Late Outcomes of a Novel Sutureless Technology for Facilitation of Supra-Aortic Arch Graft Anastomosis
Presented During:
Monday, May 4, 2026: 9:00AM - 4:00PM
McCormick Place Lakeside Center
Posted Room Name:
Exhibit Hall, Poster Area
Abstract No:
P0137
Submission Type:
Abstract Submission
Authors:
Brittany Cannon (1), Nimesh Desai (2), Yu Zhao (2), Joseph Bavaria (3)
Institutions:
(1) The University of Pennsylvania, Philadelphia, PA, (2) University of Pennsylvania, Philadelphia, PA, (3) Thomas Jefferson University, Philadelphia, PA
Submitting Author:
Brittany Cannon
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The University of Pennsylvania
The University of Pennsylvania
Co-Author(s):
*Nimesh Desai
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University of Pennsylvania
University of Pennsylvania
Yu Zhao
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University of Pennsylvania
University of Pennsylvania
*Joseph Bavaria
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Thomas Jefferson University
Thomas Jefferson University
Presenting Author:
*Nimesh Desai
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University of Pennsylvania
University of Pennsylvania
Abstract:
Objective: Open total arch repair of complex aortic pathologies is associated with significant risk of stroke and recurrent laryngeal nerve injury. A novel sutureless graft could potentially facilitate such repairs by minimizing circulatory arrest time and limiting the need for arch mobilization. We report late outcomes of our single center experience with the use of a novel sutureless anastomosis revascularization technique for debranching of supra-aortic vessels during hybrid repair.
Methods: Retrospective study of 65 patients with complex aortic pathologies who underwent classic hybrid arch (no circulatory arrest) debranching, Zone 1, Zone 2, or Zone 3 arch replacement with antegrade cerebral perfusion (ACP). Supra-aortic bypasses to vessels <10 mm in diameter using sutureless arch anastomosis were performed with a Gore Hybrid stent graft. Underlying aortic pathology was acute Type A dissection in 32 patients, chronic aortic dissection in 14, aortic arch aneurysm in 17, and ruptured aortic arch in 2 patients.
Results: Average age was 62.5 ± 11.0 years (range, 27-87 years). 26.2% of patients were female. Seventy-four grafts were implanted in 65 patients using the sutureless technique, including isolated debranching of the left common carotid artery (LCCA) in 83%, left subclavian artery (LSA) in 1.5%, right common carotid artery (RCCA) in 1.5%, concomitant LCCA and LSA in 6.2%, concomitant LCCA and RCCA in 6.2%, and concomitant LCCA and Left Vertebral Artery in 1.5%. Technical success was 100%. Mean cerebral ischemia time was 30.3 ± 12.0 minutes (range, 3-71 min). Four patients had perioperative stroke. No early (<30 days) graft occlusion occurred. There were 2 late graft occlusions, one presenting with TIA at 2years and managed with a carotid subclavian bypass, the second was an asymptomatic occlusion that occurred in the setting of a severe ascending and arch graft infection at 5 years postop. Overall freedom from sutureless graft occlusion was 95%(88.1-100%) at 5 years. There were no strokes related to loss of graft patency.
Conclusion: Hybrid repair using the novel sutureless anastomosis technique is a reasonable and effective option for treatment of complex aortic arch pathologies which simplifies technique and minimizes cerebral ischemia time. Late outcomes are favorable to traditional sewn anastomoses.
Methods: Retrospective study of 65 patients with complex aortic pathologies who underwent classic hybrid arch (no circulatory arrest) debranching, Zone 1, Zone 2, or Zone 3 arch replacement with antegrade cerebral perfusion (ACP). Supra-aortic bypasses to vessels <10 mm in diameter using sutureless arch anastomosis were performed with a Gore Hybrid stent graft. Underlying aortic pathology was acute Type A dissection in 32 patients, chronic aortic dissection in 14, aortic arch aneurysm in 17, and ruptured aortic arch in 2 patients.
Results: Average age was 62.5 ± 11.0 years (range, 27-87 years). 26.2% of patients were female. Seventy-four grafts were implanted in 65 patients using the sutureless technique, including isolated debranching of the left common carotid artery (LCCA) in 83%, left subclavian artery (LSA) in 1.5%, right common carotid artery (RCCA) in 1.5%, concomitant LCCA and LSA in 6.2%, concomitant LCCA and RCCA in 6.2%, and concomitant LCCA and Left Vertebral Artery in 1.5%. Technical success was 100%. Mean cerebral ischemia time was 30.3 ± 12.0 minutes (range, 3-71 min). Four patients had perioperative stroke. No early (<30 days) graft occlusion occurred. There were 2 late graft occlusions, one presenting with TIA at 2years and managed with a carotid subclavian bypass, the second was an asymptomatic occlusion that occurred in the setting of a severe ascending and arch graft infection at 5 years postop. Overall freedom from sutureless graft occlusion was 95%(88.1-100%) at 5 years. There were no strokes related to loss of graft patency.
Conclusion: Hybrid repair using the novel sutureless anastomosis technique is a reasonable and effective option for treatment of complex aortic arch pathologies which simplifies technique and minimizes cerebral ischemia time. Late outcomes are favorable to traditional sewn anastomoses.
ADULT CARDIAC:
Aorta and Great Vessels
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