Surgery News - February 2009 - (Page 16) 16 VASCULAR FEBRUARY 2009 • SURGERY NEWS New Data Show Poor Results After TAAA Repair BY NANCY WALSH Else vier Global Medical Ne ws N E W Y O R K — The morbidity and mortality associated with hybrid repair of thoracoabdominal aneurysms in highrisk patients remain substantial, according to data from four vascular centers. The hybrid procedure, which involves combined visceral/renal debranching and endovascular exclusion, is intended to be a less invasive approach for patients who are considered high risk for open surgery, the clinical standard. However, even though aortic cross-clamping, extracorporal perfusion, thoracotomy, and single-lung ventilation are avoided, “hybrid procedures may not be so benign, even in centers of excellence,” said Dr. Dittmar Bockler at the Veith symposium on vascular medicine sponsored by the Cleveland Clinic. In the initial report of 29 patients who underwent the hybrid procedure, there were three deaths and no cases of paraplegia (a devastating complication seen with the open surgery). The authors described their results as “encouraging” ( J. Vasc. Surg. 2006;43:1081-9). Subsequent experience has been less promising. “Because the numbers in published series are small, we pooled data from three centers, in Heidelberg, Munich, and London,” said Dr. Bockler of the University of Heidelberg (Germany). Among the 87 patients included in the CALL FOR SUBMISSIONS 2009 Clinical Congress of the American College of Surgeons Oral presentations Surgical Forum* Program Coordinator: Kathryn L. Matousek, 312/202-5336, kmatousek@facs.org (11 $1,000 Excellence in Research Awards were given in 2008) Accepted Surgical Forum abstracts will be published in a 2009 Journal of the American College of Surgeons (JACS) supplement The American College of Surgeons Division of Education welcomes submissions to the following programs to be considered for presentation at Papers Session* Program Coordinator: Beth Brown, 312/202-5325, ebrown@facs.org Poster presentation Program Coordinator: Kay Anthony, 312/202-5385, kanthony@facs.org Video presentation the 95th annual Clinical Congress, October 11–15, 2009, Chicago, IL Program Coordinator: GayLynn Dykman, 312/202-5262, gdykman@facs.org Submission information Abstracts are to be submitted online only Submission period begins November 3, 2008 Deadline: 5:00 pm (CST), March 1, 2009 Late submissions are not permitted each individual program will be posted on the ACS Web site at www.facs.org. Review the information carefully prior to submission. Duplicate submissions (submitting the same abstract to more than one program) are not allowed. *Accepted authors are encouraged to submit full mansuscripts to JACS. analysis, most were male, 24 had chronic expanding dissections, 3 had mycotic aneurysms, and 8 had Marfan syndrome or a connective tissue disease. Mean aneurysm diameter was 74 mm. Previous aortic procedures were common among the patients, all of whom were considered high risk, he noted. Analysis revealed that, at 30 days, mortality was 13%, paraplegia was 8%, dialysis and renal insufficiency was 3%, graft occlusion resulting in gut resection was 2%, and overall graft occlusion was 6%. At 1 year, the overall mortality was 25%, and rates of paraplegia, dialysis, and graft occlusion remained the same as at 30 days. The endoleakage rate was 11%. The eight type I endoleaks were treated with proximal extension in six patients; two patients had spontaneous sealing of the endoleaks. Five type III endoleaks that were treated endovascularly. Many questions about the hybrid procedure remain to be answered, Dr. Bockler said. “Should it be simultaneous or staged? What about cerebrospinal fluid drainage? We don’t know about longterm results, and we don’t know if it’s a good option for patients with [Marfan syndrome] and chronic dissection. Hybrid procedures are an alternative for repair of types I-III degenerative thoracoabdominal aortic aneurysms in very select high-risk patients who are not considered fit for open surgery, Dr. Bockler said. He added that mortality and paraplegia rates are still too high. Similar experience was reported at the symposium by Dr. Richard P. Cambria, an ACS Fellow with the division of vascular and endovascular surgery, Massachusetts General Hospital and Harvard Medical School, Boston. Between June 2005 and December 2007, 23 high-risk patients with thoracoabdominal aneurysms underwent mesenteric and renal debranching and subsequent placement of a thoracic stent graft, whereas 77 underwent open repair. The hybrid and open groups had similar mean ages (77 and 73 years, respectively) and mean aneurysm size (6.5 cm in both groups). The mean Society for Vascular Surgery (SVS) risk score was 9 in the hybrid group and 6 in the open group, and more patients in the hybrid group than in the open group had oxygen-dependent chronic obstructive pulmonary disease and prior thoracic or thoracoabdominal repairs. “Composite mortality and/or paraplegia was doubled in the hybrid group, at 22%, compared with 12% in the open group,” Dr. Cambria said. Similarly, the rate of any type of reoperation was 39% in the hybrid group, compared with 21% in the open group. Actuarial survival rates at 1 year were 74% and 72% in the hybrid and open groups, respectively. “While touted as an operation of limited extent, the hybrid repair in high-risk patients has substantial morbidity, and to really clarify its role, a prospective study in equivalent risk patients would be needed,” Dr. Cambria concluded. Dr. Bockler and Dr. Cambria declared no conflicts of interest. http://www.facs.org
Table of Contents Feed for the Digital Edition of Surgery News - February 2009 Surgery News - February 2009 Contents The 20/20 Vision ICD-10 Looms News From the College: MedPAC Flak Oncology: Best for Breast General Surgery: Weighty Problem Surgery News - February 2009 Surgery News - February 2009 - Contents (Page 1) Surgery News - February 2009 - Contents (Page 2) Surgery News - February 2009 - Contents (Page 3) Surgery News - February 2009 - Contents (Page 4) Surgery News - February 2009 - The 20/20 Vision ICD-10 Looms (Page 5) Surgery News - February 2009 - The 20/20 Vision ICD-10 Looms (Page 6) Surgery News - February 2009 - The 20/20 Vision ICD-10 Looms (Page 7) Surgery News - February 2009 - News From the College: MedPAC Flak (Page 8) Surgery News - February 2009 - News From the College: MedPAC Flak (Page 9) Surgery News - February 2009 - News From the College: MedPAC Flak (Page 10) Surgery News - February 2009 - News From the College: MedPAC Flak (Page 11) Surgery News - February 2009 - Oncology: Best for Breast (Page 12) Surgery News - February 2009 - Oncology: Best for Breast (Page 13) Surgery News - February 2009 - Oncology: Best for Breast (Page 14) Surgery News - February 2009 - Oncology: Best for Breast (Page 15) Surgery News - February 2009 - Oncology: Best for Breast (Page 16) Surgery News - February 2009 - Oncology: Best for Breast (Page 17) Surgery News - February 2009 - Oncology: Best for Breast (Page 18) Surgery News - February 2009 - General Surgery: Weighty Problem (Page 19) Surgery News - February 2009 - General Surgery: Weighty Problem (Page 20)
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