Short term and intermediate results of hybrid procedure in high risk patients needing aortic arch repair

Purpose: Zone 0 landing in thoracic endovascular aortic repair (TEVAR) has recently gained increasing attention for the treatment of high-risk patients. The aim of this study was to compare the outcomes of total endovascular aortic arch repair between branched TEVAR (bTEVAR) and chimney TEVAR (cTEVAR) in the landing zone (LZ) 0. Materials and Methods: This was a single-center, retrospective, and observational cohort study. From January 2010 to March 2020, 40 patients (bTEVAR, n=25; cTEVAR, n=15; median age: 79 years) were enrolled in this study, with a median follow-up period of 4.1 years. These patients were considered unsuitable for open surgical treatment. Results: All procedures were successful and no cases of conversion to open repair were noted during the 30-day postoperative period. The 30-day mortality was 2.5% (n=1; bTEVAR [0 of 25, 0%] vs cTEVAR [1 of 15, 6.7%]; p=0.375), the perioperative stroke rate was 10.0% (n=4; bTEVAR [4 of 25, 16.0%] vs cTEVAR [0 of 15, 0%], p=0.278), and type 1a endoleak rate was 15.0% (n=6; bTEVAR [0 of 25, 0%] vs cTEVAR [6 of 15, 40.0%], p=0.001). The risk factor for stroke was atheroma grade of ≥2 in the brachiocephalic artery (p<0.001). The risk factor for type 1a endoleak was cTEVAR (p=0.001). The 8-year survival rate was 49.9%. The aorta-related death-free rate and aortic event-free rate at 8 years were 94.4% (bTEVAR: 95.5% vs cTEVAR: 93.3%, p=0.504) and 60.7% (bTEVAR: 70.7% vs cTEVAR: 40.0%, p=0.048), respectively. Conclusions: Total endovascular aortic arch repair using bTEVAR and cTEVAR is feasible for the treatment of aortic arch diseases in high-risk patients who are unsuitable for open surgery. However, as the rate of stroke is high, strict preoperative evaluation to prevent stroke is needed. No rupture of the aneurysm was observed in cTEVAR, but patients should be selected carefully because of the high incidence of type 1a endoleak.

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Faculty Opinions recommendation of Outcomes of thoracic endovascular aortic repair using aortic arch chimney stents in high-risk patients.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.727328539.793529166 ◽

2017 ◽

Author(s):

John Augoustides

Keyword(s):

High Risk ◽

Aortic Arch ◽

Thoracic Endovascular Aortic Repair ◽

Endovascular Aortic Repair ◽

High Risk Patients ◽

Aortic Repair ◽

Risk Patients

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636 SHORT-TERM OUTCOME FOR HIGH-RISK PATIENTS AFTER ESOPHAGECTOMY

Diseases of the Esophagus ◽

10.1093/dote/doab052.636 ◽

2021 ◽

Vol 34 (Supplement_1) ◽

Author(s):

Victor Plat ◽

Wessel Stam ◽

Boukje Bootsma ◽

Jennifer Straatman ◽

Thomas Klausch ◽

...

Keyword(s):

High Risk ◽

Propensity Score ◽

Propensity Score Matching ◽

Charlson Comorbidity Index ◽

Short Term ◽

Term Outcome ◽

High Risk Patients ◽

Short Term Outcome ◽

Risk Patients ◽

Comorbidity Index

Abstract Transthoracic esophagectomy (TTE) for esophageal cancer facilitates mediastinal dissection, however it has a significant impact on cardiopulmonary status. High-risk patients may therefore be better candidates for transhiatal esophagectomy (THE) in order to prevent serious complications. This study addressed short-term outcome following TTE and THE in patients that are considered to have a higher risk of surgery-related morbidity. Methods This population-based study included patients who underwent a curative esophagectomy between 2011 and 2018, registered in the Dutch Upper GI Cancer Audit. The Charlson comorbidity index was used to assign patients to a low-risk (score ≤ 1) and high-risk group (score ≥ 2). Propensity score matching was applied to produce comparable groups between high-risk patients receiving TTE and THE. Primary endpoint was mortality (in-hospital/30-day mortality), secondary endpoints included morbidity and oncological outcomes. Additionally, a matched subgroup analysis was performed, including only cervical reconstructions. Results Of 5438 patients, 945 and 431 high-risk patients underwent TTE and THE respectively. After propensity score matching, mortality (6.3% vs 3.3%, P = 0.050), overall morbidity, Clavien-Dindo ≥3 complications, pulmonary complications, cardiac complications and re-interventions were significantly more observed after TTE compared to THE. A significantly higher mortality after TTE with a cervical reconstruction was found compared to THE (7.0% vs 2.2%, P = 0.020). Conclusion Patients with a high Charlson comorbidity index predispose for a complicated postoperative course after esophagectomy, this was more outspoken after TTE compared to THE. In daily practice these outcomes should be balanced with the lower lymph node yield, but comparable positive node count and radicality after THE.

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