Edward Chen Presents Griepp Paper at AATS Aortic Symposium

April 2018

In addition to serving on the program committee for the American Association for Thoracic Surgery (AATS) Aortic Symposium 2018, held April 26-27 in New York City, Edward P. Chen, MD, professor of surgery in the Emory Division of Cardiothoracic Surgery and a national leader in aortic surgery, presented the event's Randall B. Griepp Honorary Paper. Dr. Griepp was the founding director of the Aortic Symposium, and the lecture distinguishes the best abstract submitted to the conference.

Dr. Chen was senior author of "The 'TEVAR-First' Strategy Improves Survival Compared to Conventional Algorithms in Acute Type A Dissection with Mesenteric Malperfusion." His Emory Surgery colleagues Bradley Leshnower, MD (first author), William B. Keeling, MD, Chadwick Stouffer, MD, Yazan Duwayri, MD, and William Jordan, MD, were co-authors.

Acute type A dissection (ATAD), a tear in the ascending aorta that can extend as far as the arteries in the leg, is a highly morbid condition. In rare cases where ATAD combines with mesenteric malperfusion (MM), which is characterized by the obstruction of blood supply to the aortic branches, the condition becomes even more lethal.

For the study, Dr. Chen and his coauthors consulted the Emory Institutional Aortic Database to examine and compare three different surgical algorithms used to treat ATADMM in 28 patients between 2003-2017. Two of the algorithms incorporated thoracic endovascular aortic repair (TEVAR), a minimally invasive procedure that involves placing a covered stent graft into the descending thoracic aorta via transfemoral access.

Six patients received ascending aortic replacement followed by laparotomy +/- bowel resection (Asc/Lap), six underwent ascending aortic replacement and concomitant antegrade TEVAR (Asc/TEVAR), and 12 had TEVAR followed by ascending aortic replacement (TEVAR-1st). All of the stratgeies were performed after circulatory arrest.

In the TEVAR-1st group, the investigators found that the mean length of aortic coverage was 208±67mm; there were no cases of new postoperative paraplegia; the mean time between TEVAR and ascending aortic replacement was 28±25 hours; and mortality was 33 percent (4/12), secondary to interval aortic rupture (1), cerebrovascular accident (1), catastrophic thrombosis upon separation from cardiopulmonary bypass, and unknown etiology (1). Operative mortality was 67 percent (4/6) in the Asc/TEVAR group, and 60 percent (6/10) in the Asc/Lap group, and all deaths were secondary to persistent mesenteric ischemia.

Dr. Chen and his co-authors concluded that the TEVAR-1st strategy improves survival compared to alternative treatment algorithms in ATADMM, and that avoidance of circulatory arrest until organ ischemia is resolved provides a survival benefit.

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