Objectives: Our goal was to investigate the surgical strategy for type Ia endoleak after thoracic endovascular aortic repair (TEVAR) by reporting our experiences.
Methods: From November 2012 to September 2019, a total of 23 patients received surgical management for type Ia endoleak after TEVAR.
Results: The operations included total arch replacement with the frozen elephant trunk technique in 15 patients, direct closure of the endoleak in 2 patients, hybrid aortic arch repair in 4 patients, arch debranching with TEVAR in 1 patient and left common carotid artery to left subclavian artery bypass with TEVAR in 1 patient. Among 21 patients with cardiopulmonary bypass (CPB), the mean CPB and aortic cross-clamp times were 146.7 ± 42.2 and 81.0 ± 43.3 min, respectively. The selective cerebral perfusion time was 18.8 ± 8.2 min in 17 patients with hypothermic circulatory arrest. The in-hospital mortality was 8.7% (2/23). Type Ia endoleak was sealed successfully after surgery in 95.5% (21/22) of patients. The follow-up data were available for all 21 survivors. The median follow-up period was 18 months (range 1-84 months). During the follow-up period, a total of 8 patients died or had aortic events, including 5 deaths and 6 aortic events.
Conclusions: Different surgical strategies could be selected to treat patients with type Ia endoleak after TEVAR, with acceptable early and late outcomes.
Keywords: Endoleak; Frozen elephant trunk; Hybrid aortic arch repair; Thoracic endovascular aortic repair.
© The Author(s) 2020. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.