Upload
whitney
View
54
Download
0
Tags:
Embed Size (px)
DESCRIPTION
Mid-term results of hybrid aortic repair using a custom quadfurcated graft . Ali Khoynezhad MD, PhD, FACS, FACC Associate Professor of Cardiovascular Surgery Director of Aortic Surgery Division of Cardiothoracic Surgery Cedars-Sinai Medical Center Los Angeles, CA. Background. - PowerPoint PPT Presentation
Citation preview
Mid-term results of hybrid aortic repair using a custom quadfurcated graft
Ali Khoynezhad MD, PhD, FACS, FACCAssociate Professor of Cardiovascular Surgery
Director of Aortic SurgeryDivision of Cardiothoracic Surgery
Cedars-Sinai Medical CenterLos Angeles, CA
Background Patients with anatomic or physiologic constrains are poor endovascular or open candidates.
Hybrid repair with early promising results in this high-risk cohort
Aim of this study: feasibility and midterm follow-up of hybrid aortic repairs using a custom graft
Same graft can be used for hybrid arch or TAAA repair.
Why Hybrid?
Stroke risk up to 12%,
Mortality up to 20%
Proximal vs distal arch outcomes
Respiratory failure
Recurrent nerve injury
no aortic cross-clamping
Avoid second stage elephant trunk
& the interval mortality
342 TEVARs between 2005-2011
195 patients requiring combined open/endovascular approach
52 patients with custom graft
Indications: aneurysm in 31, chronic dissection in 15, acute type A dissection in 6
18 (35%) had hybrid TAAA
34 (65%) zone 0 hybrid arch repair
Patient Cohort
Comorbidities
Age 68 ±11 years (range 59-83)
15 (29%) patients had prior aortic operation or procedure.
12 (23%) urgent/emergent
22 (43%) with severe COPD
10 (19%) prior stroke/TIA
14 (27%) with prior MI
19 (37%) with moderate eGFR reduction (stage III CKD)
In 40 (77%) patients endovascular exclusion was performed simultaneously.
Two (4%) patients developed permanent stroke perioperatively.
No patients with spinal cord injury.
No type I or III endoleak.
No perioperative MI
6 (12%) with acute kidney injury, no new-onset hemodialysis.
11 (21%) atrial fibrillation
Results
Early mortality was 6% (n=3).
1-year and 4-year mortality were 90% & 79%
Results (cont.)
51(98%) with complete follow-up.
Office visit and imaging follow-up at 1, 6, 12 months & yearly thereafter.
At a mean follow-up of 34 ± 11 months, there were six additional late deaths (none related to aorta).
All debranching bypass grafts have remained patent.
One endovascular re-intervention at 8 months.
Follow-up
Extra-anatomic bypass off left common iliac artery
Celiac artery
Superiormesenteric
artery
Bypass graft to right renal artery after a small
Kocher maneuver;this branch is tunneled from left to right gutter in the retroperitoneal
space.
Komplettetransposition
viszeraler Gefaesse
Conclusions Hybrid aortic repair using quadfurcated graft appears to be feasible, safe and effective at mid-term follow-up.
Hybrid aortic repair represents a feasible alternative in high-risk patients.
Long-term surveillance requiring contrast administration and radiation exposure remains an unresolved issue.
Long-term results need to be established.