Global experience with an inner branched arch endograft

Stéphan Haulon, Roy K. Greenberg, Rafaëlle Spear, Matt Eagleton, Cherrie Abraham, Christos Lioupis, Eric Verhoeven, Krassi Ivancev, Tilo Kölbel, Brendan Stanley, Timothy Resch, Pascal Desgranges, Blandine Maurel, Blayne Roeder, Timothy Chuter, Tara Mastracci

Research output: Contribution to journalArticlepeer-review

144 Scopus citations

Abstract

Background: Branched endografts are a new option to treat arch aneurysm in high-risk patients.

Methods and results: We performed a retrospective multicenter analysis of all patients with arch aneurysms treated with a new branched endograft designed with 2 inner branches to perfuse the supra aortic trunks. Thirty-eight patients were included. The median age was 71 years (range, 64-74 years). An American Society of Anesthesiologists score of 3 or 4 was reported in 89.5%(95%confidence interval [CI], 79.7-99.3) of patients. The 30-day mortality rate was 13.2%(95%CI, 2.2-24.2). Technical success was obtained in 32 patients (84.2% [95% CI, 72.4-95.9]). Early secondary procedures were performed in 4 patients (10.5% [95% CI, 0.7-20.3]). Early cerebrovascular complications were diagnosed in 6 patients (15.8% [95% CI, 4.0-27.6]), including 4 transient ischemic attacks, 1 stroke, and 1 subarachnoid hemorrhage. The median follow-up was 12 months (range, 6-12 months). During follow-up, no aneurysm-related death was detected. Secondary procedures during follow-up were performed in 3 patients (9.1% [95% CI, 0.0-19.1]), including 1 conversion to open surgery. We compared the first 10 patients (early experience group) with the subsequent 28 patients. Intraoperative complications and secondary procedures were significantly higher in the early experience group. Although not statistically significant, the early mortality was higher in the early experience group (30% [95% CI, 0.0-60.0]) versus the remainder (7.1% [95% CI, 0.0-16.9]; P = .066). Being part of the early experience group and ascending aortic diameter 38 mm were found to be associated to higher rates of combined early mortality and neurologic complications.

Conclusions: Our preliminary study confirms the feasibility and safety of the endovascular repair of arch aneurysms in selected patients who may not have other conventional options. Clinical trial registration information: Thoracic IDE NCT00583817, FDA IDE# 000101.

Original languageEnglish (US)
Pages (from-to)1709-1716
Number of pages8
JournalJournal of Thoracic and Cardiovascular Surgery
Volume148
Issue number4
DOIs
StatePublished - Oct 1 2014

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

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