title: Clinical results of implantation of an endovascular covered stent-graft via midsternotomy for distal aortic arch aneurysm.
abstract: We have been implanting endovascular stent grafts (EVG) via midsternotomy for distal aortic arch surgery since February 1997. The early clinical results are evaluated.
  
  
  METHODS
  There were 11 true aneurysms (8 fusiform, 3 saccular) and one chronic type B dissection. The average age was 68 yr (63-81). EVGs were PTFE-covered two-8 bend Z stents in the first eight cases and made with the same stents and ultrathin woven Dacron grafts in the last four cases.
  
  
  RESULTS
  Total arch replacement and aortocoronary bypass grafting were combined in one and two patients, respectively. The average retrograde cerebral perfusion time was 42+/-8 min. The cardiopulmonary bypass time averaged 211+/-26 min. All patients awoke early after operation (4.5+/-1.2 h). All but one case was extubated within 24h. There was no operative mortality, but paraplegia and cerebral infarction were complicated in one case each. Their maximum diameter (73.9+/-21.2mm) decreased significantly after operation (68.7+/-20.1mm) and one year thereafter (63.1+/-16.0 mm). True aneurysms were thrombosed completely. A chronic type B dissection revealed impending rupture due to false lumen infection one year after operation. The whole descending aorta replacement was performed but the patient died 6 months thereafter due to cerebro-vascular complication.
  
  
  CONCLUSIONS
  Implantation of EVGs reduces operative invasion for distal arch surgery. This procedure should improve mortality, while long-term results have not been clarified.
authors.affiliation: Department of Cardio-Thoracic Surgery, Nagoya University School of Medicine, Nagoya, Japan. ausui@med.nagoya-u.ac.jp
authors.forename: A
authors.initials: A
authors.lastname: Usui
authors.forename: Y
authors.initials: Y
authors.lastname: Ueda
authors.forename: T
authors.initials: T
authors.lastname: Watanabe
authors.forename: O
authors.initials: O
authors.lastname: Kawaguchi
authors.forename: Y
authors.initials: Y
authors.lastname: Ohara
authors.forename: Y
authors.initials: Y
authors.lastname: Takagi
authors.forename: K
authors.initials: K
authors.lastname: Tajima
authors.forename: N
authors.initials: N
authors.lastname: Nishikimi
authors.forename: T
authors.initials: T
authors.lastname: Ishiguchi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017545:Aortic Aneurysm, Thoracic / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D011138:Polytetrafluoroethylene; D011474:Prosthesis Design; D012189:Retrospective Studies; D015607:Stents; D013249:Sternum / Q000601:surgery; D016896:Treatment Outcome
chemical_list: D011138:Polytetrafluoroethylene