Repair of the thoracic aorta by transaortic stent grafting (open stenting).
BACKGROUND
The late results of direct open stent grafting of the aortic arch for aortic arch repair have not been reported previously.


METHODS
Between September 1997 and December 2000 19 patients underwent open stent grafting with carotid artery bypass for thoracic arteriosclerotic aneurysms (TAA) of the distal aortic arch. In addition, 21 patients underwent open stent grafting with total aortic arch replacement for Stanford type A acute aortic dissection and 7 patients underwent stenting with carotid bypass for Stanford type B chronic aortic dissection.


RESULTS
The early mortality rate was 11% for TAA, 10% for type A dissection, and 0% for type B dissection. Whereas none of the TAA or type A dissection required a second operation on the thoracic aorta, 1 TAA patient died 6 months postoperatively after sudden aortic rupture and 1 type B patient required descending aortic replacement because of ulceration caused by the stent graft at 11 months postoperatively. On follow-up computed tomography scan, in TAA patients, true aneurysms excluded by the stent graft showed early thrombosis, but the absorption of thrombosed aneurysms started from 1 to 6 months postoperatively and gradually progressed. In patients with type B chronic dissection, the false lumen showed early thrombosis and the true lumen was dilated at the central portion of the graft, which might increase turbulent flow by interaction with the stent. In patients with type A acute dissection, the false lumen showed both early thrombosis and early absorption.


CONCLUSIONS
Early and late results of open stenting are acceptable and follow-up computed tomography scan may be able to predict late results of open stenting.
Uchida
Naomichi
N
Department of Cardiovascular Surgery, Hiroshima City Asa Hospital, Hiroshima, Japan. cvgeka@asa-hosp.city.hiroshima.jp
Ishihara
Hiroshi
H
Sakashita
Mitsuru
M
Kanou
Mikihiro
M
Sumiyoshi
Tatsuaki
T
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000784:Aortic Dissection / Q000401:mortality / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000401:mortality / Q000601:surgery*; D001019:Aortic Rupture / Q000401:mortality; D001161:Arteriosclerosis / Q000401:mortality / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation; D002423:Cause of Death; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality*; D012086:Reoperation; D015607:Stents; D016896:Treatment Outcome