Jakob Heinz, Dohle Daniel, Benedik Jaroslav, Jánosi Rolf Alexander, Schlosser Thomas, Wendt Daniel, Thielmann Matthias, Erbel Raimund, Tsagakis Konstantinos
Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Centre, University Hospital Essen, Essen, Germany.
Department of Cardiology, West German Heart and Vascular Centre, University Hospital Essen, Essen, Germany.
Eur J Cardiothorac Surg. 2017 Feb 1;51(2):329-338. doi: 10.1093/ejcts/ezw340.
The E-vita Open hybrid stent graft is intended to achieve one-stage treatment of the proximal and distal thoracic aorta down to the mid-thoracic level in cases of acute (AAD) or chronic (CAD) type I aortic dissection and complex thoracic aortic aneurysm (TAA). We report our long-term results up to 10-year experience.
From February 2005 until March 2015, 178 consecutive patients (mean age 59 ± 11 years) underwent surgery using the E-vita Open hybrid graft for AAD ( n = 96), CAD ( n = 43) or TAA ( n = 39). Pre-, intra- and postoperative variables, influential procedural improvements and follow-up data including aortic remodelling analyses are presented.
Overall 30-day mortality was 10%, 10% for AAD, 7% for CAD and 13% for TAA. Univariable analysis identified low left ventricular ejection fraction, peripheral arterial disease, chronic obstructive pulmonary disease and severely compromised haemodynamics as risk factors for in-hospital death. Logistic regression analysis defined compromised haemodynamics and duration of cardiopulmonary bypass as significant. After 7 years, estimated survival was 55% for AAD, 74% for CAD and 73% for TAA patients. Freedom from aorta-related late death was 94%, 91% in AAD, 100% in CAD and 97% in TAA. Positive or stable aortic remodelling down to the stent graft end was achieved in 92% AAD, 82% in CAD and full aneurysmal exclusion in 88%. Further downstream, negative remodelling was observed in 27% of the AAD, 41% of the CAD and 22% of the TAA patients. Freedom from endovascular intervention downstream was 96% in AAD, 75% in CAD and 74% in TAA patients. Freedom from thoraco-abdominal surgery was 97%, 65% and 93%, respectively.
The E-vita Open hybrid stent graft renders durable long-term performance without any proximal endoleakage or graft failure over time and represents the ideal landing or docking zone for either thoracic endovascular thoracic repair or thoraco-abdominal surgery, if required. No reinterventions were necessary down to the end of the stent graft, proving that the disease is overcome along the hybrid graft down to mid-thoracic level.
E-vita Open杂交支架型人工血管旨在对急性（AAD）或慢性（CAD）I型主动脉夹层以及复杂胸主动脉瘤（TAA）患者的胸主动脉近端和远端直至胸中段进行一期治疗。我们报告了长达10年的长期结果。
2005年2月至2015年3月，178例连续患者（平均年龄59±11岁）使用E-vita Open杂交人工血管接受手术治疗，其中AAD患者96例，CAD患者43例，TAA患者39例。呈现术前、术中和术后变量、有影响的手术改进以及包括主动脉重塑分析在内的随访数据。
总体30天死亡率为10%，AAD患者为10%，CAD患者为7%，TAA患者为13%。单因素分析确定低左心室射血分数、外周动脉疾病、慢性阻塞性肺疾病和严重受损的血流动力学为院内死亡的危险因素。逻辑回归分析确定血流动力学受损和体外循环持续时间具有显著性。7年后，AAD患者的估计生存率为55%，CAD患者为74%，TAA患者为73%。无主动脉相关晚期死亡的比例为94%，AAD患者为91%，CAD患者为100%，TAA患者为97%。在支架型人工血管末端以下实现正向或稳定主动脉重塑的比例，AAD患者为92%，CAD患者为82%，完全排除动脉瘤的比例为88%。在更远端，27%的AAD患者、41%的CAD患者和22%的TAA患者出现负向重塑。AAD患者无支架型人工血管下游血管腔内干预的比例为96%，CAD患者为75%，TAA患者为74%。无需胸腹手术的比例分别为97%、65%和93%。
E-vita Open杂交支架型人工血管随着时间推移具有持久的长期性能，无任何近端内漏或人工血管失败，并且如果需要，对于胸主动脉腔内修复或胸腹手术而言，是理想的着陆或对接区域。直至支架型人工血管末端无需再次干预，证明沿着杂交人工血管直至胸中段疾病得到了控制。
