Multi-Vessel Arch Branch Ostial Stenosis: Outcome of Extra-Anatomical Bypasses

P0221 

Abstract Submission 

Francois Dagenais (1), Rim Abdelli (2), Roxanne St-Louis (3), Eric Dumont (4)

(1) Quebec Heart and Lung Insitute, Quebec, Quebec, (2) Quebec Heart and Lung Institute, Quebec, Qc, (3) Quebec Heart and Lung Institute, Quebec City, QC, (4) Quebec Heart and Lung Institute, Quebec, QC

*Francois Dagenais    -  Contact Me
Quebec Heart and Lung Insitute

Rim Abdelli    -  Contact Me
Quebec Heart and Lung Institute

Roxanne St-Louis    -  Contact Me
Quebec Heart and Lung Institute

Eric Dumont    -  Contact Me
Quebec Heart and Lung Institute

*Francois Dagenais    -  Contact Me
Quebec Heart and Lung Insitute

Objective: Symptomatic multivessel arch branch ostial stenosis (MVABS) is a rare condition. Operative technique remains controversial and few reports assess long-term outcome. We propose a strategy incorporating the use of aorto-axillary extra-anatomical bypass (AAEAB) grafts in the management of patients with symptomatic MVABS. Early and late outcomes are reported.

Methods: Since 2015, 8 consecutive patients with symptomatic (>2) MVABS were referred for operative treatment. All operations were conducted without cardiopulmonary bypass. A multi-branch dacron graft with a 12 or 14mm main branch anastomosed to the ascending aorta was initially constructed. The AAEAB (es) was (were) initially performed to increase cerebral perfusion through the posterior circulation. Subsequently, the most severe carotid artery was revascularized in an end to end fashion followed by revascularization of the other arch branch vessels. Patients were followed prospectively in a dedicated aortic clinic

Results: Mean age was 63,6±3,4yrs; 87,5% female. A mean of 3,1±0,8 bypasses/pt were performed; with right and left AAEAB in respectively 6 and 7 patients. No stroke or hospital death were encountered. One patient required a tracheostomy for 4 days owing to partial bilateral recurrent nerve palsy. At a mean of 3,6±3,2yrs, two patients died of non-vascular causes (80% 5-yr survival). Patients remained free of recurrent symptoms. Among 27 grafts, one carotid graft showed a stenosis requiring stenting 3 years postoperatively (85,7% 5-yr bypass patency; 100% patency of AAEAB grafts)

Conclusion: Operative treatment of symptomatic multivessel arch branch ostial offers excellent symptom relief. Use of AAEAB bypass is safe, enhances cerebral perfusion through the posterior circulation before revascularizing the carotid arteries. Mid-term outcome shows excellent clinical outcome with excellent graft patency.

Aortic Arch