Single-center experience and evolution of technique with the E-vita Open prosthesis.

BACKGROUND: We report our experience in aortic arch repair with the E-vita Open hybrid prosthesis and describe the changes in our technique over time. METHODS: Between October 2013 and December 2019, 56 patients underwent a total aortic arch replacement with the E-vita Open hybrid prosthesis. The main indications were thoracic aorta aneurysm (n = 27) and acute type A aortic dissection (n = 18). We analyze the technique and results in the overall series, and compare both between our early (group I, 25 patients) and late experience (group II, 31 patients). RESULTS: Overall in-hospital mortality was 7.1% (n = 4), and permanent stroke and spinal cord injury were 3.6% and 1.8%, respectively. Fifteen patients (26.8%) underwent a planned second procedure on the distal aorta: 13 endovascular, 1 open, and 1 hybrid. Survival at 1 and 3 years was 90.7% and 80.7%, respectively. Group II included more patients with acute dissection (45.2% vs 16%, P = .02), higher rates of bilateral cerebral perfusion (100% vs 64%, P < .001), left subclavian artery perfusion during lower body circulatory arrest (87.1% vs 0%, P < .001), early reperfusion (96.8% vs 40%, P < .001), and zone 0 to 2 distal anastomosis (100% vs 72%, P = .02). In-hospital mortality (3.2% vs 12%) and permanent stroke (0% vs 8%) tended to be lower in group II. CONCLUSIONS: Total arch replacement with E-vita Open hybrid prosthesis in complex thoracic aorta disease is safe. One-stage treatment is feasible when pathology does not extend beyond the proximal descending thoracic aorta. In any case, it facilitates subsequent procedures on distal aorta if needed.

Improvement of Early Outcomes in Type A Acute Aortic Syndrome After an Aorta Code Implementation.

BACKGROUND: Reduction of variability through process reengineering can improve surgical results for patients with type A acute aortic syndrome. We compare short-term results before and after implementation of an Aorta Code for patients with type A acute aortic syndrome who underwent surgery. METHODS: The Aorta Code was implemented in a 5-hospital healthcare network in 2019. This critical pathway was based on a simple diagnostic algorithm, ongoing training, immediate patient transfer, and treatment by an expert multidisciplinary team. We retrospectively compared all patients operated on in our center before (2005-2018) and after (January 2019 to February 2023) its implementation. RESULTS: One hundred two and 70 patients underwent surgery in the precode and code periods, respectively. In the code period the number of patients operated on per year increased (from 7.3 to 16.8), and the median elapsed time until diagnosis (6.5 hours vs 4.2 hours), transfer (4 hours vs 2.2 hours), and operating room (2.7 hours vs 1.8 hours) were significantly shorter (P < .05). Aortic root repair and total arch replacement were more frequent (66.7% vs 82.9% [P = .003] and 20.6% vs 40% [P = .001]). Cardiopulmonary bypass and ischemia times were also shorter (179.7 minutes vs 148.2 minutes [P = .001] and 105 minutes vs 91.2 minutes [P = .022]). Incidence of prolonged mechanical ventilation (53.9% vs 34.3%, P = .011), major stroke (17.7% vs 7.1%, P = .047), and 30-day mortality (27.5% vs 7.1%, P = .001) decreased significantly. CONCLUSIONS: An Aorta Code can be successfully implemented by using a standardized protocol within a hospital network. The number of cases increased; time to diagnosis, transfer, and operating room were reduced; and 30- day mortality significantly decreased.