Modifications, classification, and outcomes of elephant-trunk procedures.
Ann Thorac Surg
; 96(2): 548-58, 2013 Aug.
Article
en En
| MEDLINE
| ID: mdl-23810176
ABSTRACT
BACKGROUND:
There are a variety of modified elephant-trunk methods, including use of endovascular stents. Our objectives were to classify these modifications, compare outcomes between the classic anastomotic site and these alternatives, and investigate time to second-stage elephant-trunk completion.METHODS:
From May 1992 to January 2011, 526 patients underwent a first-stage elephant-trunk procedure and were the subject of analysis.RESULTS:
Distal aortic anastomosis was located before the brachiocephalic artery in 6 patients (1.1%), between brachiocephalic and left common carotid artery (LCCA) in 1 (0.19%), between LCCA and left subclavian artery (LSCA) in 154 (29%), and beyond the LSCA (classic) in 365 (69%). Stroke occurred in 8% (n = 42) overall, 10% (n = 16) in the LCCA-LSCA group, and 6.8% (n = 25) in the classic group. Risk factors were older age and acute dissection. Thirty-day mortality was 7.6% (n = 40) and was similar for LCCA-LSCA (9.7%) and classic sites (6.3%; p = 0.7); risk factors included older age, smaller body surface area, and end-organ dysfunction. Likelihood of death before second-stage elephant trunk at 1, 4, and 8 years after operation was 16%, 22%, and 27%, respectively. The larger the distal aorta, the more likely was second-stage completion (p < 0.0001); when greater than 6 cm, 80% had second-stage completion.CONCLUSIONS:
The elephant-trunk operation is safe for a broad population, including when anastomotic sites are other than beyond the LSCA. Without second-stage completion, patient mortality increases markedly after 4 years.Palabras clave
Texto completo:
1
Base de datos:
MEDLINE
Asunto principal:
Aorta Torácica
/
Enfermedades de la Aorta
/
Stents
Tipo de estudio:
Etiology_studies
/
Risk_factors_studies
Idioma:
En
Revista:
Ann Thorac Surg
Año:
2013
Tipo del documento:
Article