초록접수 현황
| 20F-044 | 구연 발표 |
Hybrid Aortic Repair for Extensive Aortopathy: Total Arch Replacement with Antegrade Thoracic Endovascular Aortic Repair Versus Frozen Elephant Trunk Procedure
Tae-Hoon Kim1, Ha Lee1, Myeong su Kim1, Seung Jun Song2, Wan Kee Kim2, Kwang-Hun Lee3, Suk-Won Song1, Kyung-Jong Yoo4
1 Department of Thoracic and Cardiovascular Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
2 Department of Thoracic and Cardiovascular Surgery, Yongin Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
3 Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
4 Department of Thoracic and Cardiovascular Surgery, Cardiovascular Hospital, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
2 Department of Thoracic and Cardiovascular Surgery, Yongin Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
3 Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
4 Department of Thoracic and Cardiovascular Surgery, Cardiovascular Hospital, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
Purpose : The authors compared single stage hybrid aortic repair techniques for extensive aortopathy.
Methods : Between 2011 and 2019, 36 patients with extensive aortic arch aneurysm extending to descending thoracic aorta were reviewed. Total arch replacement (TAR)+frozen elephant trunk (TAR+FET group) was done in 20 patients and the other 16 patients underwent TAR+antegrade thoracic endovascular aortic repair (TAR+TEVAR group). Extensive aortopathy was defined as pathologic aorta was extended below T6 level. Antegrade TEVAR was done after cardiopulmonary bypass weaning and distal landing zone was selected under fluoroscopy. Baseline characteristics and perioperative details were reviewed. Composite event was defined as overall mortality and any aortic reintervention.
Results : There was no significant difference in baseline characteristics between TAR+FET and TAR+TEVAR. There was no significant difference between 2 groups regarding 30-day mortality, spinal cord ischemia, ARF and Stroke (Table). In TAR+TEVAR group, there was no reintervention during follow up. On the contrary, reintervention rate was 30% (n=6) in TAR+FET group. In 2 patients of TAR+FET group, stent induced new entry tear (SINE) on distal landing zone and type Ib endoleak were observed. There was no difference between 2 groups regarding overall mortality. TAR+TEVAR group demonstrated significantly better freedom from reintervention compared with TAR+FET (Log-rank p=0.024, Figure). Multivariable risk factor analysis for composite event revealed that TAR+TEVAR (Hazards ratio [HR] 0.238, p=0.030) was a significant favorable predictor and preoperative maximum thoracic aorta diameter (HR 1.047, p=0.006) was a significant risk factor
Conclusion : FET seems to be related with type Ib endoleak and distal SINE which is risk factor for reintervention. In conclusion, single stage TAR+antegrade TEVAR demonstrated acceptable short-term outcome and favorable long-term durability compared with TAR+FET.
Methods : Between 2011 and 2019, 36 patients with extensive aortic arch aneurysm extending to descending thoracic aorta were reviewed. Total arch replacement (TAR)+frozen elephant trunk (TAR+FET group) was done in 20 patients and the other 16 patients underwent TAR+antegrade thoracic endovascular aortic repair (TAR+TEVAR group). Extensive aortopathy was defined as pathologic aorta was extended below T6 level. Antegrade TEVAR was done after cardiopulmonary bypass weaning and distal landing zone was selected under fluoroscopy. Baseline characteristics and perioperative details were reviewed. Composite event was defined as overall mortality and any aortic reintervention.
Results : There was no significant difference in baseline characteristics between TAR+FET and TAR+TEVAR. There was no significant difference between 2 groups regarding 30-day mortality, spinal cord ischemia, ARF and Stroke (Table). In TAR+TEVAR group, there was no reintervention during follow up. On the contrary, reintervention rate was 30% (n=6) in TAR+FET group. In 2 patients of TAR+FET group, stent induced new entry tear (SINE) on distal landing zone and type Ib endoleak were observed. There was no difference between 2 groups regarding overall mortality. TAR+TEVAR group demonstrated significantly better freedom from reintervention compared with TAR+FET (Log-rank p=0.024, Figure). Multivariable risk factor analysis for composite event revealed that TAR+TEVAR (Hazards ratio [HR] 0.238, p=0.030) was a significant favorable predictor and preoperative maximum thoracic aorta diameter (HR 1.047, p=0.006) was a significant risk factor
Conclusion : FET seems to be related with type Ib endoleak and distal SINE which is risk factor for reintervention. In conclusion, single stage TAR+antegrade TEVAR demonstrated acceptable short-term outcome and favorable long-term durability compared with TAR+FET.
책임저자: Suk-Won Song
Department of Thoracic and Cardiovascular Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
발표자: Tae-Hoon Kim, E-mail : airtech2@yuhs.ac