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Concomitant left subclavian artery revascularization with carotid-subclavian transposition during zone 2 thoracic endovascular aortic repair.

Authors
  • Bianco, Valentino1
  • Sultan, Ibrahim2
  • Kilic, Arman3
  • Aranda-Michel, Edgar1
  • Cuddy, Richard James4
  • Srivastava, Avantika4
  • Navid, Forozan3
  • Gleason, Thomas G3
  • 1 Division of Cardiac Surgery, Department of Cardiothoracic Surgery, Pittsburgh, Pa.
  • 2 Division of Cardiac Surgery, Department of Cardiothoracic Surgery, Pittsburgh, Pa; Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pa. Electronic address: [email protected]
  • 3 Division of Cardiac Surgery, Department of Cardiothoracic Surgery, Pittsburgh, Pa; Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pa.
  • 4 University of Pittsburgh, Pittsburgh, Pa.
Type
Published Article
Journal
The Journal of thoracic and cardiovascular surgery
Publication Date
Apr 01, 2020
Volume
159
Issue
4
Pages
1222–1227
Identifiers
DOI: 10.1016/j.jtcvs.2019.03.060
PMID: 31030960
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

Left subclavian revascularization has become an integral part of thoracic endovascular aortic repair to extend the proximal landing zone. This is most commonly achieved via carotid-subclavian bypass; however, this can be achieved via vessel transposition. All patients who had zone 2 thoracic endovascular aortic repairs without branched grafts from 2007 to 2018 were included in the study. The primary outcomes were adverse events, including operative mortality, paraplegia, left arm ischemia, and stroke. Multivariable regression analysis was performed for baseline characteristics associated with adverse events. A total of 58 patients underwent left subclavian artery transposition for zone 2 thoracic endovascular aortic repair coverage. Operative (30-day) mortality occurred in 3 patients (5.2%). The majority of patients were operated on under urgent (N = 25; 43.1%) or emergency (N = 12; 20.7%) status. Indications for thoracic endovascular aortic repair included aneurysmal disease (34.5%) and type B aortic dissection (chronic [13.8%]; acute [51.7%]). Major adverse events included paraplegia (N = 1; 1.7%), transient paraparesis (N = 3; 5.2%), and stroke (N = 2; 3.4%). Over a mean follow-up of 2.8 years, there were 5 deaths (8.6%). On multivariable analysis, prior stroke (odds ratio, 31.4; 1.95-506.72; P = .02) was an independent predictor of adverse events. Carotid-subclavian transposition offers patients a safe and effective method for left subclavian artery revascularization during thoracic endovascular aortic repair with zone 2 coverage with no increased operative risk and a low complication rate. Copyright © 2019 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

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