Clinical results of implantation of an endovascular covered stent-graft via midsternotomy for distal aortic arch aneurysm

We have been implanting endovascular stent grafts (EVG) via midsternotomy f or distal aortic arch surgery since February 1997, The early clinical resul ts are evaluated. Methods: There were 11 true aneurysms (8 fusiform, 3 saccular) and one chro nic type B dissection. The average age was 68 yr (63-81), EVCs were PTFE-co vered two-8 bend 2 stents in the first eight cases and made with the same s tents and ultrathin woven Dacron grafts in the last four cases. Results: Total arch replacement and aortocoronary bypass grafting were comb ined in one and two patients, respectively. The average retrograde cerebral perfusion time was 42 +/- 8 min. The cardiopulmonary bypass time averaged 211 +/- 26 min. All patients awoke early after operation (4.5 +/- 1.2 h), A ll but one case was extubated within 24 h, There was no operative mortality , but paraplegia and cerebral infarction were complicated in one case each. Their maximum diameter (73.9 +/- 21.2 mm) decreased significantly after op eration (68.7 +/- 20.1 mm) and one year thereafter (63.1 +/- 16.0 mm). True aneurysms were thrombosed completely. A chronic type B dissection revealed impending rupture due to false lumen infection one year after operation, T he whole descending aorta replacement was performed but the patient died 6 months thereafter due to cerebro-vascular complication, Conclusion: Implantation of EVCs reduces operative invasion for distal arch surgery. This procedure should improve mortality, while long-term results have not been clarified. (C) 2000 The International Society for Cardiovascu lar Surgery. Published by Elsevier Science Ltd. All rights reserved.