title: One-stage repair in complex multisegmental thoracic aneurysmal disease: results of a multicentre study.
abstract: OBJECTIVE
  Patients with thoracic aneurysmal disease involving the arch and the descending or thoracoabdominal aorta may require more than one surgical intervention. The results of one-stage repair using a hybrid stent-graft in the frozen elephant trunk manner are presented.
  
  
  METHODS
  Between January 2005 and March 2012, 113 (age 67 ± 10 years) of 358 registered patients in the International E-Vita Open Registry were operated on for combined arch and descending and thoracoabdominal aortic aneurysm. Thirty-one (27%) patients had a previous cardiothoracic, abdominal aortic surgery or endovascular repair. The E-Vita Open hybrid stent-graft was used in all cases. Postoperatively and during the follow-up (100%), aortic image examinations were performed.
  
  
  RESULTS
  Combined arch replacement and antegrade stent-grafting distally (graft diameter 34 ± 4 mm) were performed under selective cerebral perfusion (72 ± 27 min) and hypothermic visceral ischaemia (65 ± 27 min). Postoperatively, aneurysm exclusion was completely and partially achieved in 80% and 20%, respectively. In-hospital mortality and survival rate after 5 years were 12% (13 of 113) and 78%, respectively. Latest aortic imaging demonstrated 93% complete aneurysm exclusion. Freedom from secondary endovascular intervention and open surgery were 88 and 90%, respectively.
  
  
  CONCLUSIONS
  In multisegmental thoracic aneurysmal disease, combined arch replacement with distal repair by a hybrid stent-graft enables one-stage treatment with acceptable mortality. Aneurysm exclusion by the stent-graft seems to be primarily curative and allows easier access for distal open or endovascular reintervention.
authors.affiliation: Department of Cardiovascular Surgery, Hospital Clínico, University of Barcelona, Barcelona, Spain.
authors.forename: Carlos-A
authors.initials: CA
authors.lastname: Mestres
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Tsagakis
authors.forename: Davide
authors.initials: D
authors.lastname: Pacini
authors.forename: Roberto
authors.initials: R
authors.lastname: Di Bartolomeo
authors.forename: Martin
authors.initials: M
authors.lastname: Grabenwöger
authors.forename: Michael
authors.initials: M
authors.lastname: Borger
authors.forename: Robert S
authors.initials: RS
authors.lastname: Bonser
authors.forename: Heinz
authors.initials: H
authors.lastname: Jakob
mesh_terms: D000368:Aged; D001014:Aortic Aneurysm / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015607:Stents; D015996:Survival Rate
keywords: Aneurysmal disease; Aorta; Aortic surgery; Frozen elephant trunk