1
|
Rong D, Chen X, Han J, Yin J, Ge Y, Liu F, Guo W. Anatomic feasibility of a modular Endo-Bentall stent graft system for type A aortic dissection. J Vasc Surg 2023; 78:1359-1366.e2. [PMID: 37572892 DOI: 10.1016/j.jvs.2023.07.062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 07/01/2023] [Accepted: 07/04/2023] [Indexed: 08/14/2023]
Abstract
OBJECTIVE The implementation of thoracic endovascular aortic repair in patients with type A aortic dissection has been strictly constrained due to the pulsatile movement and distensibility and the insufficient length of landing zones on ascending aorta. The most prevalent anatomical limitation is the insufficient length of proximal and distal landing zones. We propose a modularly designed Endo-Bentall stent graft system to broaden the scope of thoracic endovascular aortic repair in the ascending aorta by covering intimal tears in the aortic root and ascending aorta and reconstructing coronary arteries. This study was conducted to assess the anatomical feasibility of a novel stent graft design. METHODS In this study, we included 152 patients with type A aortic dissection for image measurement and analysis. All computed tomography angiography images were assessed on a 3mensio Workstation version 10.2 (3mensio Medical Imaging B.V.) utilizing the centerline method. We compared the diameters and lengths at various planes in relation to the proposed anatomical criteria for the modular Endo-Bentall stent graft system. RESULTS The patients were predominantly male (67.1%), with a median age of 56.5 years (interquartile range, 50.0-65.0 years). Among all aortic dissections, 91.5% extended proximally to the sinotubular junction, whereas only 8.6% were restricted to the tubular ascending aorta. The median perimeter-derived diameter of the aortic annulus was 24.1 mm. The median maximum aortic diameter at the sinotubular junction and brachiocephalic trunk were 44.6 mm and 43.5 mm, respectively. The median height of the left coronary artery, right coronary artery, and sinus of Valsalva were 12.7 mm, 16.7 mm, and 28.4 mm, respectively. After applying exclusion criteria, 66.4% of all patients were anatomically eligible for the modular Endo-Bentall stent graft system. A total of 85.1% of patients were suitable for stent grafts with lengths of 70 mm, 80 mm, or 90 mm. Both antegradely and retrogradely tapered stent grafts were required, according to the diameter differences between the STJ and brachiocephalic trunk. CONCLUSIONS Utilizing the modular Endo-Bentall stent-graft design, approximately two-thirds of patients with type A aortic dissection are anatomically eligible for endovascular repair. Further animal studies are required to optimize the device design.
Collapse
Affiliation(s)
- Dan Rong
- Department of Vascular and Endovascular Surgery, Chinese PLA General Hospital, Beijing, China
| | - Xin Chen
- Department of Emergency, Chinese PLA General Hospital, Beijing, China
| | | | | | - Yangyang Ge
- Department of Vascular and Endovascular Surgery, Chinese PLA General Hospital, Beijing, China
| | - Feng Liu
- Department of Vascular and Endovascular Surgery, Chinese PLA General Hospital, Beijing, China
| | - Wei Guo
- Department of Vascular and Endovascular Surgery, Chinese PLA General Hospital, Beijing, China; Chinese PLA Medical School, Beijing, China.
| |
Collapse
|
2
|
Ahmad W, Liebezeit-Sievert M, Wegner M, Alokhina A, Wahlers T, Dorweiler B, Luehr M. Feasibility of Total Endovascular Repair of the Aorta in Patients with Acute Type A Aortic Dissection: Morphological Analysis of 119 Patients. J Clin Med 2023; 12:5615. [PMID: 37685682 PMCID: PMC10488701 DOI: 10.3390/jcm12175615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 08/16/2023] [Accepted: 08/27/2023] [Indexed: 09/10/2023] Open
Abstract
(1) Background: This study aimed to morphologically analyze acute type A aortic dissection (aTAAD) patients for potential endovascular treatment candidates. The objective was to specify requirements for aTAAD endovascular devices. (2) Methods: A single-center retrospective analysis included aTAAD patients who underwent open surgical repair between November 2005 and December 2020. Preoperative CTA scans were used for morphological analysis, assessing endovascular repair eligibility. Statistical tests were performed. (3) Results: A total of 129 patients with aTAAD were studied, with 119 included. Entry tear (ET) locations were identified, mainly in the aortic root, 20 mm above the sinotubular junction (STJ) and within the ascending aorta (20 mm above STJ to -20 mm before the brachiocephalic trunk). Endovascular treatment was deemed feasible for 36 patients, with suggested solutions for the aortic arch and descending aorta. Significant differences were observed between eligible and noneligible groups for aortic diameter, false lumen diameter, distance between STJ and entry tear, and more. Dissection extension showed no significant difference. (4) Conclusions: Morphological analysis identified potential aTAAD candidates for endovascular treatment, highlighting differences between eligible and noneligible morphologies. This study offers insights for implementing endovascular approaches in aTAAD treatment and emphasizes the need for research and standardized protocols.
Collapse
Affiliation(s)
- Wael Ahmad
- Department of Vascular and Endovascular Surgery, Faculty of Medicine, University Hospital Cologne, University of Cologne, 50937 Cologne, Germany (B.D.)
| | - Mark Liebezeit-Sievert
- Department of Vascular and Endovascular Surgery, Faculty of Medicine, University Hospital Cologne, University of Cologne, 50937 Cologne, Germany (B.D.)
| | - Moritz Wegner
- Department of Vascular and Endovascular Surgery, Faculty of Medicine, University Hospital Cologne, University of Cologne, 50937 Cologne, Germany (B.D.)
| | - Anastasiia Alokhina
- Department of Cardiothoracic Surgery, Heart Centre, Faculty of Medicine, University Hospital Cologne, University of Cologne, 50937 Cologne, Germany (M.L.)
| | - Thorsten Wahlers
- Department of Cardiothoracic Surgery, Heart Centre, Faculty of Medicine, University Hospital Cologne, University of Cologne, 50937 Cologne, Germany (M.L.)
| | - Bernhard Dorweiler
- Department of Vascular and Endovascular Surgery, Faculty of Medicine, University Hospital Cologne, University of Cologne, 50937 Cologne, Germany (B.D.)
| | - Maximilian Luehr
- Department of Cardiothoracic Surgery, Heart Centre, Faculty of Medicine, University Hospital Cologne, University of Cologne, 50937 Cologne, Germany (M.L.)
| |
Collapse
|
3
|
Rylski B, Schilling O, Czerny M. Acute aortic dissection: evidence, uncertainties, and future therapies. Eur Heart J 2023; 44:813-821. [PMID: 36540036 DOI: 10.1093/eurheartj/ehac757] [Citation(s) in RCA: 25] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 10/27/2022] [Accepted: 12/05/2022] [Indexed: 12/24/2022] Open
Abstract
Remarkable progress has become especially apparent in aortic medicine in the last few decades, leading to essential changes in how thoracic aortic dissection is understood and treated. This state-of-the-art review article addresses the mechanisms of acute aortic dissection, explaining the role of its primary entry location, proximal, and distal dissection extension in their clinical presentation and impact on the decision-making process towards the best treatment approach. The latest evidence on novel treatment methods for acute aortic syndromes is presented, and the diverse dissection classification systems that remain uncertain are discussed, which reveals the need for shared terminology and more clarity. Finally, future aspects are discussed in treating acute aortic dissection, such as the endovascular treatment of aortic dissection Type A and biomarkers for acute aortic syndromes.
Collapse
Affiliation(s)
- Bartosz Rylski
- Department of Cardiovascular Surgery, Heart Centre Freiburg University, Hugstetter Str. 55, 79106 Freiburg, Germany.,Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany
| | - Oliver Schilling
- Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany.,Institute for Surgical Pathology, Hugstetter Str. 55, 79106 Freiburg, Germany
| | - Martin Czerny
- Department of Cardiovascular Surgery, Heart Centre Freiburg University, Hugstetter Str. 55, 79106 Freiburg, Germany.,Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany
| |
Collapse
|
4
|
Kreibich M, Siepe M, Berger T, Beyersdorf F, Soschynski M, Schlett CL, Czerny M, Rylski B. Intervention rates and outcomes in medically managed uncomplicated descending thoracic aortic dissections. J Thorac Cardiovasc Surg 2023; 165:958-965.e4. [PMID: 34001355 DOI: 10.1016/j.jtcvs.2021.03.126] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 03/22/2021] [Accepted: 03/31/2021] [Indexed: 01/16/2023]
Abstract
OBJECTIVE To evaluate the long-term incidence and outcome of aortic interventions for medically managed uncomplicated thoracic aortic dissections. METHODS Between January 2012 and December 2018, 91 patients were discharged home with an uncomplicated, medically treated aortic dissection (involving the descending aorta with or without aortic arch involvement, no ascending involvement). After a median period of 4 (first quartile: 2, third quartile: 11) months, 30 patients (33%) required an aortic intervention. Patient characteristics, radiographic, treatment, and follow-up data were compared for patients with and without aortic interventions. A competing risk regression model was analyzed to identify independent predictors of aortic intervention and to predict the risk for intervention. RESULTS Patients who underwent aortic interventions had significantly larger thoracic (P = .041) and abdominal (P = .015) aortic diameters, the dissection was significantly longer (P = .035), there were more communications between both lumina (P = .040), and the first communication was significantly closer to the left subclavian artery (P = .049). A descending thoracic aortic diameter exceeding 45 mm was predictive for an aortic intervention (P = .001; subdistribution hazard ratio: 3.51). The risk for aortic intervention was 27% ± 10% and 36% ± 11% after 1 and 3 years, respectively. Fourteen patients (47%) underwent thoracic endovascular aortic repair, 11 patients (37%) thoracic endovascular aortic repair and left carotid to subclavian bypass, 3 patients (10%) total arch replacement with the frozen elephant trunk technique, and 2 patients (7%) thoracoabdominal aortic replacement. We observed no in-hospital mortality. CONCLUSIONS The need for secondary aortic interventions in patients with initially medically managed, uncomplicated descending aortic dissections is substantial. The full spectrum of aortic treatment options (endovascular, hybrid, conventional open surgical) is required in these patients.
Collapse
Affiliation(s)
- Maximilian Kreibich
- Faculty of Medicine, Department of Cardiovascular Surgery, University Heart Center Freiburg, Albert-Ludwigs-University of Freiburg, Freiburg, Germany.
| | - Matthias Siepe
- Faculty of Medicine, Department of Cardiovascular Surgery, University Heart Center Freiburg, Albert-Ludwigs-University of Freiburg, Freiburg, Germany
| | - Tim Berger
- Faculty of Medicine, Department of Cardiovascular Surgery, University Heart Center Freiburg, Albert-Ludwigs-University of Freiburg, Freiburg, Germany
| | - Friedhelm Beyersdorf
- Faculty of Medicine, Department of Cardiovascular Surgery, University Heart Center Freiburg, Albert-Ludwigs-University of Freiburg, Freiburg, Germany
| | - Martin Soschynski
- Faculty of Medicine, Department for Diagnostic and Interventional Radiology, Medical Center-University of Freiburg, Albert-Ludwigs-University of Freiburg, Freiburg, Germany
| | - Christopher L Schlett
- Faculty of Medicine, Department for Diagnostic and Interventional Radiology, Medical Center-University of Freiburg, Albert-Ludwigs-University of Freiburg, Freiburg, Germany
| | - Martin Czerny
- Faculty of Medicine, Department of Cardiovascular Surgery, University Heart Center Freiburg, Albert-Ludwigs-University of Freiburg, Freiburg, Germany
| | - Bartosz Rylski
- Faculty of Medicine, Department of Cardiovascular Surgery, University Heart Center Freiburg, Albert-Ludwigs-University of Freiburg, Freiburg, Germany
| |
Collapse
|
5
|
Gouveia e Melo R, Stana J, Prendes CF, Kölbel T, Peterss S, Stavroulakis K, Rantner B, Pichlmaier M, Tsilimparis N. Current state and future directions of endovascular ascending and arch repairs: The motion towards an endovascular Bentall procedure. Semin Vasc Surg 2022; 35:350-363. [DOI: 10.1053/j.semvascsurg.2022.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 07/01/2022] [Accepted: 07/01/2022] [Indexed: 11/11/2022]
|
6
|
Li X, Zhu L, Zhang L, Song C, Zhang H, Xia S, Guo W, Jing Z, Lu Q. Anatomical Feasibility Study on Novel Ascending Aortic Endograft With More Proximal Landing Zone for Treatment of Type A Aortic Dissection. Front Cardiovasc Med 2022; 9:843551. [PMID: 35463748 PMCID: PMC9019117 DOI: 10.3389/fcvm.2022.843551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 03/07/2022] [Indexed: 11/13/2022] Open
Abstract
Objective Type A aortic dissection (TAAD) is associated with high morbidity and mortality, and open surgery is the best treatment option. Development of endovascular repair devices for TAAD will benefit patients deemed unfit for open surgery. In this study, we performed a thorough investigation of anatomical features in Asian patients with TAAD to learn about the patient eligibility of a novel ascending aortic endograft technique. Methods Computed tomography angiography (CTA) images of TAAD cases in our institution from January 2015 to November 2021 were reviewed, and three-dimensional reconstructions were performed with the Endosize software (Therenva, Rennes, France). Anatomic structures including length measured along centerline and greater/lesser curvature, ascending aorta/aortic root dimensions, as well as location of entry tear and extent of dissection were analyzed. Results A total of 158 patients were included [median age 58 years, interquartile range (IQR), 30–76 years; 115 males, 72.8%]. In 99 (62.7%) of the cases, entry tear was distal to the sinotubular junction (STJ). In 106 (67.1%) of the cases, the pathology proximally extended into the aortic root, which was intramural hematoma in 37 (23.4%) of the cases, and the aortic root was free from the pathology in 52 (32.9%) of the cases. The median distance from the STJ to the proximal edge of the ostium of the innominate artery (IA) measured along the centerline was 65 mm (IQR 58–74 mm). The median distance from the distal edge of the higher coronary ostium to the STJ was 7.95 mm (IQR 5.625–10.9 mm). The bare metal stent part was set between the edge of the higher coronary ostium and the STJ. In our series, 63 (39.9%) of the cases had this distance >10 mm. The relative difference was <20% between the STJ and the proximal edge of the ostium of the IA in 92 (58.2%) of the cases. Ascending aorta radius of curvature was 52.2 mm (IQR 43.7–63.7 mm). Conclusions Our study demonstrates that 56.3% of the TAAD cases would be amenable to endovascular repair by the novel ascending aortic endograft, with sufficient landing zone free of the dissected aorta.
Collapse
|
7
|
Gandet T, Westermann D, Conradi L, Panuccio G, Heidemann F, Rohlffs F, Kölbel T. Modular Endo-Bentall Procedure Using a "Rendez-Vous Access". J Endovasc Ther 2021; 29:711-716. [PMID: 34964371 DOI: 10.1177/15266028211065959] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE The concept of a single endovascular valve-carrying conduit device was designated endo-Bentall, but published experience is limited to a single case. This technical note describes an alternative modular endo-Bentall technique and a novel access technique to implant it. TECHNIQUE A 82-year-old woman with chest pain referred for a 10 cm symptomatic aneurysm of the distal arch and descending aorta. An ascending aortic aneurysm of 5.5 cm prevented endovascular aortic arch repair due to lack of a proximal landing zone. The technique is a modular approach combining a physician-modified endograft (PMEG) with 3 large fenestrations for coronary artery perfusion and a transcatheter aortic valve implantation (TAVI). A "rendez-vous access" with a transapical and transfemoral through-and-through wire offered rapid sequential deployment in a modular fashion of both components. The PMEG was deployed first, landing 5 mm deep in the left ventricular outflow tract (LVOT) and the transcatheter aortic valve was implanted few millimeters below. The endo-Bentall procedure was combined with endovascular aortic arch repair. CONCLUSION A modular endo-Bentall procedure combining a PMEG and TAVI is feasible and adaptable to emergent setting using the "rendez-vous access."
Collapse
Affiliation(s)
- Thomas Gandet
- Department of Vascular Medicine, German Aortic Center Hamburg, University Heart & Vascular Center, Hamburg, Germany
| | - Dirk Westermann
- Department of General and Interventional Cardiology, University Heart & Vascular Center, Hamburg, Germany
| | - Lenard Conradi
- Department of Cardiovascular Surgery, University Heart & Vascular Center, Hamburg, Germany
| | - Giuseppe Panuccio
- Department of Vascular Medicine, German Aortic Center Hamburg, University Heart & Vascular Center, Hamburg, Germany
| | - Franziska Heidemann
- Department of Vascular Medicine, German Aortic Center Hamburg, University Heart & Vascular Center, Hamburg, Germany
| | - Fiona Rohlffs
- Department of Vascular Medicine, German Aortic Center Hamburg, University Heart & Vascular Center, Hamburg, Germany
| | - Tilo Kölbel
- Department of Vascular Medicine, German Aortic Center Hamburg, University Heart & Vascular Center, Hamburg, Germany
| |
Collapse
|
8
|
Einfluss der bikuspiden und trikuspiden Aortenklappe bei Typ-A-Aortendissektion. ZEITSCHRIFT FUR HERZ THORAX UND GEFASSCHIRURGIE 2021. [DOI: 10.1007/s00398-021-00468-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
9
|
Kreibich M, Berger T, Rylski B, Czerny M. Therapie von Aortenpathologien mit Beteiligung des Aortenbogens. ZEITSCHRIFT FUR HERZ THORAX UND GEFASSCHIRURGIE 2021. [DOI: 10.1007/s00398-021-00456-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
10
|
Piffaretti G, Czerny M, Riambau V, Gottardi R, Wolfgruber T, Probst C, Matt P, Antonello M, Gerosa G, Hamady M, Fontana F, Ferrarese S, Lomazzi C, Grassi V, Fernandez-Alonso S, Trimarchi S. Endovascular repair of ascending aortic diseases with custom-made endografts. Eur J Cardiothorac Surg 2021; 59:741-749. [PMID: 33394032 DOI: 10.1093/ejcts/ezaa383] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 08/28/2020] [Accepted: 09/15/2020] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVES The aim of this article is to report the mid-term results of ascending thoracic endovascular aortic repair using a custom-made device (CMD). METHODS This was a retrospective study performed at tertiary centres. Nine patients considered unfit for open surgery received elective total endovascular repair of the ascending aorta with a Relay® (Terumo Aortic, Sunrise; FL, USA) CMD: pseudoaneurysn (n = 5), localized dissection (n =3) and contained rupture (n = 1). RESULTS Primary clinical success was achieved in all patients with no major complications and no early conversion to open surgery. All patients were discharged home and independent: median length of stay was 7 days (interquartile range, 6-18). No patient was lost to follow-up at a median 26 months (interquartile range, 12-36). Three patients died 2, 6 and 24 months after intervention; 1 was aorta related (late aorto-atrial fistula due to infection that required open surgery). At the last follow-up available, no endoleaks, migrations, fractures or ruptures were observed in the remaining 6 patients. CONCLUSIONS Ascending thoracic endovascular aortic repair with Terumo Aortic CMDs was technically feasible, effective and safe in very selected lesions. CMDs showed good ascending aorta conformability with different configurations and diameters, and satisfactory mid-term durability as shown by both structural integrity and aortic lesion exclusion.
Collapse
Affiliation(s)
- Gabriele Piffaretti
- Vascular Surgery-Department of Medicine and Surgery, ASST Settelaghi University Teaching Hospital, University of Insubria School of Medicine, Varese, Italy
| | - Martin Czerny
- Department of Cardiovascular Surgery, Faculty of Medicine, Heart Centre Freiburg University, University of Freiburg, Freiburg, Germany
| | - Vicente Riambau
- Vascular Surgery Division, Cardiovascular Institute, Hospital Clinic University of Barcelona, Barcelona, Spain
| | - Roman Gottardi
- Department of Cardiac Surgery, Paracelsus Medical University, Salzburg, Austria
| | - Thomas Wolfgruber
- Department of Cardiac Surgery, Paracelsus Medical University, Salzburg, Austria.,Department of Radiology, Paracelsus Medical University, Salzburg, Austria
| | - Chris Probst
- Department of Cardiac Surgery, University of Bonn, Bonn, Germany
| | - Peter Matt
- Department of Cardiac Surgery, Herzzentrum Luzern, Luzern, Switzerland
| | - Michele Antonello
- Vascular and Cardiac Surgery-Department of Cardiac, Thoracic and Vascular Sciences, University of Padua School of Medicine, Padua, Italy
| | - Gino Gerosa
- Vascular and Cardiac Surgery-Department of Cardiac, Thoracic and Vascular Sciences, University of Padua School of Medicine, Padua, Italy
| | - Mohamad Hamady
- Interventional Radiology-Department of Surgery and Cancer, St Mary's Hospital Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Federico Fontana
- Interventional Radiology-Department of Medicine and Surgery, ASST Settelaghi University Teaching Hospital, University of Insubria School of Medicine, Varese, Italy
| | - Sandro Ferrarese
- Vascular Surgery-Department of Medicine and Surgery, ASST Settelaghi University Teaching Hospital, University of Insubria School of Medicine, Varese, Italy.,Cardiac Surgery-Department of Medicine and Surgery, ASST Settelaghi University Teaching Hospital, University of Insubria School of Medicine, Varese, Italy
| | - Chiara Lomazzi
- Vascular Surgery, Fondazione IRCCS Cà Granda, Milan, Italy
| | - Viviana Grassi
- Vascular Surgery, Fondazione IRCCS Cà Granda, Milan, Italy
| | | | - Santi Trimarchi
- Vascular Surgery, Fondazione IRCCS Cà Granda, Milan, Italy.,Department of Clinical and Community Sciences, Ospedale Maggiore Policlinico, Milan, Italy
| |
Collapse
|
11
|
Grewal A, Odonkor P, Ghoreishi M, Deshpande SP. Anesthetic Considerations in Endovascular Repair of the Ascending Aorta. J Cardiothorac Vasc Anesth 2021; 35:3085-3097. [PMID: 34059437 DOI: 10.1053/j.jvca.2021.04.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Revised: 04/10/2021] [Accepted: 04/14/2021] [Indexed: 11/11/2022]
Abstract
Since the first endovascular aortic repair in 1990, endovascular devices and the indications for their use have significantly grown. Considerable progress has been made in endovascular devices and techniques, such that endovascular repair is now considered first-line treatment for patients with descending aortic disease. However, for patients with ascending aortic disease, open surgical repair with cardiopulmonary bypass and hypothermic cardiac arrest was the only option until recently. Although the outcomes for open surgical repair of the ascending aorta have improved over the years, approximately 30% of patients with an emergent surgical indication, such as type A aortic dissection, are considered to be too high risk for open repair. For these patients, endovascular repair of the ascending aorta offers a life-saving procedure. The ascending aorta is regarded as the final frontier for endovascular therapy. Endovascular repair of it has posed a formidable challenge thus far, due to its unique anatomy, hemodynamic forces, and lack of an appropriate stent-graft designed specifically for the ascending aorta. Although currently there are no comprehensive data from randomized clinical trials, there are several case series and case reports that have shown favorable outcomes. Improvements in available devices soon will drive an exponential increase in the number of patients undergoing endovascular ascending aortic repair. In this review, the authors discuss multiple aspects of endovascular ascending aortic repair including the unique surgical and anesthetic considerations, the devices used, and the available outcomes data, and future directions are also explored.
Collapse
Affiliation(s)
- Ashanpreet Grewal
- Department of Anesthesiology, Division of Cardiothoracic Anesthesiology, University of Maryland School of Medicine, Baltimore, MD.
| | - Patrick Odonkor
- Department of Anesthesiology, Division of Cardiothoracic Anesthesiology, University of Maryland School of Medicine, Baltimore, MD
| | - Mehrdad Ghoreishi
- Department of Surgery, Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, MD
| | - Seema P Deshpande
- Department of Anesthesiology, Division of Cardiothoracic Anesthesiology, University of Maryland School of Medicine, Baltimore, MD
| |
Collapse
|
12
|
Yuan X, Kan X, Xu XY, Nienaber CA. Finite element modeling to predict procedural success of thoracic endovascular aortic repair in type A aortic dissection. JTCVS Tech 2020; 4:40-47. [PMID: 34317961 PMCID: PMC8307501 DOI: 10.1016/j.xjtc.2020.10.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 10/08/2020] [Indexed: 01/16/2023] Open
Abstract
Objective Thoracic endovascular aortic repair (TEVAR) is recommended for type B aortic dissection and recently has even been used in selected cases of proximal (Stanford type A) aortic dissections in scenarios of prohibitive surgical risk. However, mechanical interactions between the native aorta and stent-graft are poorly understood, as some cases ended in failure. The aim of this study is to explore and better understand biomechanical changes after TEVAR and predict the result via virtual stenting. Methods A case of type A aortic dissection was considered inoperable and selected for TEVAR. The procedure failed due to stent-graft migration even with precise deployment. A novel patient-specific virtual stent-graft deployment model based on finite element method was employed to analyze TEVAR-induced changes under such conditions. Two landing positions were simulated to investigate the reason for stent-graft migration immediately after TEVAR and explore options for optimization. Results Simulation of the actual procedure revealed that the proximal bare metal stent pushed the lamella into the false lumen and led to further stent-graft migration during the launch phase. An alternative landing position has reduced the local deformation of the dissection lamella and avoided stent-graft migration. Higher maximum principal stress (>20 KPa) was found on the lamella with deployment at the actual position, while the alternative strategy would have reduced the stress to <5 KPa. Conclusions Virtual stent-graft deployment simulation based on finite element model could be helpful to both predict outcomes of TEVAR and better plan future endovascular procedures.
Collapse
Affiliation(s)
- Xun Yuan
- Cardiology and Aortic Centre, Royal Brompton & Harefield NHS Foundation Trust, London, United Kingdom.,National Heart and Lung Institute, School of Medicine, Imperial College London, London, United Kingdom
| | - Xiaoxin Kan
- Department of Chemical Engineering, Imperial College London, London, United Kingdom
| | - Xiao Yun Xu
- Department of Chemical Engineering, Imperial College London, London, United Kingdom
| | - Christoph A Nienaber
- Cardiology and Aortic Centre, Royal Brompton & Harefield NHS Foundation Trust, London, United Kingdom.,National Heart and Lung Institute, School of Medicine, Imperial College London, London, United Kingdom
| |
Collapse
|
13
|
Trimarchi S, Grassi V, Lomazzi C, Domanin M, Bissacco D, Bellosta R, Piffaretti G. Endovascular type A aortic repair-When? J Card Surg 2020; 36:1742-1744. [PMID: 33029800 DOI: 10.1111/jocs.15103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 09/10/2020] [Accepted: 09/24/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Santi Trimarchi
- Department of Surgery, Vascular Surgery, Ospedale Maggiore Policlinico, Fondazione IRCCS Cà Granda, Milan, Italy.,Department of Clinical and Community Sciences, University of Milan School of Medicine, Milan, Italy
| | - Viviana Grassi
- Department of Surgery, Vascular Surgery, Ospedale Maggiore Policlinico, Fondazione IRCCS Cà Granda, Milan, Italy
| | - Chiara Lomazzi
- Department of Surgery, Vascular Surgery, Ospedale Maggiore Policlinico, Fondazione IRCCS Cà Granda, Milan, Italy
| | - Maurizio Domanin
- Department of Surgery, Vascular Surgery, Ospedale Maggiore Policlinico, Fondazione IRCCS Cà Granda, Milan, Italy.,Department of Clinical and Community Sciences, University of Milan School of Medicine, Milan, Italy
| | - Daniele Bissacco
- Department of Surgery, Vascular Surgery, Ospedale Maggiore Policlinico, Fondazione IRCCS Cà Granda, Milan, Italy
| | - Raffaello Bellosta
- Vascular Surgery, Cardiovascular Department, Poliambulanza Foundation Hospital, Brescia, Italy
| | - Gabriele Piffaretti
- Vascular Surgery, Department of Medicine and Surgery, ASST Settelaghi University Teaching Hospital, University of Insubria School of Medicine, Varese, Italy
| |
Collapse
|
14
|
Distal Stent Graft–Induced New Entries After the Frozen Elephant Trunk Procedure. Ann Thorac Surg 2020; 110:1271-1279. [DOI: 10.1016/j.athoracsur.2020.02.017] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 01/12/2020] [Accepted: 02/04/2020] [Indexed: 11/20/2022]
|
15
|
Gerosa G, Cibin G, Antonello M, D'Onofrio A. One-stage off pump combined transapical aortic valve replacement and ascending aorta endografting. Eur J Cardiothorac Surg 2020; 59:ezaa301. [PMID: 32910160 DOI: 10.1093/ejcts/ezaa301] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 07/13/2020] [Accepted: 07/18/2020] [Indexed: 11/13/2022] Open
Abstract
An 84-year-old patient was referred for severe symptomatic aortic valve stenosis and focal chronic dissection of the ascending aorta. After multidisciplinary discussion, the patient was scheduled for combined transapical transcatheter aortic valve replacement and ascending aorta stent-grafting. The procedure was performed with a balloon aortic valvuloplasty followed by a custom-made stent graft implantation into the ascending aorta and then by balloon-expandable transapical transcatheter aortic valve replacement. The patient had an uneventful hospital stay. In conclusion, in selected high-risk patients, transapical combined ascending aorta stent-grafting and transcatheter aortic valve replacement are feasible and safe.
Collapse
Affiliation(s)
- Gino Gerosa
- Division of Cardiac Surgery, University of Padova, Padova, Italy
| | - Giorgia Cibin
- Division of Cardiac Surgery, University of Padova, Padova, Italy
| | | | | |
Collapse
|
16
|
Tao L, Xianhao B, Yuxi Z, Ziwen L, Ziyi X, Zhaoxiang Z, Mingwei W, Yiming L, Ding X, Jiaxuan F, Rui F, Jian Z, Zaiping J. Thoracic aortic computed tomography angiography in swine: establishment of a baseline for endovascular evaluation of the ascending aorta. Interact Cardiovasc Thorac Surg 2020; 31:248-253. [PMID: 32500150 DOI: 10.1093/icvts/ivaa077] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 03/09/2020] [Accepted: 03/18/2020] [Indexed: 12/19/2022] Open
Abstract
AbstractOBJECTIVESOur goal was to establish a baseline of computed tomography (CT) angiographic data for the porcine ascending thoracic aorta for endovascular evaluation of animal experiments and device development.METHODSThoracic aortic CT angiography was conducted on 49 pigs with an average body weight of 60–65 kg. The CT angiographic scans were done on an imaging reconstruction workstation to obtain the specific aortic geometric data, including the diameters of the planes, the heights among the planes and the clock positions of target arteries.RESULTSFourteen important planes were defined in the study for endograft customizing reference. The diameters of the planes were measured, and the heights among the planes were recorded. For endograft fenestrations, the right coronary artery ostium clock position was 100.11 ± 7.29°, and the brachiocephalic trunk ostium clock position was 74.72 ± 6.45°. The best projection angle of the tangent position of the left coronary artery was the right anterior oblique 17 ± 7° position. A pig with a rare congenital giant dilated aorta was found among the candidate experimental animals.CONCLUSIONSFor experimental porcine models, CT angiography has proved to be a suitable imaging technique. The established baseline angiography of the swine can provide reference values for future animal experiments and device development.
Collapse
Affiliation(s)
- Li Tao
- Endovascular Diagnosis and Treatment Center for Heart Valvular Diseases, and Endovascular Diagnosis and Treatment Center for Aortic Dissection, Changhai Hospital, Navy Medical University, Shanghai, China
| | - Bao Xianhao
- Endovascular Diagnosis and Treatment Center for Heart Valvular Diseases, and Endovascular Diagnosis and Treatment Center for Aortic Dissection, Changhai Hospital, Navy Medical University, Shanghai, China
| | - Zhao Yuxi
- Endovascular Diagnosis and Treatment Center for Heart Valvular Diseases, and Endovascular Diagnosis and Treatment Center for Aortic Dissection, Changhai Hospital, Navy Medical University, Shanghai, China
| | - Li Ziwen
- Department of Radiology, Changhai Hospital, Navy Medical University, Shanghai, China
| | - Xu Ziyi
- Endovascular Diagnosis and Treatment Center for Heart Valvular Diseases, and Endovascular Diagnosis and Treatment Center for Aortic Dissection, Changhai Hospital, Navy Medical University, Shanghai, China
- Department of Vascular Surgery, Changhai Hospital, Navy Medical University, Shanghai, China
| | - Zeng Zhaoxiang
- Endovascular Diagnosis and Treatment Center for Heart Valvular Diseases, and Endovascular Diagnosis and Treatment Center for Aortic Dissection, Changhai Hospital, Navy Medical University, Shanghai, China
| | - Wu Mingwei
- Endovascular Diagnosis and Treatment Center for Heart Valvular Diseases, and Endovascular Diagnosis and Treatment Center for Aortic Dissection, Changhai Hospital, Navy Medical University, Shanghai, China
| | - Li Yiming
- Endovascular Diagnosis and Treatment Center for Heart Valvular Diseases, and Endovascular Diagnosis and Treatment Center for Aortic Dissection, Changhai Hospital, Navy Medical University, Shanghai, China
| | - Xu Ding
- Endovascular Diagnosis and Treatment Center for Heart Valvular Diseases, and Endovascular Diagnosis and Treatment Center for Aortic Dissection, Changhai Hospital, Navy Medical University, Shanghai, China
| | - Feng Jiaxuan
- Endovascular Diagnosis and Treatment Center for Heart Valvular Diseases, and Endovascular Diagnosis and Treatment Center for Aortic Dissection, Changhai Hospital, Navy Medical University, Shanghai, China
- Department of Vascular Surgery, Changhai Hospital, Navy Medical University, Shanghai, China
| | - Feng Rui
- Endovascular Diagnosis and Treatment Center for Heart Valvular Diseases, and Endovascular Diagnosis and Treatment Center for Aortic Dissection, Changhai Hospital, Navy Medical University, Shanghai, China
- Department of Vascular Surgery, Changhai Hospital, Navy Medical University, Shanghai, China
| | - Zhou Jian
- Endovascular Diagnosis and Treatment Center for Heart Valvular Diseases, and Endovascular Diagnosis and Treatment Center for Aortic Dissection, Changhai Hospital, Navy Medical University, Shanghai, China
- Department of Vascular Surgery, Changhai Hospital, Navy Medical University, Shanghai, China
| | - Jing Zaiping
- Endovascular Diagnosis and Treatment Center for Heart Valvular Diseases, and Endovascular Diagnosis and Treatment Center for Aortic Dissection, Changhai Hospital, Navy Medical University, Shanghai, China
- Department of Vascular Surgery, Changhai Hospital, Navy Medical University, Shanghai, China
| |
Collapse
|
17
|
Czerny M, Siepe M, Beyersdorf F, Feisst M, Gabel M, Pilz M, Pöling J, Dohle DS, Sarvanakis K, Luehr M, Hagl C, Rawa A, Schneider W, Detter C, Holubec T, Borger M, Böning A, Rylski B. Prediction of mortality rate in acute type A dissection: the German Registry for Acute Type A Aortic Dissection score. Eur J Cardiothorac Surg 2020; 58:700-706. [DOI: 10.1093/ejcts/ezaa156] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 03/16/2020] [Accepted: 03/24/2020] [Indexed: 12/12/2022] Open
Abstract
Abstract
OBJECTIVES
The goal was to develop a scoring system to predict the 30-day mortality rate for patients undergoing surgery for acute type A aortic dissection on the basis of the German Registry for Acute Type A Aortic Dissection (GERAADA) data set and to provide a Web-based application for standard use.
METHODS
A total of 2537 patients enrolled in GERAADA who underwent surgery between 2006 and 2015 were analysed. Variable selection was performed using the R-package FAMoS. The robustness of the results was confirmed via the bootstrap procedure. The coefficients of the final model were used to calculate the risk score in a Web-based application.
RESULTS
Age [odds ratio (OR) 1.018, 95% confidence interval (CI) 1.009–1.026; P < 0.001; 5-year OR: 1.093], need for catecholamines at referral (OR 1.732, 95% CI 1.340–2.232; P < 0.001), preoperative resuscitation (OR 3.051, 95% CI 2.099–4.441; P < 0.001), need for intubation before surgery (OR 1.949, 95% CI 1.465–2.585; P < 0.001), preoperative hemiparesis (OR 1.442, 95% CI 0.996–2.065; P = 0.049), coronary malperfusion (OR 1.870, 95% CI 1.386–2.509; P < 0.001), visceral malperfusion (OR 1.748, 95% CI 1.198–2.530; P = 0.003), dissection extension to the descending aorta (OR 1.443, 95% CI 1.120–1.864; P = 0.005) and previous cardiac surgery (OR 1.772, 95% CI 1.048–2.903; P = 0.027) were independent predictors of the 30-day mortality rate. The Web application based on the final model can be found at https://www.dgthg.de/de/GERAADA_Score.
CONCLUSIONS
The GERAADA score is a simple, effective tool to predict the 30-day mortality rate for patients undergoing surgery for acute type A aortic dissection. We recommend the widespread use of this Web-based application for standard use.
Collapse
Affiliation(s)
- Martin Czerny
- Department of Cardiovascular Surgery, University Heart Center Freiburg, Bad Krozingen, Germany
- Faculty of Medicine, Albert Ludwigs University Freiburg, Freiburg, Germany
| | - Matthias Siepe
- Department of Cardiovascular Surgery, University Heart Center Freiburg, Bad Krozingen, Germany
- Faculty of Medicine, Albert Ludwigs University Freiburg, Freiburg, Germany
| | - Friedhelm Beyersdorf
- Department of Cardiovascular Surgery, University Heart Center Freiburg, Bad Krozingen, Germany
- Faculty of Medicine, Albert Ludwigs University Freiburg, Freiburg, Germany
| | - Manuel Feisst
- Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany
| | - Michael Gabel
- Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany
| | - Maximilian Pilz
- Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany
| | - Jochen Pöling
- Department of Cardiac Surgery, Schuechtermann Clinic, Bad Rothenfelde, Germany
| | - Daniel-Sebastian Dohle
- Department of Cardiothoracic and Vascular Surgery, University Hospital, Johannes Gutenberg University, Mainz, Germany
| | | | - Maximilian Luehr
- Department of Cardiac Surgery, University Hospital, LMU Munich, Munich, Germany
| | - Christian Hagl
- Department of Cardiac Surgery, University Hospital, LMU Munich, Munich, Germany
| | - Arif Rawa
- Department of Cardiac Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Wilke Schneider
- Department for Thoracic and Cardiovascular Surgery, University Hospital Tübingen, Eberhard Karls University, Tübingen, Germany
| | - Christian Detter
- Department of Cardiovascular Surgery, University Heart Center Hamburg, Hamburg, Germany
| | - Tomas Holubec
- Department of Thoracic and Cardiovascular Surgery, Johann Wolfgang Goethe University, Frankfurt/Main, Germany
| | - Michael Borger
- Department of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
| | - Andreas Böning
- Department of Adult and Pediatric Cardiovascular Surgery, Giessen University Hospital, Giessen, Germany
| | - Bartosz Rylski
- Department of Cardiovascular Surgery, University Heart Center Freiburg, Bad Krozingen, Germany
- Faculty of Medicine, Albert Ludwigs University Freiburg, Freiburg, Germany
| |
Collapse
|
18
|
Kreibich M, Rylski B, Beyersdorf F, Siepe M, Czerny M. Endo-Bentall for proximal aortic dissection: from conception to application. Asian Cardiovasc Thorac Ann 2020; 29:697-700. [PMID: 32436718 DOI: 10.1177/0218492320929211] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The endovascular treatment of pathologies of the ascending aorta has not been incorporated into routine clinical practice. The aim of this article is to provide an overview of the endovascular treatment of pathologies of the ascending aorta, particularly type A aortic dissection. A thorough analysis and discussion of anatomical, physiological, clinical and technical challenges, and obstacles is performed. Conventional straight stent-grafts alone are not capable of fixing the entire complex underlying problem in the vast majority of patients with acute type A aortic dissection. An endovascular valve-carrying conduit consisting of a proximal transcatheter aortic valve connected to a covered stent-graft would be able to close a primary entry tear in the ascending aorta, ensure coronary perfusion, initiate true lumen expansion, treat malperfusion, treat aortic regurgitation, drain any pericardial effusion through a transapical approach, and possibly stabilize the distal aorta. Two thirds of all patients with acute aortic dissection are potential candidates for endovascular treatment, and the concept may help to significantly improve survival in patients with acute aortic dissection.
Collapse
Affiliation(s)
- Maximilian Kreibich
- Department of Cardiovascular Surgery, Heart Centre Freiburg University, Freiburg, Germany.,Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Bartosz Rylski
- Department of Cardiovascular Surgery, Heart Centre Freiburg University, Freiburg, Germany.,Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Friedhelm Beyersdorf
- Department of Cardiovascular Surgery, Heart Centre Freiburg University, Freiburg, Germany.,Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Matthias Siepe
- Department of Cardiovascular Surgery, Heart Centre Freiburg University, Freiburg, Germany.,Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Martin Czerny
- Department of Cardiovascular Surgery, Heart Centre Freiburg University, Freiburg, Germany.,Faculty of Medicine, University of Freiburg, Freiburg, Germany
| |
Collapse
|
19
|
Atkins MD, Reardon MJ. Endovascular repair of type A dissection: the next frontier. ITALIAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY 2020. [DOI: 10.23736/s1824-4777.20.01432-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
20
|
Kreibich M, Rylski B. Bringing down mortality to single digits in type A aortic dissection: Japan can. Eur J Cardiothorac Surg 2020; 57:667-668. [PMID: 31923317 DOI: 10.1093/ejcts/ezz359] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Affiliation(s)
- Maximilian Kreibich
- Department of Cardiovascular Surgery, Heart Centre Freiburg University, Freiburg, Germany.,Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Bartosz Rylski
- Department of Cardiovascular Surgery, Heart Centre Freiburg University, Freiburg, Germany.,Faculty of Medicine, University of Freiburg, Freiburg, Germany
| |
Collapse
|
21
|
Kreibich M, Rylski B, Czerny M, Pingpoh C, Siepe M, Beyersdorf F, Khurshan F, Vallabhajosyula P, Szeto WY, Bavaria JE, Desai ND, Branchetti E. Type A Aortic Dissection in Patients With Bicuspid Aortic Valve Aortopathy. Ann Thorac Surg 2020; 109:94-100. [DOI: 10.1016/j.athoracsur.2019.05.022] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2018] [Revised: 04/03/2019] [Accepted: 05/02/2019] [Indexed: 01/16/2023]
|
22
|
Wamala I, Heck R, Falk V, Buz S. Endovascular treatment of acute type A aortic dissection in a nonagenarian: stabilization of a short covered stent using a bare-metal stent. Interact Cardiovasc Thorac Surg 2019; 29:978-980. [DOI: 10.1093/icvts/ivz206] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Revised: 07/18/2019] [Accepted: 07/25/2019] [Indexed: 11/12/2022] Open
Abstract
Abstract
Endovascular treatment is a viable alternative therapy in high-risk patients with acute type A aortic dissection. However, the optimal endovascular treatment strategy is still evolving. Herein, we present a case of a 91-year-old man who successfully underwent repair of an ascending aortic dissection using a stent-in-stent technique. At 1-year follow-up, the stent demonstrated repair durability.
Collapse
Affiliation(s)
- Isaac Wamala
- Department of Cardiovascular and Thoracic Surgery, German Heart Institute Berlin, Berlin, Germany
| | - Roland Heck
- Department of Cardiovascular and Thoracic Surgery, German Heart Institute Berlin, Berlin, Germany
| | - Volkmar Falk
- Department of Cardiovascular and Thoracic Surgery, German Heart Institute Berlin, Berlin, Germany
| | - Semih Buz
- Department of Cardiovascular and Thoracic Surgery, German Heart Institute Berlin, Berlin, Germany
| |
Collapse
|
23
|
Pacini D, Murana G, Di Marco L. Anatomic feasibility of stenting type A aortic dissection: Paving the way for the future. J Thorac Cardiovasc Surg 2018; 157:35-36. [PMID: 30029786 DOI: 10.1016/j.jtcvs.2018.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 06/04/2018] [Accepted: 06/05/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Davide Pacini
- Cardiac Surgery Unit, Cardio-Thoraco-Vascular Department, S. Orsola Hospital, University of Bologna, Bologna, Italy.
| | - Giacomo Murana
- Cardiac Surgery Unit, Cardio-Thoraco-Vascular Department, S. Orsola Hospital, University of Bologna, Bologna, Italy
| | - Luca Di Marco
- Cardiac Surgery Unit, Cardio-Thoraco-Vascular Department, S. Orsola Hospital, University of Bologna, Bologna, Italy
| |
Collapse
|