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Ann Thorac Surg 2007;83:441-449
© 2007 The Society of Thoracic Surgeons

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J. Maxwell Chamberlain Memorial Paper for Adult Cardiac Surgery

Stent-Grafting of the Thoracic Aorta by the Cardiothoracic Surgeon

Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, Berlin, Germany

Accepted for publication September 7, 2006.

^_* Address correspondence to Dr Zipfel, Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, Augustenburger Platz 1, Berlin 13353, Germany (Email: zipfel{at}dhzb.de).

Presented at the Forty-second Annual Meeting of The Society of Thoracic Surgeons, Chicago, IL, Jan 30–Feb 1, 2006. Winner of the J. Maxwell Chamberlain Memorial Award for Adult Cardiac Surgery.

BACKGROUND: We evaluated endovascular stent-grafting as a new technique in aortic surgery.

METHODS: One hundred ninety-six stent-grafts were implanted in the thoracic aorta in 172 patients. All procedures but one were performed in the operating room by a team of cardiothoracic surgeons; 112 operations (57%) were emergency procedures. Twenty-four procedures (12%) were reoperations for endoleaks. The left subclavian artery origin was covered in 46 cases and the left common carotid artery in 2 cases. Access was by femoral cut-down in 174 procedures, percutaneous femoral approach in 1, and by conduit to the iliac arteries or infrarenal aorta in 17. Surgical reconstruction of damaged access vessels became necessary in 10 cases.

RESULTS: Thirty-day mortality was 9.7% (19 patients). Paraplegia occurred in 1.0% (2 patients). Primary technical success was 85.2%, secondary 91.8%. Six conversions to open repair were necessary, 3 during the procedures and 3 secondarily before discharge. Actuarial survival was 79% at 1 year, 67% at 3 years, and 55% at 5 years.

CONCLUSIONS: The results are excellent, taking into account the high incidence of emergency procedures and that open surgery is not promising in many patients. The cardiothoracic surgeon can perform the procedure after adequate training in endovascular techniques. Surgical skills are mandatory because of the potential need for extended surgical approach to the access vessels or immediate conversion to open surgery. Therefore, the operating room is the preferred site for this procedure.

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