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Jędrzejczak T, Rynio P, Lewandowski M, Kazimierczak A. Externalized transapical guidewire technique after artificial aortic valve replacement during complete endovascular aortic arch repair. Wideochir Inne Tech Maloinwazyjne 2021; 16:227-233. [PMID: 33786138 PMCID: PMC7991936 DOI: 10.5114/wiitm.2020.93987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 02/23/2020] [Indexed: 11/23/2022] Open
Abstract
An externalized transapical guidewire (ETAG) technique has been used for safe delivery of high-profile devices through a tortuous aorta to zone 0, which is currently precluded after mechanical artificial aortic valve replacement (AVR). The aim of the study was to report one center's experience (based on 3 cases) of a unique modification to the ETAG technique used for the first time during total endovascular aortic arch repair after AVR. This report contains technical notes regarding a new method of steering the guidewire from the apex inside the artificial aortic valve during total endovascular aortic arch repair after AVR and the details crucial in preparation for this mini-invasive procedure. As a conclusion, the ETAG technique could be performed after mechanical AVR with active positioning of the guidewire carried out under the control of transesophageal echocardiography.
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Affiliation(s)
- Tomasz Jędrzejczak
- Cardiac Surgery Department, Pomeranian Medical University, Szczecin, Poland
| | - Paweł Rynio
- Vascular Surgery Department, Pomeranian Medical University, Szczecin, Poland
| | - Maciej Lewandowski
- Cardiac Surgery Department, Pomeranian Medical University, Szczecin, Poland
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Thoracic endovascular repair for retrograde acute type A aortic dissection as an alternative choice. Gen Thorac Cardiovasc Surg 2020; 68:1397-1404. [DOI: 10.1007/s11748-020-01397-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 05/27/2020] [Indexed: 10/24/2022]
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Tsilimparis N, Drewitz S, Detter C, Spanos K, von Kodolitsch Y, Rohlffs F, Reichenspurner H, Debus ES, Kölbel T. Endovascular Repair of Ascending Aortic Pathologies With Tubular Endografts: A Single-Center Experience. J Endovasc Ther 2019; 26:439-445. [PMID: 31140362 DOI: 10.1177/1526602819852083] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Purpose: To investigate the endovascular treatment of ascending aortic pathologies of high-risk patients unsuitable for open repair. Materials and Methods: From 2010 to 2017, 24 patients (mean age 70±15 years, range 29-90; 18 men) were treated at a single center for various pathologies of the ascending aorta, including acute or chronic type A aortic dissections (n=16), pseudoaneurysms (n=6), fixation of a dislocated percutaneous aortic valve (n=2), and miscellaneous indications (n=3). The patients were selected following an interdisciplinary case evaluation, attended by cardiologists and cardiac and vascular surgeons. The Zenith Ascend TAA Endovascular Graft was implanted; simultaneous procedures were performed in 13 patients. Of the total 27 Ascend TEVAR procedures (24 primary and 3 reinterventions), 17 were performed urgently and 10 electively. The primary outcome measure was 30-day survival. The secondary outcomes were cardiovascular complications, midterm survival, and reintervention rate. Results: Clinical success was achieved in all but 1 case. The 30-day survival was 79% (19/24); of the 5 deaths only 1 was directly related to the endograft implanted. In the 30-day postoperative period, there was 1 myocardial infarction, 2 major strokes, a mycotic pseudoaneurysm, a case of Ascend TEVAR-induced high-grade aortic insufficiency, and a minor stroke; 1 patient developed paraplegia after concurrent implantation of a 4-branched abdominal stent-graft. Two patients had a reintervention within 30 days for the pseudoaneurysm and the aortic insufficiency, respectively. During a mean follow-up of 11 months (0-35 months), there was 1 late death (cancer) and 1 additional reintervention at 10 months for a late type Ia endoleak (12.5% reintervention rate). Conclusion: Endovascular repair of ascending aortic pathologies with stent-grafts is a feasible treatment option with acceptable early and midterm outcomes in high-risk patients unsuitable for open surgery. The complexity of Ascend TEVAR might justify higher reintervention rates.
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Affiliation(s)
- Nikolaos Tsilimparis
- 1 Department of Vascular Medicine, German Aortic Center, University Heart Center, Hamburg, Germany.,2 Department of Vascular Surgery, Ludwig-Maximilians-University Hospital Munich, Germany
| | - Stefan Drewitz
- 1 Department of Vascular Medicine, German Aortic Center, University Heart Center, Hamburg, Germany
| | - Christian Detter
- 3 Department of Cardiovascular Surgery, German Aortic Center, University Heart Center, Hamburg, Germany
| | - Konstantinos Spanos
- 1 Department of Vascular Medicine, German Aortic Center, University Heart Center, Hamburg, Germany
| | - Yskert von Kodolitsch
- 4 Department of Cardiology, German Aortic Center, University Heart Center, Hamburg, Germany
| | - Fiona Rohlffs
- 1 Department of Vascular Medicine, German Aortic Center, University Heart Center, Hamburg, Germany
| | - Herrmann Reichenspurner
- 3 Department of Cardiovascular Surgery, German Aortic Center, University Heart Center, Hamburg, Germany
| | - E Sebastian Debus
- 1 Department of Vascular Medicine, German Aortic Center, University Heart Center, Hamburg, Germany
| | - Tilo Kölbel
- 1 Department of Vascular Medicine, German Aortic Center, University Heart Center, Hamburg, Germany
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