Long-term outcomes of total arch replacement using a 4-branched graft

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Presentation transcript:

Long-term outcomes of total arch replacement using a 4-branched graft Yuki Ikeno, MD, Koki Yokawa, MD, Takashi Matsueda, MD, Katsuhiro Yamanaka, MD, PhD, Takeshi Inoue, MD, Hiroshi Tanaka, MD, PhD, Yutaka Okita, MD, PhD The Journal of Thoracic and Cardiovascular Surgery Volume 157, Issue 1, Pages 75-85.e3 (January 2019) DOI: 10.1016/j.jtcvs.2018.09.118 Copyright © 2018 The American Association for Thoracic Surgery Terms and Conditions

Figure 1 A, Overall survival. B, Overall survival by pathology: non-dissection (blue line), acute dissection (red line), and chronic dissection (green line). Significant differences were found between non-dissection and acute dissection as well as non-dissection and chronic dissection. Overall survival in the Japanese healthy population adjusted for age and sex. C, Non-dissection. D, Acute dissection. E, Chronic dissection. The Journal of Thoracic and Cardiovascular Surgery 2019 157, 75-85.e3DOI: (10.1016/j.jtcvs.2018.09.118) Copyright © 2018 The American Association for Thoracic Surgery Terms and Conditions

Figure 2 A, Freedom from repeated aortic operation. B, Freedom from repeated aortic operation by pathology: non-dissection (blue line), acute dissection (red line), and chronic dissection (green line). A significant difference was found between non-dissection and acute dissection. C, Freedom from additional aortic operation. D, Freedom from additional aortic operation by pathology: non-dissection (blue line), acute dissection (red line), and chronic dissection (green line). non-dissection (blue line), acute dissection (red line), and chronic dissection (green line). Significant differences were found between (non-dissection and chronic dissection as well as acute dissection and chronic dissection). The Journal of Thoracic and Cardiovascular Surgery 2019 157, 75-85.e3DOI: (10.1016/j.jtcvs.2018.09.118) Copyright © 2018 The American Association for Thoracic Surgery Terms and Conditions

Figure E1 Overall survival according to time from operation over 18 years. The first 6 years (1999-2004) (red line), the second 6 years (2005-2010) (green line), and the last 6 years (2011-2016) (blue line). The Journal of Thoracic and Cardiovascular Surgery 2019 157, 75-85.e3DOI: (10.1016/j.jtcvs.2018.09.118) Copyright © 2018 The American Association for Thoracic Surgery Terms and Conditions

Figure E2 A, Freedom from aortic-related death. B, Freedom from aortic-related death by pathology: non-dissection (blue line), acute dissection (red line), and chronic dissection (green line). The Journal of Thoracic and Cardiovascular Surgery 2019 157, 75-85.e3DOI: (10.1016/j.jtcvs.2018.09.118) Copyright © 2018 The American Association for Thoracic Surgery Terms and Conditions

Figure E3 A, Survival without major adverse aortic event (MAAE). B, MAAE-free survival by pathology: non-dissection (blue line), acute dissection (red line), and chronic dissection (green line). C, Freedom from stroke. The Journal of Thoracic and Cardiovascular Surgery 2019 157, 75-85.e3DOI: (10.1016/j.jtcvs.2018.09.118) Copyright © 2018 The American Association for Thoracic Surgery Terms and Conditions

Surgical schema of total arch replacement using a 4-branched graft. The Journal of Thoracic and Cardiovascular Surgery 2019 157, 75-85.e3DOI: (10.1016/j.jtcvs.2018.09.118) Copyright © 2018 The American Association for Thoracic Surgery Terms and Conditions

Video 1 The aortic arch was opened under moderate hypothermic circulatory arrest with antegrade selective cerebral perfusion for brain protection. To prevent left recurrent nerve injury, we made a direct circumferential transection from the inner side of the distal end of the aneurysm without longitudinal incision of the aortic arch. After the distal anastomosis, antegrade perfusion of the lower body and rewarming was started. Subsequently, the proximal anastomosis was performed, followed by coronary reperfusion. Finally, the aortic arch was divided to make arch vessel buttons. Three-arch vessels were reconstructed, individually, using a 4-branched graft and 5-0 polypropylene sutures. Video available at: https://www.jtcvs.org/article/S0022-5223(18)32823-X/fulltext. The Journal of Thoracic and Cardiovascular Surgery 2019 157, 75-85.e3DOI: (10.1016/j.jtcvs.2018.09.118) Copyright © 2018 The American Association for Thoracic Surgery Terms and Conditions

The Journal of Thoracic and Cardiovascular Surgery 2019 157, 75-85 The Journal of Thoracic and Cardiovascular Surgery 2019 157, 75-85.e3DOI: (10.1016/j.jtcvs.2018.09.118) Copyright © 2018 The American Association for Thoracic Surgery Terms and Conditions