[Surgical Treatment for Various Types of Thoracic Aortic Disease using Commercially Available Open Stent Graft;Early Results and Technical Pitfalls].

BACKGROUND: The open stent grafting, in other words "frozen elephant trunk (FET)" technique has been played an important role in surgical treatment of extensive thoracic aortic pathologies. J Graft Open Stent Graft (JOSG) was a new Japan-made commercially available product. We have recently introduced this attractive device as an alternative to self-made open stent graft. PATIENTS: Twenty consecutive patients underwent aortic arch replacement using the JOSG as a FET in our institution. A JOSG was implanted:atherosclerotic thoracic aortic aneurysm (n=10), acute type A aortic dissection( n=6), chronic type B dissection( n=4). RESULTS: There was no operative death, but 1 patient died of multiple organ failure 5 weeks after the operation. Spinal cord injury was observed in 1 patient. Although JOSG implantation was completed in all patients, we experienced 2 cases of technical device failure during operation. After distal anastomosis with the insertion of JOSG to the downstream aorta, antegrade perfusion of extracorporeal circulation became difficult due to JOSG obstruction. Severe kinking of JOSG might occurred because of the tortuous distal arch to descending aorta and the excellent flexing properties of the JOSG. In patients with aortic dissection presenting narrow true lumen, subsequent endovascular stent graft placement was required because of inadequate obliteration of the false lumen. CONCLUSIONS: Thoracic aortic surgery using JOSG was introduced and performed with acceptable morbidity and mortality. JOSG was expected to contribute to the surgical treatment of thoracic aortic diseases, but a few serious complications of JOSG related to its structural property should be kept in mind for the safety of the procedure.