Outcomes of secondary procedures after primary thoracic endovascular aortic repair†.
OBJECTIVE
The purpose of this study is to retrospectively evaluate, with an 'all-comers' approach, the survival and outcome of patients following secondary surgical or interventional procedures after thoracic endovascular aortic repair (TEVAR).


METHODS
Between October 2002 and December 2013, 371 patients with different aortic pathologies underwent primary TEVAR at our institution. Fifty-six out of the 371 patients (15.1%, 18 females, mean age 62.3 ± 13.7 years) required secondary procedures, either interventionally (N = 31; 55.4%) or surgically (N = 25; 44.6%), due to stent graft-related complications. After TEVAR complications comprised endoleaks (N = 28; 7.5%), organ malperfusion (N = 9; 2.4%), aorto-oesophageal/-bronchial fistulae (N = 9; 2.4%), stent graft infections (N = 4; 1.1%), aneurysm progression (N = 3; 0.8%), retrograde type A aortic dissection (N = 2; 0.5%) and aortic regurgitation (N = 1; 0.3%).


RESULTS
The overall in-hospital mortality rate was 10.7% (N = 5): open surgery (N = 1; 4%) versus reintervention (N = 5; 16%; P = 0.14). The cumulative survival rates after secondary procedures at 6 months, 1 year and 3 years were 80.4, 73.5 and 69.3%, respectively. Postoperative complications either for open surgery or reintervention comprised stroke (8 vs 9.6%; P = 0.82), paraplegia (4 vs 6.4%; P = 0.68), renal failure (16 vs 3.2%; P = 0.09), respiratory failure (12 vs 0%; P = 0.04), sepsis (16 vs 3.2%; P = 0.87), organ malperfusion (4 vs 3.2%; P = 0.87) and need for a tertiary procedure (8 vs 6.4%; P = 0.82).


CONCLUSIONS
Stent graft complications after primary TEVAR were not infrequent and often required secondary procedures for definite treatment. Endoleaks (type Ia), organ malperfusion, stent graft infections, fistula formation and expanding aneurysm occurred predominantly during early and mid-term follow-up. Despite the high-risk nature of the complications, secondary open surgical or interventional procedures may be successfully performed with an acceptable outcome.
Department of Cardiac Surgery, Leipzig Heart Centre - University of Leipzig, Leipzig, Germany mnozdrzykowski@yahoo.de.
Michal
M
Nozdrzykowski
Department of Cardiac Surgery, Leipzig Heart Centre - University of Leipzig, Leipzig, Germany.
Maximilian
M
Luehr
Department of Cardiac Surgery, Leipzig Heart Centre - University of Leipzig, Leipzig, Germany.
Jens
J
Garbade
Department for Interventional Angiology, University Hospital Leipzig, Leipzig, Germany.
Andrej
A
Schmidt
Department of Cardiac Surgery, Leipzig Heart Centre - University of Leipzig, Leipzig, Germany.
Sergey
S
Leontyev
Department of Cardiac Surgery, Leipzig Heart Centre - University of Leipzig, Leipzig, Germany.
Martin
M
Misfeld
Department of Cardiac Surgery, Leipzig Heart Centre - University of Leipzig, Leipzig, Germany.
Friedrich-Wilhelm
FW
Mohr
Department of Cardiac Surgery, Leipzig Heart Centre - University of Leipzig, Leipzig, Germany.
Christian D
CD
Etz
D000368:Aged; D000784:Aortic Dissection / Q000601:surgery*; D001013:Aorta, Thoracic / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000401:mortality / Q000706:statistics & numerical data; D057510:Endovascular Procedures / Q000009:adverse effects / Q000401:mortality / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies
Aortic aneurysm; Chronic aortic dissection; Reintervention; Reoperation; Stent graft complications; Thoracic endovascular repair