Comparison of aortic arch repair using the endovascular technique, total arch replacement and staged surgery†.
OBJECTIVE
We evaluated the operative and long-term outcomes of various approaches for aortic arch repair.


METHODS
A total of 436 consecutive patients who underwent aortic arch repair from January 2001 to March 2016 in our centre were evaluated. Of these, 276 underwent conventional total arch replacement (TAR), and 118 underwent thoracic endovascular repair (TEVAR). The remaining 42 patients underwent staged thoracic endovascular repair (STEVAR). A total of 72 patients in the TEVAR group were matched to 72 patients who underwent open surgery including TAR or STEVAR by using propensity score analysis.


RESULTS
Surgical outcomes showed shorter ICU and hospital stay in the TEVAR group ( P  < 0.001 and P  < 0.001, respectively). The 30-day mortality and neurologic dysfunction showed no significant difference among the three groups (2.8 and 5.4% in TAR group, 1.7 and 8.5% in TEVAR group and 0 and 2.4% in STEVAR group; P  = 0.500 and P  = 0.297, respectively). Long-term survival was not significantly different among the three groups (78% in TAR group, 67% in TEVAR group and 81% in STEVAR group at 5 years; P  = 0.123). Freedom from aortic reintervention was lower in the TEVAR group than in other groups (98% in TAR, 92% in TEVAR and 97% in STEVAR at 5 years, P  = 0.040).


CONCLUSIONS
Operative outcomes showed no significant differences between the groups except for early recovery after TEVAR. Long-term survival was similar between groups; however, TEVAR had inferior reintervention free rate.
Department of Cardiovascular Surgery, Keio University School of Medicine, Tokyo, Japan.
Akihiro
A
Yoshitake
Department of Cardiovascular Surgery, Keio University School of Medicine, Tokyo, Japan.
Kazuma
K
Okamoto
Department of Cardiovascular Surgery, Keio University School of Medicine, Tokyo, Japan.
Masataka
M
Yamazaki
Department of Cardiovascular Surgery, Keio University School of Medicine, Tokyo, Japan.
Naritaka
N
Kimura
Department of Cardiovascular Surgery, Keio University School of Medicine, Tokyo, Japan.
Akinori
A
Hirano
Department of Cardiovascular Surgery, Keio University School of Medicine, Tokyo, Japan.
Yasunori
Y
Iida
Department of Preventive Medicine and Public Health, Biostatistics Unit at Clinical Translational Research Center, Keio University School of Medicine, Tokyo, Japan.
Takayuki
T
Abe
Department of Cardiovascular Surgery, Keio University School of Medicine, Tokyo, Japan.
Hideyuki
H
Shimizu
D000368:Aged; D000369:Aged, 80 and over; 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; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome
Aortic arch aneurysm ; Endovascular procedures; Hybrid arch repair ; Total arch replacement 