Single-center experience and evolution of technique with the E-vita Open
prosthesis.
Abstract
Background: We report our experience in aortic arch repair with the
E-vita Open hybrid prosthesis and describe the changes in our technique
over time. Methods: Between October 2013 and December 2019, 56 patients
underwent a total aortic arch replacement with the E-vita Open hybrid
prosthesis. Main indications were thoracic aorta aneurysm (n=27) and
acute type A aortic dissection (n=18). We analyze the technique and
results in the overall series, and compare both between our early (Group
I, 25 patients) and late experience (Group II, 31 patients). Results:
Overall in-hospital mortality was 7.1% (4), and permanent stroke and
spinal cord injury were 3.6% and 1.8% respectively. 15 patients
(26.8%) underwent a planned second procedure on the distal aorta: 13
endovascular, 1 open and 1 hybrid. Survival at 1 and 3 years was 90.7%
and 80.7%. Group II included more patients with acute dissection
(45.2% vs 16%, p=0.02), a higher rate of bilateral cerebral perfusion
(100% vs 64%, p<0.001), left subclavian artery perfusion
during lower body circulatory arrest (87.1% vs 0%, p<0.001),
early reperfusion (96.8% vs 40%, p<0.001), and zone 0-2
distal anastomosis (100% vs 72%, p=0.02). In-hospital mortality (3.2%
vs 12%) and permanent stroke (0% vs 8%) tended to be lower in Group
II. Conclusions: Total arch replacement with E-vita Open hybrid
prosthesis in complex thoracic aorta disease is safe. One-stage
treatment is feasible when pathology does not extend beyond the proximal
descending thoracic aorta. In any case, it facilitates subsequent
procedures on distal aorta if needed.