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Early and mid-term outcomes of endovascular and open surgical repair of non-dissected aortic arch aneurysm

Título de la revista
Hori, Daijiro
Okamura, Homare
Yamamoto, Takahiro
Nishi, Satoshi
Yuri, Koichi
Kimura, Naoyuki
Yamaguchi, Atsushi
Adachi, Hideo



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Título del volumen
European Association for Cardio-Thoracic Surgery
Oxford University Press


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OBJECTIVES: With the introduction of endovascular stent graft technology, a variety of surgical options are available for patients with aortic aneurysms. We sought to evaluate early-term and mid-term outcomes of patients undergoing endovascular and open surgical repair for non-dissected aortic arch aneurysm. METHODS: Overall, 200 patients underwent treatment for isolated non-dissected aortic arch aneurysm between January 2008 and February 2016: 133 patients had open surgery and 67, endovascular repair. Early-term and mid-term outcomes were compared. RESULTS: Seventy percent (n?=?47) needing endovascular repair underwent fenestrated stent graft and 30% (n?=?20) underwent the debranched technique. Patients in the open surgery group were younger (71 vs 75 years, P?<?0.001) and had a lower prevalence of ischaemic heart disease (11% vs 35%, P?<?0.001). Intensive care unit stay (1 vs 3 days, P?<?0.001), hospital stay (11 vs 17 days, P?<?0.001) and surgical time (208 vs 390?min, P?<?0.001) were lower in the endovascular repair group than in the open surgery group. There were 3 in-hospital deaths each in the open surgery and endovascular groups (2% vs 5%, respectively, P?=?0.40). Mid-term survival (P?<?0.001) and freedom from reintervention (P?=?0.009) were better in the open surgery than in the endovascular repair group. No aneurysm-related deaths were observed. The propensity-matched comparison (n?=?58) demonstrated that survival was better in the open surgery group (P?=?0.011); no significant difference was seen in the reintervention rate (P?=?0.28). CONCLUSIONS: Close follow-up for re-intervention may reduce the risk for aneurysm-related deaths and provide acceptable outcomes in patients undergoing endovascular repair.
Palabras clave
Aortic arch aneurysm , Fenestrated stent graft , TEVAR , Open surgery