Long-term experience with the E-vita Open hybrid graft in complex thoracic aortic disease
Long-term experience with the E-vita Open hybrid graft in complex thoracic aortic disease
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DOI：
10.1093/ejcts/ezw340
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发表时间：
2017-02-01
影响因子：
3.4
通讯作者：
Tsagakis, Konstantinos
中科院分区：
文献类型：
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作者：
Jakob, Heinz;Dohle, Daniel;Tsagakis, Konstantinos
目的：E-vita Open混合型覆膜支架预期用于在急性（AAD）或慢性（CAD）I型主动脉夹层和复杂胸主动脉瘤（TAA）病例中实现胸主动脉近端和远端至胸中段水平的一期治疗。我们报告了我们长达10年的长期结果。方法：从2005年2月至2015年3月，178例连续患者（平均年龄59 ± 11岁）接受了使用E-vita Open Hybrid移植物治疗AAD（n = 96）、CAD（n = 43）或TAA（n = 39）的手术。术前，术中和术后变量，有影响力的程序改进和后续数据，包括主动脉重塑analyses.RESULTS：总体30天死亡率为10%，10%的AAD，7%的CAD和13%的TAA。单变量分析确定低左心室射血分数，外周动脉疾病，慢性阻塞性肺疾病和严重受损的血流动力学为院内死亡的危险因素。Logistic回归分析将血流动力学受损和心肺转流持续时间定义为显著。7年后，AAD患者的估计生存率为55%，CAD患者为74%，TAA患者为73%。无血栓相关晚期死亡率为94%，AAD为91%，CAD为100%，TAA为97%。在92%的AAD、82%的CAD和88%的完全闭塞中，实现了向下至覆膜支架末端的积极或稳定的主动脉重塑。在更下游，在27%的AAD、41%的CAD和22%的TAA患者中观察到负重塑。AAD、CAD和TAA患者下游无血管内介入率分别为96%、75%和74%。免于胸腹手术的比率分别为97%、65%和93%.CONCLUSION：E-VITA Open混合型覆膜支架具有持久的长期性能，随着时间的推移，不会出现任何近端内漏或覆膜支架失效，并且如果需要，它是胸腔内修复术或胸腹手术的理想着陆或对接区域。直至覆膜支架末端无需再次介入，证明疾病可沿混合型覆膜支架沿着向下至胸中段水平克服。
OBJECTIVES: The E-vita Open hybrid stent graft is intended to achieve one-stage treatment of the proximal and distal thoracic aorta down to the mid-thoracic level in cases of acute (AAD) or chronic (CAD) type I aortic dissection and complex thoracic aortic aneurysm (TAA). We report our long-term results up to 10-year experience.METHODS: From February 2005 until March 2015, 178 consecutive patients (mean age 59 +/- 11 years) underwent surgery using the E-vita Open hybrid graft for AAD (n = 96), CAD (n = 43) or TAA (n = 39). Pre-, intra-and postoperative variables, influential procedural improvements and follow-up data including aortic remodelling analyses are presented.RESULTS: Overall 30-day mortality was 10%, 10% for AAD, 7% for CAD and 13% for TAA. Univariable analysis identified low left ventricular ejection fraction, peripheral arterial disease, chronic obstructive pulmonary disease and severely compromised haemodynamics as risk factors for in-hospital death. Logistic regression analysis defined compromised haemodynamics and duration of cardiopulmonary bypass as significant. After 7 years, estimated survival was 55% for AAD, 74% for CAD and 73% for TAA patients. Freedom from aorta-related late death was 94%, 91% in AAD, 100% in CAD and 97% in TAA. Positive or stable aortic remodelling down to the stent graft end was achieved in 92% AAD, 82% in CAD and full aneurysmal exclusion in 88%. Further downstream, negative remodelling was observed in 27% of the AAD, 41% of the CAD and 22% of the TAA patients. Freedom from endovascular intervention downstream was 96% in AAD, 75% in CAD and 74% in TAA patients. Freedom from thoraco-abdominal surgery was 97%, 65% and 93%, respectively.CONCLUSIONS: The E-vita Open hybrid stent graft renders durable long-term performance without any proximal endoleakage or graft failure over time and represents the ideal landing or docking zone for either thoracic endovascular thoracic repair or thoraco-abdominal surgery, if required. No reinterventions were necessary down to the end of the stent graft, proving that the disease is overcome along the hybrid graft down to mid-thoracic level.