P137. Late Outcomes of a Novel Sutureless Technology for Facilitation of Supra-Aortic Arch Graft Anastomosis
University of Pennsylvania
Philadelphia, PA
United States - Contact Me
Dr. Nimesh Desai is a cardiovascular surgeon who serves as Co-Director of the Penn Aorta Center and an Associate Professor of Surgery at the Hospital of the University of Pennsylvania. He also serves as Associate Director of the Cardiovascular Outcomes, Quality, and Evaluative Research (CAVOQER) Center at Penn. He received his medical degree from the Schulich School of Medicine at the University of Western Ontario and his doctorate of philosophy in clinical epidemiology from the University of Toronto. He completed an integrated Cardiac Surgery Residency at the University of Toronto and is a Fellow of the Royal College of Surgeons of Canada. He holds several national leadership positions in cardiovascular surgery including Co-Chair of the Society of Thoracic Surgeons Aortic Surgery Task Force and Co-Chair of the Society of Thoracic Surgeons/American College of Cardiology Transcather Valve Therapies Registry Risk Modelling Sub-Committee.
Dr. Desai’s research interests include organizing large multi-center clinical trials to assess new cardiovascular technologies and health process evaluations using big-data and novel statistical approaches to improve quality of care for cardiac patients. Dr. Desai is Primary Investigator of over 10 clinical trials currently ongoing at Penn, holds grants for database and registry development and was recently awarded funding from the NHLBI to develop and direct a Clinical and Implementation Research Skills Program (CIRSP) for surgical trainees as part of a successful Penn U01 submission. Dr. Desai’s clinical focus is on advanced aortic surgery, both endovascular and open, percutaneous valve replacement, complex valve surgery, multiple arterial grafting and arrhythmia surgery.
Description
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.
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