Early and Midterm Outcomes of Open Surgical Correction After Thoracic Endovascular Aortic Repair

Background. We present a single center's experience of secondary interventions after thoracic endovascular aortic repair (TEVAR). Methods. One hundred and forty-seven patients underwent TEVAR at our institution between 2000 and 2012. A total of 26 patients (19 male, mean age 68.4 +/- 12.7 years), including 7 patients with primary TEVAR at other centers, underwent secondary interventions. The median interval to secondary intervention was 17.2 months (range, 0.22 to 36.1). The indications for secondary interventions included procedure-related dissection (n = 1), collapse of the endovascular device (n = 1), aortoesophageal fistula (n = 1), residual dissection (n = 3), and endoleaks causing dilation of the sac (n = 17) or aortic rupture (n = 3). Sixteen patients underwent open conversion including total arch replacement (n = 2), extensive replacement of the aortic arch or descending aorta (n = 10), and thoracoabdominal aortic replacement (n = 4). Second-time TEVAR was performed in the remaining 10 patients. Results. The in-hospital mortality rate was 11.5% (3 patients; 1 case of multiorgan failure after open conversion, and 1 case of mesenteric ischemia and 1 case of aortic rupture after second-time TEVAR). Postoperative stroke after second-time TEVAR occurred in 1 patient. The cumulative survival rate of the 26 patients was 80.0% +/- 8.0% at 5 years after secondary intervention. Short proximal neck (p = 0.0036), steep angulation of landing zones (p = 0.033), and nonuse of commercially available devices (p = 0.011) were significantly correlated with incidence of TEVAR failure. Conclusions. Secondary surgical procedures after TEVAR can be performed with low mortality and morbidity, despite the precarious preoperative conditions and complex aortic pathologies of patients. (C) 2013 by The Society of Thoracic Surgeons