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Single-center experience and evolution of technique with the E-vita Open prosthesis.
  • +4
  • Luis Maroto,
  • Manuel Carnero,
  • Francisco Cobiella,
  • Rosa Beltrao,
  • Enrique Villagrán,
  • Fernando Reguillo,
  • Daniel Pérez-Camargo
Luis Maroto
Hospital Clínico San Carlos
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Manuel Carnero
Hospital Clínico San Carlos
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Francisco Cobiella
Hospital Clínico San Carlos
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Rosa Beltrao
Hospital Clínico San Carlos
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Enrique Villagrán
Hospital Clínico San Carlos
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Fernando Reguillo
Hospital Clínico San Carlos
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Daniel Pérez-Camargo
Hospital Clínico San Carlos
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Peer review status:ACCEPTED

31 May 2020Submitted to Journal of Cardiac Surgery
02 Jun 2020Submission Checks Completed
02 Jun 2020Assigned to Editor
02 Jun 2020Reviewer(s) Assigned
17 Jun 2020Review(s) Completed, Editorial Evaluation Pending
17 Jun 2020Editorial Decision: Revise Major
30 Jun 20201st Revision Received
02 Jul 2020Submission Checks Completed
02 Jul 2020Assigned to Editor
02 Jul 2020Reviewer(s) Assigned
06 Jul 2020Review(s) Completed, Editorial Evaluation Pending
06 Jul 2020Editorial Decision: Accept

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.