Endovascular versus open elephant trunk completion for extensive aortic disease

Eric E. Roselli, Sreekumar - Subramanian, Zhiyuan Sun, Jahanzaib Idrees, Edward Nowicki, Eugene H. Blackstone, Roy K. Greenberg, Lars G. Svensson, Bruce W. Lytle

Research output: Contribution to journalArticle

29 Citations (Scopus)

Abstract

Objectives To compare the outcomes between patients undergoing endovascular (EEC) or open (OEC) approaches to second-stage elephant trunk completion (EC). Methods From 1993 to 2010, 225 patients underwent second-stage EC (EEC, n = 92; OEC, n = 133). Propensity matching was performed for a fair comparison. Results The EEC patients were older, more likely to have atrial fibrillation, and had a smaller proximal aorta. The 30-day mortality was 6.2% (6.5% EEC vs 6% OEC, P =.88). No difference was found in bleeding (8.8%), stroke (3%), renal failure (4%), or spinal cord injury (4%); however, the OEC patients required tracheostomy more often (10 vs 1, P =.014). Survival after second-stage EC at 6 months and 1 and 5 years was 91%, 90%, and 77%, respectively. Survival and major morbidity did not differ after matching (44 pairs). However, the EEC group had shorter stays (9.9 ± 13 vs 13 ± 9 days, P <.0001) and received less blood (3 ± 8 vs 6 ± 8 U, P =.0001) than did the OEC group. This was maintained after matching. During follow-up, 32 endoleaks (3 type I, 27 type II, 2 type III) occurred; 26 (28%) EEC and 13 of 76 (17%) OEC patients underwent reoperation. The approach was not related to the risk of death in either hazard phase, but a larger descending diameter predicted a greater risk in the early phase. Conclusions Death and complications occur similarly after OEC or EEC. The early toll might be greater after OEC, at the cost of reintervention for EEC. EEC expands the options to older patients and allows for earlier completion. Second-stage repair should not be delayed, and all patients require lifelong imaging surveillance.

Original languageEnglish (US)
Pages (from-to)1408-1416
Number of pages9
JournalJournal of Thoracic and Cardiovascular Surgery
Volume146
Issue number6
DOIs
StatePublished - Dec 2013

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Aortic Diseases
European Union
Endoleak
Survival
Tracheostomy
Spinal Cord Injuries
Reoperation
Atrial Fibrillation
Renal Insufficiency
Aorta
Stroke
Hemorrhage
Morbidity
Mortality

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery
  • Pulmonary and Respiratory Medicine

Cite this

Endovascular versus open elephant trunk completion for extensive aortic disease. / Roselli, Eric E.; Subramanian, Sreekumar -; Sun, Zhiyuan; Idrees, Jahanzaib; Nowicki, Edward; Blackstone, Eugene H.; Greenberg, Roy K.; Svensson, Lars G.; Lytle, Bruce W.

In: Journal of Thoracic and Cardiovascular Surgery, Vol. 146, No. 6, 12.2013, p. 1408-1416.

Research output: Contribution to journalArticle

Roselli, EE, Subramanian, S, Sun, Z, Idrees, J, Nowicki, E, Blackstone, EH, Greenberg, RK, Svensson, LG & Lytle, BW 2013, 'Endovascular versus open elephant trunk completion for extensive aortic disease', Journal of Thoracic and Cardiovascular Surgery, vol. 146, no. 6, pp. 1408-1416. https://doi.org/10.1016/j.jtcvs.2013.07.070
Roselli, Eric E. ; Subramanian, Sreekumar - ; Sun, Zhiyuan ; Idrees, Jahanzaib ; Nowicki, Edward ; Blackstone, Eugene H. ; Greenberg, Roy K. ; Svensson, Lars G. ; Lytle, Bruce W. / Endovascular versus open elephant trunk completion for extensive aortic disease. In: Journal of Thoracic and Cardiovascular Surgery. 2013 ; Vol. 146, No. 6. pp. 1408-1416.
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AU - Roselli, Eric E.

AU - Subramanian, Sreekumar -

AU - Sun, Zhiyuan

AU - Idrees, Jahanzaib

AU - Nowicki, Edward

AU - Blackstone, Eugene H.

AU - Greenberg, Roy K.

AU - Svensson, Lars G.

AU - Lytle, Bruce W.

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N2 - Objectives To compare the outcomes between patients undergoing endovascular (EEC) or open (OEC) approaches to second-stage elephant trunk completion (EC). Methods From 1993 to 2010, 225 patients underwent second-stage EC (EEC, n = 92; OEC, n = 133). Propensity matching was performed for a fair comparison. Results The EEC patients were older, more likely to have atrial fibrillation, and had a smaller proximal aorta. The 30-day mortality was 6.2% (6.5% EEC vs 6% OEC, P =.88). No difference was found in bleeding (8.8%), stroke (3%), renal failure (4%), or spinal cord injury (4%); however, the OEC patients required tracheostomy more often (10 vs 1, P =.014). Survival after second-stage EC at 6 months and 1 and 5 years was 91%, 90%, and 77%, respectively. Survival and major morbidity did not differ after matching (44 pairs). However, the EEC group had shorter stays (9.9 ± 13 vs 13 ± 9 days, P <.0001) and received less blood (3 ± 8 vs 6 ± 8 U, P =.0001) than did the OEC group. This was maintained after matching. During follow-up, 32 endoleaks (3 type I, 27 type II, 2 type III) occurred; 26 (28%) EEC and 13 of 76 (17%) OEC patients underwent reoperation. The approach was not related to the risk of death in either hazard phase, but a larger descending diameter predicted a greater risk in the early phase. Conclusions Death and complications occur similarly after OEC or EEC. The early toll might be greater after OEC, at the cost of reintervention for EEC. EEC expands the options to older patients and allows for earlier completion. Second-stage repair should not be delayed, and all patients require lifelong imaging surveillance.

AB - Objectives To compare the outcomes between patients undergoing endovascular (EEC) or open (OEC) approaches to second-stage elephant trunk completion (EC). Methods From 1993 to 2010, 225 patients underwent second-stage EC (EEC, n = 92; OEC, n = 133). Propensity matching was performed for a fair comparison. Results The EEC patients were older, more likely to have atrial fibrillation, and had a smaller proximal aorta. The 30-day mortality was 6.2% (6.5% EEC vs 6% OEC, P =.88). No difference was found in bleeding (8.8%), stroke (3%), renal failure (4%), or spinal cord injury (4%); however, the OEC patients required tracheostomy more often (10 vs 1, P =.014). Survival after second-stage EC at 6 months and 1 and 5 years was 91%, 90%, and 77%, respectively. Survival and major morbidity did not differ after matching (44 pairs). However, the EEC group had shorter stays (9.9 ± 13 vs 13 ± 9 days, P <.0001) and received less blood (3 ± 8 vs 6 ± 8 U, P =.0001) than did the OEC group. This was maintained after matching. During follow-up, 32 endoleaks (3 type I, 27 type II, 2 type III) occurred; 26 (28%) EEC and 13 of 76 (17%) OEC patients underwent reoperation. The approach was not related to the risk of death in either hazard phase, but a larger descending diameter predicted a greater risk in the early phase. Conclusions Death and complications occur similarly after OEC or EEC. The early toll might be greater after OEC, at the cost of reintervention for EEC. EEC expands the options to older patients and allows for earlier completion. Second-stage repair should not be delayed, and all patients require lifelong imaging surveillance.

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