title: Stent-grafting of the thoracic aorta by the cardiothoracic surgeon.
abstract: 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.
authors.affiliation: Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, Berlin, Germany. zipfel@dhzb.de
authors.forename: Burkhart
authors.initials: B
authors.lastname: Zipfel
authors.forename: Robert
authors.initials: R
authors.lastname: Hammerschmidt
authors.forename: Thomas
authors.initials: T
authors.lastname: Krabatsch
authors.forename: Semih
authors.initials: S
authors.lastname: Buz
authors.forename: Yuguo
authors.initials: Y
authors.lastname: Weng
authors.forename: Roland
authors.initials: R
authors.lastname: Hetzer
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017545:Aortic Aneurysm, Thoracic / Q000628:therapy*; D019917:Blood Vessel Prosthesis Implantation; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000401:mortality; D004638:Emergency Treatment; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010264:Paraplegia / Q000209:etiology; D015607:Stents; D016019:Survival Analysis; D019616:Thoracic Surgical Procedures / Q000009:adverse effects / Q000401:mortality