Early results after implantation of Siena™ Collared Graft in elephant-trunk procedure

AM Dell'Aquila; SRB Schneider; D Schlarb; A Rukosujew; S Martens

doi:10.1055/s-0032-1332540

The Thoracic and Cardiovascular Surgeon, Table of Contents

Early results after implantation of Siena™ Collared Graft in elephant-trunk procedure

AM Dell'Aquila ¹, SRB Schneider ¹, D Schlarb ¹, A Rukosujew ¹, S Martens ¹

¹Universitätsklinikum Münster, Klinik und Poliklinik für Thorax-, Herz- und Gefäßchirurgie, Münster, Germany

Abstract

Objective: We report on our experience with a simplified elephant-trunk procedure with an innovative prosthesis (Vascutek® Siena™ Collared Graft). This prosthesis consists of a proximal portion (20 cm), a collar and a distal portion (30 cm). The collar, made of a gelatin-coated woven polyester, constitutes the suture portion to the descending aorta. This can be trimmed in any desired diameter for the suture. Moreover the presence of radiopaque markers in the distal portion facilitates second stage endovascular procedures.

Methods: Between January 2011 and September 2012, 16 consecutive patients (7 women; mean age, 64.8 ± 11.2 years) underwent elephant trunk procedure. Underlying aortic disease were acute dissection (n = 5), chronic dissection (n = 3), aneurysm (n = 6) and PAU (n = 2). Mean preoperative diameter of descending aorta was 49.1 ± 14.1 mm (range 71.7 – 29.7 mm). Four patients had undergone previous heart surgery. Concomitant procedures included: ascending aortic replacement in 13 patients; root replacement in 1; aortic valve replacement in 3, CABG in 2 and mitral repair in 1.

Results: Cardiopulmonary bypass time was 274.3 ± 102.8 minutes, mean duration of antegrade cerebral perfusion was 71.9 ± 22.6. Two patients deceased due to multiorgan failure on the 4^th and 8^th post-operative day respectively. Another in-hospital death occurred due to a cerebral hemorrhage on the 39^th post-operative day. Major adverse events included: stroke (n = 1), postoperative resternotomy for bleeding (n = 3), renal failure requiring temporary dialysis (n = 2); recurrent nerve paresis (n = 2). Mean in-Hospital-stay was 32.8 ± 24 days. After a mean follow-up of 7.8 ± 5.5 months all discharged patients were alive. Five patients have been scheduled for stent-graft implantation of descending aorta, two of them underwent successful stent-graft implantation.

Conclusions: This experience suggests that Siena™ collared graft is a good treatment option for aortic arch pathologies. The presence of the collar allows an easy anastomosis with any diameter of the distal aorta. Later treatment of the descending aorta with stent grafts is facilitated by the landing zone and radiopaque markers of the prosthesis.