Early outcomes of extra-thoracic debranching thoracic endovascular aortic repair for distal aortic arch disease.

Thoracic endovascular aortic repair (TEVAR) combined with supra-aortic debranching is a promising approach for distal aortic arch disease, especially in high-risk patients. Most debranching TEVAR procedures for distal arch pathologies can now be performed by using extra-thoracic bypass and endovascular repair, without intra-thoracic manipulation needing sternotomy or thoracotomy. To compare the early outcomes of extra-thoracic debranching TEVAR with those of conventional arch replacement, we retrospectively reviewed data from 20 high-risk patients with distal aortic arch disease who underwent extra-thoracic debranching TEVAR and 16 patients who underwent total arch replacement from March 2009 to November 2011. Patient demographics, operative data, and outcomes in each group were evaluated and compared. The mean follow-up period was 22.4 ± 12.7 months. In the extra-thoracic debranching TEVAR group, primary technical success was achieved in all cases. One patient (5 %) died of low cardiac output syndrome within 30 days after surgery. Two patients had perioperative morbidities (10 %); both had a stroke during the procedure. No endoleak or graft migration was observed, and all bypass grafts remained patent. No patient had paraplegia, a new aortic event, or surgical site infection. In conclusion, the early outcomes of extra-thoracic debranching TEVAR in high-risk patients with distal aortic arch disease were satisfactory and encouraging, compared with conventional arch replacement. Extra-thoracic debranching TEVAR has the advantage of less invasiveness and no possibility of sternal infection.