Rorris Filippos-Paschalis, Antonopoulos Constantine N, Gissis Ilias, Tsagakis Konstantinos, Kokotsakis John
Department of Thoracic and Cardiovascular Surgery, Evangelismos General Hospital, Athens, Greece.
Department of Thoracic and Cardiovascular Surgery, Evangelismos General Hospital, Athens, Greece.
Ann Vasc Surg. 2022 Aug;84:211-217. doi: 10.1016/j.avsg.2022.01.034. Epub 2022 Mar 3.
The ever-changing landscape of aortic arch surgery necessitates a constant update on the available devices and technologies for the contemporary management of complex aortic diseases. The E-Vita OPEN NEO hybrid stent graft system offers a unique approach for aortic arch replacement with the frozen elephant trunk technique. In contrast to its predecessors and other commercially available devices, it fits to each individual patient's needs by allowing for more proximal graft anastomosis. We sought to present our initial experience with the novel E-Vita OPEN NEO hybrid stent graft system focusing on its description, optimal graft selection, operative technique, and results in a clinical setting.
We prospectively collected data on all patients in whom the E-Vita OPEN NEO device was used between October 2020 and May 2021. The primary outcome was perioperative or with 30-day mortality. Secondary outcomes were the incidence of neurologic complications (stroke and spinal cord ischemia) and endoleak on a postoperative computed tomography angiography.
During the study period, six patients received the novel hybrid stent device. The mean patient age was 59.3 ± 13.3 years and 83% were male. Two patients were operated on an emergent setting due to acute Stanford type A aortic dissection and there were two reoperations in patients with a history of previous repaired type A dissection. There was no perioperative or 30-day mortality and none of the patients exhibited adverse neurologic events. Two patients required completion thoracic endovascular repair due to type Ib endoleak. One patient died after a prolonged stay in the intensive care unit due to pneumonia and multiorgan failure.
This novel device adapts to each patient's characteristics and offers a curative option for acute and chronic aortic arch and descending aortic conditions such as aneurysmal disease and aortic dissection. In addition, it offers an excellent landing station for potential endovascular therapies and allows for complete aortic remodeling.
主动脉弓手术的形势不断变化，这就需要持续更新用于当代复杂主动脉疾病管理的现有设备和技术。E-Vita OPEN NEO混合支架移植物系统为采用冰冻象鼻技术进行主动脉弓置换提供了一种独特方法。与之前的产品和其他市售设备相比，它通过允许更靠近近端的移植物吻合来满足每个患者的需求。我们试图介绍我们使用新型E-Vita OPEN NEO混合支架移植物系统的初步经验，重点是其描述、最佳移植物选择、手术技术以及临床环境中的结果。
我们前瞻性收集了2020年10月至2021年5月期间所有使用E-Vita OPEN NEO设备的患者的数据。主要结局是围手术期或30天死亡率。次要结局是术后计算机断层扫描血管造影时神经并发症（中风和脊髓缺血）和内漏的发生率。
在研究期间，6例患者接受了新型混合支架装置。患者平均年龄为59.3±13.3岁，83%为男性。2例患者因急性Stanford A型主动脉夹层在紧急情况下接受手术，2例有既往A型夹层修复史的患者进行了再次手术。没有围手术期或30天死亡率，且没有患者出现不良神经事件。2例患者因Ib型内漏需要完成胸段血管腔内修复。1例患者在重症监护病房长期住院后因肺炎和多器官衰竭死亡。
这种新型设备可适应每个患者的特点，为急性和慢性主动脉弓及降主动脉疾病（如动脉瘤疾病和主动脉夹层）提供了一种治愈性选择。此外，它为潜在的血管腔内治疗提供了一个极好的着陆点，并允许进行完全的主动脉重塑。
