Thorac Cardiovasc Surg 2016; 64 - OP176
DOI: 10.1055/s-0036-1571610

Antegrade Descending Stent Implantation in Acute Type a Aortic Dissection Improves Short- and Mid-term Outcomes

P. Banerjee 1, U. Schurr 1, F. Rueter 1, D. Bolliger 2, J. Fassl 2, M. Grapow 1, O. Reuthebuch 1, F. Eckstein 1, P. Matt 1
  • 1University Hospital Basel, Division of Cardiac Surgery, Basel, Switzerland
  • 2University Hospital Basel, Division of Anesthesia and Intensive Care Medicine, Basel, Switzerland

Objective: We hypothesized that antegrade stent graft implantation into the descending aorta during acute type A aortic dissection (AAAD) surgery is not only a safe procedure but improves patient outcome compared with isolated standard open repair.

Methods: All consecutive patients undergoing surgery for AAAD at our institution from 2010 to 2015. 126 patients underwent hemiarch replacement in hypothermic circulatory arrest, HCA (standard group). Since 2013, 27 patients underwent the standard procedure combined with antegrade delivery of a covered conformable stent into the descending aorta (stented group). All data were prospectively collected.

Results: The logistic EuroSCORE was mean 42 (standard) versus 31 (stented), p = 0.03. Circulatory perfusion time was 149 (standard) versus 165 (stented) min, p = 0.1; aortic clamping 89 (standard) versus 107 (stented) min, p = 0.5. Circulatory arrest was initiated at 28°C bladder temperature in both groups. Stented patients had longer circulatory arrest times with antegrade cerebral perfusion, 31 versus 23 minute, p< 0.001. Implanted stent sizes ranged from 31–40 mm, stent lengths from 10–15 cm. Stroke occurred in 22% (standard) versus 7% (stented), p = 0.03; paraplegia developed 2% (standard) versus 0% (stented), p = 0.5. Maximum creatinine values were 165 µmol/l (standard) versus 138 µmol/l (stented), p = 0.2. Abdominal intervention due to intestinal ischemia was needed in 16 patients, 13% (standard) versus 2 patient, 7% (stented), p = 0.4. ICU time was 8 days (standard) versus 5 days (stented), p = 0.09. 30-day mortality was 13% (standard) versus 0% (stented) (p = 0.03), and 6-month survival was 85% (standard) versus 100% (stented) (p = 0.04).

Conclusion: Antegrade stent graft implantation into the descending aorta during AAAD repair is a safe procedure. HCA time is increased, but patients with an implanted stent show improved short- and mid-term outcomes.