquartile range, 0.52-5.20 years) with no difference (P = .22) between dissection and aneurysm groups. Conclusions Siena collared graft represents a reliable platform for the treatment of diffuse aneurysmal disease. This device offers the flexibility required in the treatment of extended aortic lesions and guarantees the choice of the most appropriate approach for treatment completion. In this context, the availability of hybrid grafts has not modified the role of this device in arch surgery.<br />Graphical abstract Study outline and the main results of our experience.
- Subjects :
- Pulmonary and Respiratory Medicine
medicine.medical_specialty
Elephant trunks
aortic arch surgery
CSF, cerebrospinal spinal fluid
Context (language use)
thoracic endovascular repair
TEVAR, thoracic endovascular aortic repair
ET, elephant trunk
Aneurysm
Interquartile range
SINE, stent graft–induced new entry tear
Medicine
Stroke
Adult: Aorta
IQR, interquartile range
business.industry
PAU, penetrating aortic ulcer
LCL, lower confidence limit
OSR, open surgical repair
medicine.disease
elephant trunk technique
Confidence interval
Surgery
CT, computed tomography
CI, confidence interval
OR, odds ratio
Dissection
aorta
business
Paraplegia
Subjects
Details
- ISSN :
- 26662507
- Volume :
- 6
- Database :
- OpenAIRE
- Journal :
- JTCVS techniques
- Accession number :
- edsair.doi.dedup.....59daab4070cb8e64647ed42c5569da8b