Stent-grafting of the thoracic aorta by the cardiothoracic surgeon

Objectives: We evaluated endovascular stent-grafting as a new technique in cardiothoracic surgery.

Material and Methods: In 103 patients (76 male and 27 female, aged 17–88 years, mean 60 years) 116 stent-grafts (105 Talent®, 7 E-vita®, 2 Zenith®, 2 Endofit®) were implanted. Endografts were selected and sized according to the preoperative CT scans. All procedures were performed in the cardiovascular OR. Intraoperative imaging was done with a C-arm with DSA and TEE in dissections and difficult cases. Seventy (60%) were emergency procedures. Thirteen procedures were reoperations for endoleaks.

Results: The left subclavian artery (LSA) origin was covered in 23 procedures (20%). Femoral cut-down for access was performed in 108 procedures and sheath-through-graft access to the common iliac artery or infrarenal aorta in 7. Surgical reconstruction of damaged access vessels became necessary in 6 procedures. One patient died from fatal perforation of the iliac artery. Hospital mortality was 8.6%. Paraplegia occurred in 1.7%. Primary technical success was 88%, secondary 94%. No conversions to open repair were necessary. Two patients had elective secondary conversions. Secondary revascularization of the LSA was performed in 4 cases.

Indication for endograft procedures	n
Traumatic ruptures	21
Penetrating atherosclerotic ulcers	28
True aneurysms	13
Type-B dissections	30
Suture aneurysms	5
Posttraumatic aneurysms	3
Other indications	3
Reop. endografts for leaks	13
Total	116

Conclusions: Endovascular repair of the thoracic aorta can be performed easily by the cardiothoracic surgeon with a limited set of endovascular instruments. The OR is the preferred site for the endograft procedure because of the high incidence of emergency procedures and the potential need for extended surgical approach to the access vessels. The surgical C-arm with DSA provides sufficient quality of imaging for the implantation. A sufficient stock of stent-grafts is advisable.