HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Hazim J. Safi Anthony L. Estrera Eyal Porat Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Safi, H. J. Articles by Azizzadeh, A. Search for Related Content PubMed PubMed Citation Articles by Safi, H. J. Articles by Azizzadeh, A. Related Collections Great vessels

Ann Thorac Surg 2007;83:S815-S818
© 2007 The Society of Thoracic Surgeons

---

Supplement

Optimization of Aortic Arch Replacement: Two-Stage Approach

Department of Cardiothoracic and Vascular Surgery, The University of Texas at Houston Medical School, Memorial Hermann Heart and Vascular Institute, Houston, Texas

^_* Address correspondence to Dr Safi, Department of Cardiothoracic and Vascular Surgery, The University of Texas at Houston Medical School, 6410 Fannin St, Suite 450, Houston, TX 77030. (Email: hazim.j.safi{at}uth.tmc.edu).

Presented at Aortic Surgery Symposium X, New York, NY, April 27–28, 2006.

BACKGROUND: Aneurysms of the aortic arch seldom occur alone. They usually involve the ascending aorta. Occasionally, the aneurysm also involves the descending thoracic or thoracoabdominal aorta. We advocate a staged approach for repair of these extensive aortic aneurysms, with the ascending and arch generally being repaired in the first stage and the descending thoracic or thoracoabdominal aorta being repaired in the second stage.

METHODS: Between February 1991 and December 2005, we repaired aneurysms of the ascending, arch, descending thoracic, and thoracoabdominal aorta in 2120 patients. Of these, 254 (12.0%) involved the ascending, arch, and descending aorta (extensive aortic aneurysm). A first-stage repair was done in 254 patients, and 115 returned for a second-stage repair for a total of 369 procedures performed.

RESULTS: First-stage 30-day mortality was 6.3% (16/254), with the glomerular filtration rate (GFR) exceeding 70 mL/min in 2.9% of patients and less than 70 mL/min in 10.5% (p < 0.03). Second-stage 30-day mortality was 9.6% (11/115), with GFR exceeding 70 mL/min in 4.9% and less than 70 mL/min in 9.8% (not significant). The incidence of postoperative stroke for the first stage was 2.0% (5/254), and the rate of neurologic deficit (paraplegia and paraparesis) was .9% (1/115) in the second stage. The mortality for the interval of 31 days to 6 weeks after the first-stage operation was 2.9% (7/238).

CONCLUSIONS: Aneurysms involving the transverse arch with extensive involvement of the ascending and descending thoracic or thoracoabdominal aorta can be effectively repaired using the two-stage technique with acceptable morbidity and mortality. GFR correlates to surgical outcome in the first-stage repair. After the first stage, prompt treatment of the remaining segment of aorta is crucial to success.

This article has been cited by other articles:

				B. Lima, E. E. Roselli, E. G. Soltesz, D. R. Johnston, A. C. Pujara, J. Idrees, and L. G. Svensson Modified and "Reverse" Frozen Elephant Trunk Repairs for Extensive Disease and Complications After Stent Grafting Ann. Thorac. Surg., January 1, 2012; 93(1): 103 - 109. [Abstract] [Full Text] [PDF]

				D. Pacini, K. Tsagakis, H. Jakob, C.-A. Mestres, A. Armaro, G. Weiss, M. Grabenwoger, M. A. Borger, F. W. Mohr, R. S. Bonser, et al. The Frozen Elephant Trunk for the Treatment of Chronic Dissection of the Thoracic Aorta: A Multicenter Experience Ann. Thorac. Surg., November 1, 2011; 92(5): 1663 - 1670. [Abstract] [Full Text] [PDF]

				M. Di Eusanio, A. Armaro, L. Di Marco, D. Pacini, C. Savini, S. Martin Suarez, E. Pilato, and R. Di Bartolomeo Short- and midterm results after hybrid treatment of chronic aortic dissection with the frozen elephant trunk technique Eur J Cardiothorac Surg, October 1, 2011; 40(4): 875 - 880. [Abstract] [Full Text] [PDF]

				A. Kulik, C. F. Castner, and N. T. Kouchoukos Outcomes After Total Aortic Arch Replacement With Right Axillary Artery Cannulation and a Presewn Multibranched Graft Ann. Thorac. Surg., September 1, 2011; 92(3): 889 - 897. [Abstract] [Full Text] [PDF]

				H. Kondoh, T. Funatsu, K. Toda, S. Kainuma, S. Kuki, and K. Taniguchi Optimal graft diameter and location reduce postoperative complications after total arch replacement with long elephant trunk for arch aneurysm J. Thorac. Cardiovasc. Surg., August 1, 2011; 142(2): 319 - 325. [Abstract] [Full Text] [PDF]

				F. Ius, C. Hagl, A. Haverich, and M. Pichlmaier Elephant trunk procedure 27 years after Borst: what remains and what is new? Eur J Cardiothorac Surg, July 1, 2011; 40(1): 1 - 12. [Abstract] [Full Text] [PDF]

				R. Di Bartolomeo, D. Pacini, C. Savini, E. Pilato, S. Martin-Suarez, L. Di Marco, and M. Di Eusanio Complex thoracic aortic disease: Single-stage procedure with the frozen elephant trunk technique J. Thorac. Cardiovasc. Surg., December 1, 2010; 140(6_suppl): S81 - S85. [Abstract] [Full Text] [PDF]

				E. E. Roselli, E. G. Soltesz, T. Mastracci, L. G. Svensson, and B. W. Lytle Antegrade Delivery of Stent Grafts to Treat Complex Thoracic Aortic Disease Ann. Thorac. Surg., August 1, 2010; 90(2): 539 - 546. [Abstract] [Full Text] [PDF]

				N. Uchida, H. Shibamura, A. Katayama, M. Sutoh, M. Kuraoka, and H. Ishihara Long-term results of the frozen elephant trunk technique for the extensive arteriosclerotic aneurysm J. Thorac. Cardiovasc. Surg., April 1, 2010; 139(4): 913 - 917. [Abstract] [Full Text] [PDF]

				C.-H. Park, C.-H. Choi, Y.-B. Jeon, J.-I. Lee, S.-Y. Hyun, and K.-Y. Park Staged Repair of a Chronic Dissecting Aneurysm With the Two Elephant Trunks Technique Ann. Thorac. Surg., December 1, 2009; 88(6): e69 - e71. [Abstract] [Full Text] [PDF]

				N. Kawaharada, Y. Kurimoto, T. Ito, T. Koyanagi, A. Yamauchi, M. Nakamura, N. Takagi, and T. Higami Hybrid treatment for aortic arch and proximal descending thoracic aneurysm: experience with stent grafting for second-stage elephant trunk repair Eur J Cardiothorac Surg, December 1, 2009; 36(6): 956 - 961. [Abstract] [Full Text] [PDF]

				Y. Okamoto, M. Matsumoto, and H. Inoue Single-stage repair of extended thoracic aortic aneurysm Interact CardioVasc Thorac Surg, March 1, 2009; 8(3): 377 - 378. [Abstract] [Full Text] [PDF]

				K. Okada, A. Tanaka, H. Munakata, M. Matsumori, Y. Morimoto, Y. Tanaka, T. Maehara, and Y. Okita Extended replacement of aortic arch aneurysms through left posterolateral thoracotomy Eur J Cardiothorac Surg, February 1, 2009; 35(2): 270 - 275. [Abstract] [Full Text] [PDF]

				G. C. Hughes, C. F. Sulzer, R. L. McCann, and M. Swaminathan Endovascular Approaches to Complex Thoracic Aortic Disease Seminars in Cardiothoracic and Vascular Anesthesia, December 1, 2008; 12(4): 298 - 319. [Abstract] [PDF]

				C. D. Etz, K. A. Plestis, F. A. Kari, M. Luehr, C. A. Bodian, D. Spielvogel, and R. B. Griepp Staged repair of thoracic and thoracoabdominal aortic aneurysms using the elephant trunk technique: a consecutive series of 215 first stage and 120 complete repairs Eur J Cardiothorac Surg, September 1, 2008; 34(3): 605 - 615. [Abstract] [Full Text] [PDF]

				M. Karck and H. Kamiya Progress of the treatment for extended aortic aneurysms; is the frozen elephant trunk technique the next standard in the treatment of complex aortic disease including the arch? Eur J Cardiothorac Surg, June 1, 2008; 33(6): 1007 - 1013. [Abstract] [Full Text] [PDF]