engleski

Stented elephant trunk with E-Vita: our experience

Introduction: Frozen elephant trunk is still the golden standard in treating complex aortic pathologies, eventhough patients require second surgery via thoracotomy. With implementation of stented elephant trunk, such procedure can be done without need for second operation. We present our initial results of E-vita stented elephant trunk. Patients and methods: From July 2011 to December 2013 we used this procedure in eleven patients, five female, six male. Average age was 63±7 years with median logistic Euroscore I of 11 (5, 47- 26, 02), with Euroscore I of 11 in chronic setting, and 11, 28 in acute setting. We routinely used right axillary cannulation for cardiopulmonary bypass and bilateral antegrade cerebral perfusion with left common carotid artery. When target temperature was achived the stent was deployed and the graft sutured to the proximal aorta with reimplantation of the supraaortic branches starting from left subclavian artery to the brachiocephalic trunk respectively. Results: Eight patient (73%) were operated due to aortic dissection, six of them in acute setting, and two in chronic setting, and the other three (27%) were operated because of aortic aneurysm. Six (55%) of the patients underwent isolated E- vita implantation, and five patients underwent concomitant aortic valve or aortic root surgery. Median CPB time was 158 min (110-537), with 101 min (59-244) of cross clamp, and 57 min (44-225) of circulatory arrest. Median coolong temp was 25ºC (18ºC-28ºC). We mostly used graft 24, although the range was from 24 to 36. Four patients (36%) underwent revision due to bleeding, one of who also had TEA of left subclavian artery due to occlusion of the graft. One patient was reoperated for sternal wound infection. One patient had CVI with long term complications, and one with short term complications, also damage of the recurrent nerve was observed in three patients (27%), and resolved in two of these. One patient died in ICU which presents a perioperative mortality of 9% and two patients died during long term follow up. Conclusion: The stented elephant trunk with E-vita is a good alternative for treatment of complex cases of aortic pathology with acceptable surgical risks and satisfactory results.

E-vita ; Aortic aneurysm

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