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): Daniel Zimpfer Ernst Weigang Michael Grimm Martin Czerny Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Gottardi, R. Articles by Czerny, M. Search for Related Content PubMed PubMed Citation Articles by Gottardi, R. Articles by Czerny, M. Related Collections Great vessels

---

Original Articles: Adult Cardiac

Supra-aortic Transposition for Combined Vascular and Endovascular Repair of Aortic Arch Pathology

^a Department of Cardiothoracic Surgery, University of Vienna Medical School, Vienna, Austria
^b Department of Interventional Radiology, University of Vienna Medical School, Vienna, Austria
^c Department of Cardiothoracic and Vascular Surgery, University Hospital Mainz, Mainz, Germany

Accepted for publication June 13, 2008.

^_* Address correspondence to Dr Czerny, Waehringer Guertel 18-20, Vienna, A-1090, Austria (Email: martin.czerny{at}meduniwien.ac.at).

Presented at the Poster Session of the Forty-fourth Annual Meeting of The Society of Thoracic Surgeons, Fort Lauderdale, FL, Jan 28–30, 2008.

Background: Supra-aortic transpositions in various extents followed by endovascular stent graft placement are now an established tool in the treatment of various pathologies affecting the aortic arch. Results remain to be determined.

Methods: From 1996 through 2007, 73 patients (median age, 71 years) presented with aortic arch pathology (atherosclerotic aneurysms, n = 42; type B dissections, n = 9; penetrating ulcers, n = 17; traumatic lesions, n = 2; aneurysms based on prior surgery for aortic coarctation, n = 3). Strategy for distal arch disease was subclavian-to-carotid transposition (n = 24) or autologous double-vessel transposition through upper hemisternotomy (n = 36). For entire arch disease, total supra-aortic rerouting with a reversed bifurcated prosthesis was applied (n = 13). Endovascular stent graft placement was performed metachronously.

Results: In-hospital mortality was 6.8% (n = 5). Persistent early type I and III endoleak rate was 9.6%. Persistent late type I and III endoleak rate was 5.5%. Overall actuarial survival was 90%, 86%, and 72% at 1, 3, and 5 years. Mean follow-up is 37 months (range, 1 to 120). Early and late endoleak formation was independently predicted by the number of prostheses (early odds ratio [OR] 0.210, p = 0.0003; late OR 0.216, p = 0.012), whereas logistic EuroSCORE (European System for Cardiac Operative Risk Evaluation) reached borderline significance regarding late endoleaks (OR 2.1, p = 0.095). An earlier year of implantation reached borderline significance predicting survival (OR 1.9, p = 0.062). Furthermore, survival was independently predicted by higher logistic EuroSCORE levels (OR 1.8, p = 0.020). Interestingly, type of arch rerouting did not influence endoleak formation and survival (OR 0.9, p = 0.812).

Conclusions: Results after supra-aortic transpositions in various extents followed by endovascular stent graft placement for the treatment of various pathology affecting the aortic arch are promising. Endoleak formation is directly related to the number of prostheses and may be reduced by longer devices. Each type of arch rerouting, irrespective of extent, has turned out to be effective. Therefore, extended applications of these combined treatment strategies substantially augment the therapeutic options.

This article has been cited by other articles:

				M. Czerny, M. Funovics, G. Sodeck, J. Dumfarth, M. Schoder, A. Juraszek, T. Dziodzio, C. Loewe, D. Reineke, E. Krahenbuhl, et al. Results After Thoracic Endovascular Aortic Repair in Penetrating Atherosclerotic Ulcers Ann. Thorac. Surg., August 1, 2011; 92(2): 562 - 567. [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]

				M. Czerny, M. Hoebartner, G. Sodeck, M. Funovics, A. Juraszek, T. Dziodzio, M. Grimm, and M. Ehrlich The influence of gender on mortality in patients after thoracic endovascular aortic repair Eur J Cardiothorac Surg, July 1, 2011; 40(1): e1 - e5. [Abstract] [Full Text] [PDF]

				A. Hoffman, J. A. Parker, A. Raweh, and R. Autschbach Restoration of the thoracic aorta in Type A dissection with hybrid prothesis Asian Cardiovasc Thorac Ann, April 1, 2011; 19(2): 123 - 127. [Abstract] [Full Text] [PDF]

				M. Czerny, B. Pfannmuller, M. A. Borger, A. Schmidt, F. W. Mohr, and M. Grabenwoger Hybrid debranching technique for aortic arch replacement MMCTS, January 1, 2011; 2011(0824): mmcts.2011.005108 - mmcts.2011.005108. [Abstract] [Full Text] [PDF]

				M. Czerny, M. Funovics, G. Sodeck, J. Dumfarth, M. Schoder, A. Juraszek, T. Dziodzio, D. Zimpfer, C. Loewe, J. Lammer, et al. Long-term results of thoracic endovascular aortic repair in atherosclerotic aneurysms involving the descending aorta J. Thorac. Cardiovasc. Surg., December 1, 2010; 140(6_suppl): S179 - S184. [Abstract] [Full Text] [PDF]

				M. Czerny, M. Funovics, M. Ehrlich, M. Hoebartner, G. Sodeck, J. Dumfarth, M. Schoder, A. Juraszek, T. Dziodzio, C. Loewe, et al. Risk Factors of Mortality in Different Age Groups After Thoracic Endovascular Aortic Repair Ann. Thorac. Surg., August 1, 2010; 90(2): 534 - 538. [Abstract] [Full Text] [PDF]

				M. Czerny, S. Roedler, S. Fakhimi, G. Sodeck, M. Funovics, J. Dumfarth, J. Holfeld, M. Schoder, A. Juraszek, T. Dziodzio, et al. Midterm Results of Thoracic Endovascular Aortic Repair in Patients With Aneurysms Involving the Descending Aorta Originating From Chronic Type B Dissections Ann. Thorac. Surg., July 1, 2010; 90(1): 90 - 94. [Abstract] [Full Text] [PDF]

				R. Gottardi, J. Dumfarth, J. Holfeld, M. Schoder, M. Funovics, G. Laufer, M. Grimm, and M. Czerny Symptomatic spinal cord malperfusion after stent-graft coverage of the entire descending aorta Eur J Cardiothorac Surg, May 1, 2010; 37(5): 1081 - 1085. [Abstract] [Full Text] [PDF]

				J. Dumfarth, R. Gottardi, J. Holfeld, M. Schoder, T. Dziodzio, A. Juraszek, M. Hoebartner, G. Laufer, M. Grimm, and M. Czerny Translocation of the supra-aortic vessels and stent grafting of the aortic arch MMCTS, January 1, 2010; 2010(0311): mmcts.2008.003871 - mmcts.2008.003871. [Abstract] [Full Text] [PDF]

				G. C. Hughes, M. A. Daneshmand, K. R. Balsara, H. A. Achneck, B. Sileshi, S. M. Lee, and R. L. McCann "Hybrid" Repair of Aneurysms of the Transverse Aortic Arch: Midterm Results Ann. Thorac. Surg., December 1, 2009; 88(6): 1882 - 1888. [Abstract] [Full Text] [PDF]

				K. Tsagakis, M. Kamler, H. Kuehl, W. Kowalczyk, P. Tossios, M. Thielmann, B. Osswald, R. Erbel, H. Eggebrecht, and H. Jakob Avoidance of Proximal Endoleak Using a Hybrid Stent Graft in Arch Replacement and Descending Aorta Stenting Ann. Thorac. Surg., September 1, 2009; 88(3): 773 - 779. [Abstract] [Full Text] [PDF]

				I. Schuster, M. Dorfmeister, S. Scheuter-Mlaker, R. Gottardi, M. Hoebartner, S. Roedler, T. Dziodzio, A. Juraszek, C. Loewe, M. Funovics, et al. Endovascular and Conventional Treatment of Thoracic Aortic Aneurysms: A Comparison of Costs Ann. Thorac. Surg., June 1, 2009; 87(6): 1801 - 1805. [Abstract] [Full Text] [PDF]