Pre-sewn Multi-branched Aortic Graft and 3D-Printing Guidance for Crawford Extent II or III Thoracoabdominal Aortic Aneurysm Repair

Abstract

Reconstruction of the visceral and segmental arteries is a challenging part of open surgical repair of extensive thoracoabdominal aortic aneurysm (TAAA). For more efficient reconstruction of these branching vessels, a technique of using pre-hand-sewn multi-branched aortic graft (octopod technique) has been adopted with the aid of 3D-printing-guidance in latest cases. The octopod graft has been employed for the extent II or III TAAA repair, in which the commercially available two 4-branched aortic grafts were interconnected before surgery. Since January 2017, 3D-printed-aortic model has been used to efficiently replicate the projected aorta shape fitted to patient's anatomy. From May 2015 through Oct 2019, 20 patients (median age, 40years; range, 23-65; 5 females) underwent extent II or III TAAA repair using the octopod technique with (n = 9) or without (n=11) 3D-printing-guidance. Thirteen patients (65%) were diagnosed as Marfan syndrome. Eighteen patients (90%) had undergone prior aorta repair including 4 patients (20%) undergoing redo-thoracotomy. Revascularization of segmental arteries was conducted in 19 patients (95%, median, N = 2; range, 1-4). Median pump and entire procedural times were 173.5 minutes (interquartile range [IQR], 136.8-187.8) and 441 minutes (IQR, 392.8-492.3), respectively. There was no operative mortality or stroke, however, permanent paraplegia occurred in one patient (5%). During follow-up (median 35months, range 1-56 months), all of reconstructed branched vessels remained wide patent on CT. The octopod technique for open TAAA repair showed favorable early and mid-term results with high feasibility of procedural efficiency. 3D-printing guidance is expected to improve the flow of surgical procedures especially in challenging anatomy.

Keywords: Branched graft; Marfan syndrome; Open repair; Thoracoabdominal aorta.