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Inter-Stage Mortality in Two-Stage Elephant Trunk Surgery
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  • Ayman Saeyeldin,
  • Anton Gryaznov,
  • Mohammad Zafar,
  • Jinlin Wu,
  • Sandip Mukherjee,
  • Prashanth Vallabhajosyula,
  • Bulat Ziganshin,
  • John Elefteriades
Ayman Saeyeldin
Aortic Institute at Yale-New Haven, Yale University School of Medicine
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Anton Gryaznov
Aortic Institute at Yale-New Haven, Yale University School of Medicine
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Mohammad Zafar
Aortic Institute at Yale-New Haven, Yale University School of Medicine
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Jinlin Wu
Aortic Institute at Yale-New Haven, Yale University School of Medicine
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Sandip Mukherjee
Aortic Institute at Yale-New Haven, Yale University School of Medicine
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Prashanth Vallabhajosyula
Aortic Institute at Yale-New Haven, Yale University School of Medicine
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Bulat Ziganshin
Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine
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John Elefteriades
Aortic Institute at Yale-New Haven, Yale University School of Medicine
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Abstract

Purpose: Diffuse mega-aorta is challenging. Prior studies have raised concerns regarding the safety of the open two-stage elephant trunk (ET) approach for extensive thoracic aortic aneurysm (TAA), specifically in regard to inter-stage mortality. This study evaluates the safety of the two-stage ET approach for management of extensive TAA. Methods: Between 2003–2018, 152 patients underwent a Stage I ET procedure by a single surgeon (mean age 64.5±14.8). Second stage ET procedure was planned in 60 patients (39.4%) and to-date has been performed in 54 patients (90%). (In the remaining patients, the elephant trunk was prophylactic for the long-term, with no plan for near-term utilization). Results: In-hospital mortality after the Stage I procedure was 3.3% (5/152). In patients planned for Stage II, the median inter-stage interval was 5 weeks (range: 0-14). Of the remaining six patients with planned, but uncompleted Stage II procedures, five patients expired from various causes in the interval period (inter-stage mortality of 8.3%). There were no cases of aortic rupture in the inter-stage interval. Stage II was completed in 58 patients (including 4 unplanned) with 30-day morality of 10.3% (6/58). Seven patients developed strokes after Stage II (12%), and three patients (5.1%) developed paraplegia. Conclusions: The overall mortality, including Stage I, inter-stage interval, and Stage II was 18.6%. This cumulative mortality for the open two-staged ET approach for treatment of extensive TAA is acceptable for aortic disease of this severity. Fear of inter-stage rupture should not preclude the aggressive Two-Stage approach to management of extensive TAA.

Peer review status:ACCEPTED

16 Oct 2020Submitted to Journal of Cardiac Surgery
20 Oct 2020Submission Checks Completed
20 Oct 2020Assigned to Editor
20 Oct 2020Reviewer(s) Assigned
09 Nov 2020Review(s) Completed, Editorial Evaluation Pending
09 Nov 2020Editorial Decision: Revise Minor
30 Nov 20201st Revision Received
02 Dec 2020Submission Checks Completed
02 Dec 2020Assigned to Editor
02 Dec 2020Reviewer(s) Assigned
26 Dec 2020Review(s) Completed, Editorial Evaluation Pending
26 Dec 2020Editorial Decision: Accept