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 for distal aortic arch surgery since February 1997. The early clinical results are evaluated.Methods: There were 11 true aneurysms (8 fusiform, 3 saccular) and one chronic type B dissection. The average age was 68yr (63-81). EVGs were PTFE-covered two-8 bend Z stents in the first eight cases and made with the same stents and ultrathin woven Dacron grafts in the last four cases.Results: Total arch replacement and aortocoronary bypass grafting were combined in one and two patients, respectively. The average retrograde cerebral perfusion time was 42±8min. The cardiopulmonary bypass time averaged 211±26min. All patients awoke early after operation (4.5±1.2h). All but one case was extubated within 24h. There was no operative mortality, but paraplegia and cerebral infarction were complicated in one case each. Their maximum diameter (73.9±21.2mm) decreased significantly after operation (68.7±20.1mm) and one year thereafter (63.1±16.0mm). True aneurysms were thrombosed completely. A chronic type B dissection revealed impending rupture due to false lumen infection one year after operation. The whole descending aorta replacement was performed but the patient died 6months thereafter due to cerebro-vascular complication.Conclusion: Implantation of EVGs reduces operative invasion for distal arch surgery. This procedure should improve mortality, while long-term results have not been clarified. Copyright (C) 2000 The International Society for Cardiovascular Surgery.