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Gibello L, Antonello M, Civilini E, Pellenc Q, Bellosta R, Carbonari L, Bonardelli S, Freyrie A, Riambau V, Varetto G, Verzini F. Multicentre experience of antegrade thoracic endovascular aortic repair for the treatment of thoracic aortic diseases. Eur J Cardiothorac Surg 2024; 65:ezae185. [PMID: 38733578 DOI: 10.1093/ejcts/ezae185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 04/09/2024] [Accepted: 04/21/2024] [Indexed: 05/13/2024] Open
Abstract
OBJECTIVES The goal of this multicentre retrospective cohort study was to evaluate technical success and early and late outcomes of thoracic endovascular repair (TEVAR) with grafts deployed upside down through antegrade access, to treat thoracic aortic diseases. METHODS Antegrade TEVAR operations performed between January 2010 and December 2021 were collected and analysed. Both elective and urgent procedures were included. Exclusion criteria were endografts deployed in previous or concomitant surgical or endovascular repairs. RESULTS Fourteen patients were enrolled; 13 were males (94%) with a mean age of 71 years (interquartile range 62; 78). Five patients underwent urgent procedures (2 ruptured aortas and 3 symptomatic patients). Indications for treatment were 8 (57%) aneurysms/pseudoaneurysms, 3 (21%) dissections and 3 (21%) penetrating aortic ulcers. Technical success was achieved in all procedures. Early mortality occurred in 4 (28%) cases, all urgent procedures. Median follow-up was 13 months (interquartile range 1; 44). Late deaths occurred in 2 (20%) patients, both operated on in elective settings. The first died at 19 months of aortic-related reintervention; the second died at 34 months of a non-aortic-related cause. Two patients (14%) underwent aortic-related reinterventions for late type I endoleak. The survival rate of those having the elective procedures was 100%, 84% and 67% at 12, 24 and 36 months, respectively. Freedom from reintervention was 92%, 56% and 56% at 12, 24 and 36 months, respectively. CONCLUSIONS Antegrade TEVAR can seldom be considered an alternative when traditional retrograde approach is not feasible. Despite good technical success and few access-site complications, this study demonstrates high rates of late type I endoleak and aortic-related reinterventions.
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Affiliation(s)
- Lorenzo Gibello
- Unit of Vascular Surgery, Department of Surgical Sciences, University of Turin, AOU Città della Salute e della Scienza di Torino, Turin, Italy
| | - Michele Antonello
- Section of Vascular and Endovascular Surgery, Department of Cardiac Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Efrem Civilini
- Humanitas University Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Quentin Pellenc
- Department of Thoracic and Vascular Surgery, Marfan Syndrome National Referral Center, Bichat University Hospital, APHP, Paris, France
- Vascular and Endovascular Surgery Division, La Cote HealthCare Group, Morges, VD, Switzerland
| | - Raffaello Bellosta
- Vascular and Endovascular Surgery, Poliambulanza Foundation Hospital, Brescia, Italy
| | | | - Stefano Bonardelli
- Vascular Surgery, Department of Surgery, Spedali Civili University Teaching Hospital, University of Brescia School of Medicine, Brescia, Italy
| | - Antonio Freyrie
- Vascular Surgery, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Vincent Riambau
- Department of Vascular Surgery, Cardiovascular Institute, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Gianfranco Varetto
- Unit of Vascular Surgery, Department of Surgical Sciences, University of Turin, AOU Città della Salute e della Scienza di Torino, Turin, Italy
| | - Fabio Verzini
- Unit of Vascular Surgery, Department of Surgical Sciences, University of Turin, AOU Città della Salute e della Scienza di Torino, Turin, Italy
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Gouveia E Melo R, Fernández Prendes C, Khanafer A, Wanhainen A, Mani K, Rouhani G, Chao V, Tay KH, Chong TT, Adam D, Dias N, Agaev A, Tsilimparis N. Common Designs of Custom-Made Fenestrated Arch Devices and Applicability of an Off-the-Shelf Design. J Endovasc Ther 2023:15266028231179593. [PMID: 37300282 DOI: 10.1177/15266028231179593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
OBJECTIVES To analyze device designs, similarities and overlaps of custom-made fenestrated arch endografts intended for mid/distal arch thoracic endovascular aortic repair. MATERIALS AND METHODS A multicenter cross-sectional study analyzing custom-made anonymized graft plans was performed. Graft plans were included from a cohort of mid/distal aortic arch repairs using custom-made fenestrated aortic endografts treated at 8 centers. Grafts targeting >2 arteries were excluded. No patient/clinical data were analyzed. A descriptive analysis was performed followed by an analysis of overlap of the designs to reach a common design in which the greatest number of grafts would overlap. RESULTS One hundred thirty-one graft plans were included. All grafts were custom-made grafts from the COOK Medical Fenestrated arch platform. Ninety-four (71.8%) had a scallop-and-single-fenestration design, 33 (25.2%) had a single fenestration and 4 (4.3%) a single scallop. For analysis purposes, these latter 4 grafts were excluded. Two main graft plans (Plans 1 and 2) were proposed after analysis with similar configuration (1 scallop with 30 mm width, 20 mm height, 12:00 position; 1 preloaded fenestration with 8 mm diameter, 26 mm from the top of the graft and 12:00 position; tapered, with a 193 mm length and 32 mm distal diameter) but with 2 different proximal diameters of 38 mm (Plan 1) and 44 mm (Plan 2), reaching an overall feasibility of 85.8% (n=109), being 47.2% (n=60) and 38.6% (n=49) for each design, respectively. CONCLUSION The degree of overlap between the studied fenestrated and/or scalloped thoracic endovascular aneurysm repair (TEVAR) graft designs was high. Future studies analyzing these designs in a real-world cohort of patients are needed to further address off-the-shelf feasibility. CLINICAL IMPACT In a multicenter study analyzing 127 fenestrated aortic arch endograft plans from 9 aortic centers, we found that the degree of overlap between the studied fenestrated and/or scalloped arch graft designs was high and that 2 proposed graft designs would be theoretically applicable in 85.8% of cases. Future studies analyzing these designs in a real-world cohort of patients are needed to further address off-the-shelf feasibility.
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Affiliation(s)
- Ryan Gouveia E Melo
- Department of Vascular Surgery, Ludwig Maximilian University Hospital, Munich, Germany
| | | | - Adib Khanafer
- University of Otago, Christchurch, Christchurch Hospital, Christchurch, New Zealand
| | - Anders Wanhainen
- Department of Surgical Sciences, Vascular Surgery, Uppsala University, Uppsala, Sweden
| | - Kevin Mani
- Department of Surgical Sciences, Vascular Surgery, Uppsala University, Uppsala, Sweden
| | - Guido Rouhani
- Section of Vascular Surgery, Klinikum Frankfurt Höchst, Frankfurt, Germany
| | | | | | | | - Donald Adam
- Department of Vascular and Endovascular Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Nuno Dias
- Vascular Center Malmö, Department of Thoracic Surgery and Vascular Diseases, Skåne University Hospital, Malmö, Sweden
- Department of Clinical Sciences, Malmö, Lund University, Malmö, Sweden
| | - Arzou Agaev
- Department of Vascular Surgery, Cardiovascular Center Bad Neustadt, Bad Neustadt, Germany
| | - Nikolaos Tsilimparis
- Department of Vascular Surgery, Ludwig Maximilian University Hospital, Munich, Germany
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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]
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Chastant R, Belarbi A, Ozdemir BA, Alric P, Gandet T, Canaud L, Legend FIGUREABLE. Homemade fenestrated physician-modified stent-grafts for arch aortic degenerative aneurysms. J Vasc Surg 2022; 76:1133-1140.e2. [PMID: 35697312 DOI: 10.1016/j.jvs.2022.04.041] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Revised: 02/06/2022] [Accepted: 04/05/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To evaluate early and medium-term outcomes of single and double fenestrated physician-modified endovascular grafts (PMEGs) for total endovascular degenerative aortic arch aneurysm repair. METHODS This single-center retrospective analysis of prospectively collected data included 52 patients, from August 2013 through January 2021, undergoing home-made fenestrated thoracic endovascular aortic repair (TEVAR) for degenerative aortic aneurysms. In all cases a distal smaller fenestration for the left subclavian artery (LSA) was fashioned and the only one stented. For double-fenestrated endograft a proximal larger fenestration that incorporated both the brachiocephalic trunk and left common carotid artery was added. RESULTS 52 patients with degenerative aortic arch aneurysms were treated. There were 36 men and the mean age was 75 ± 8 years. 31% treated with a single LSA fenestration, while 69% had a double-fenestrated TEVAR. 10% (n=5) were emergent procedures. Technical success was 100%. The median time requirement for stent graft modification was 22 ± 6 minutes. Thirty-day mortality was 2% (n=1). 5 patients (10%) had a cerebrovascular event including 2 transient ischemic attack, one minor stroke with full neurological recovery and 2 with sequelae. 2 patients (4%) experienced perioperative retrograde dissection during follow-up. No patient had a type I, type III or type II endoleak from the LSA. No patient required re-intervention. All supra-aortic trunks were patent. During a mean follow up of 18 ± 11 months, there were no conversion to open surgical repair, aortic rupture or paraplegia. CONCLUSIONS Single or double PMEG is a safe and suitable tool for the treatment of high morbidity pathology such as aortic arch degenerative aneurysm repair. This device can be used in elective and emergency patients.
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Affiliation(s)
- Robin Chastant
- Department of Thoracic and Vascular Surgery, Arnaud de Villeneuve Hospital, Montpellier, France.
| | - Amin Belarbi
- Department of Thoracic and Vascular Surgery, Arnaud de Villeneuve Hospital, Montpellier, France
| | - Baris Ata Ozdemir
- Department of Thoracic and Vascular Surgery, Arnaud de Villeneuve Hospital, Montpellier, France; University of Bristol, Bristol, United Kingdom
| | - Pierre Alric
- Department of Thoracic and Vascular Surgery, Arnaud de Villeneuve Hospital, Montpellier, France; PhyMedExp, Univ Montpellier, CNRS, INSERM, CHU Montpellier, Montpellier, France
| | - Thomas Gandet
- Department of Thoracic and Vascular Surgery, Arnaud de Villeneuve Hospital, Montpellier, France; PhyMedExp, Univ Montpellier, CNRS, INSERM, CHU Montpellier, Montpellier, France
| | - Ludovic Canaud
- Department of Thoracic and Vascular Surgery, Arnaud de Villeneuve Hospital, Montpellier, France; PhyMedExp, Univ Montpellier, CNRS, INSERM, CHU Montpellier, Montpellier, France.
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Kishimoto Y, Yoshikawa Y, Morimoto K, Onohara T, Horie H, Kumagai K, Nii R, Nishimura M. Impact of frailty on early and mid-term outcomes of hybrid aortic arch repair. Surg Today 2022; 52:1194-1201. [PMID: 34984573 DOI: 10.1007/s00595-021-02443-x] [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: 05/12/2021] [Accepted: 11/22/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE The purpose of this study was to investigate the impact of frailty on the clinical outcomes of hybrid aortic arch repair with debranching of the supra-aortic arteries. METHODS Consecutive patients ≥ 75 years old who underwent hybrid aortic arch repair from January 2010 to December 2019 were retrospectively analyzed. Using the Canadian Study of Health and Aging (CSHA) scale, all patients with a CSHA scale score > 4 were defined as frail. The frail patients (FP) group and the non-frail patients (NFP) group were compared regarding the early and mid-term outcomes of hybrid aortic arch repair. RESULTS A total of 84 patients were included. The early postoperative results were not markedly different between the groups, except that the rate of transfer to a rehabilitation hospital was higher in the FP group than in the NFP group. The survival at 5 years was significantly lower in the FP group at 43.0% than in the NFP group at 67.7% (P = 0.015). However, the freedom from aorta-related death was not significantly different between the two groups. CONCLUSION Frailty did not affect the short-term outcomes of hybrid aortic arch repair; however, the mid-term outcomes, including the survival, of the frail patients were significantly worse than those of the non-frail patients, mostly because of non-aorta-related causes.
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Affiliation(s)
- Yuichiro Kishimoto
- Division of Cardiovascular Surgery, Tottori University School of Medicine, 36-1 Nishi-cho, Yonago, Tottori, 683-8504, Japan
| | - Yasushi Yoshikawa
- Division of Cardiovascular Surgery, Tottori University School of Medicine, 36-1 Nishi-cho, Yonago, Tottori, 683-8504, Japan.
| | - Kenichi Morimoto
- Division of Cardiovascular Surgery, Tottori University School of Medicine, 36-1 Nishi-cho, Yonago, Tottori, 683-8504, Japan
| | - Takeshi Onohara
- Division of Cardiovascular Surgery, Tottori University School of Medicine, 36-1 Nishi-cho, Yonago, Tottori, 683-8504, Japan
| | - Hiromu Horie
- Division of Cardiovascular Surgery, Tottori University School of Medicine, 36-1 Nishi-cho, Yonago, Tottori, 683-8504, Japan
| | - Kunitaka Kumagai
- Division of Cardiovascular Surgery, Tottori University School of Medicine, 36-1 Nishi-cho, Yonago, Tottori, 683-8504, Japan
| | - Rikuto Nii
- Division of Cardiovascular Surgery, Tottori University School of Medicine, 36-1 Nishi-cho, Yonago, Tottori, 683-8504, Japan
| | - Motonobu Nishimura
- Division of Cardiovascular Surgery, Tottori University School of Medicine, 36-1 Nishi-cho, Yonago, Tottori, 683-8504, Japan
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Saito Y, Yamamoto H, Fukuda I, Miyata H, Minakawa M, Motomura N. The results of aortic arch replacement using antegrade cerebral perfusion in haemodialysis patients: analysis of the Japan cardiovascular surgery database. Eur J Cardiothorac Surg 2021; 61:162-169. [PMID: 34148088 DOI: 10.1093/ejcts/ezab252] [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: 01/12/2021] [Revised: 04/08/2021] [Accepted: 04/14/2021] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVES There have been limited data available regarding aortic arch replacement in dialysis patients. The purpose of this study was to examine real-world data and to determine the impact of preoperative dialysis status and other risks on surgical aortic arch replacement using the Japan Cardiovascular Surgery Database. METHODS A total of 5044 patients who underwent elective, isolated aortic arch replacement using antegrade cerebral perfusion during 2014-2017 were eligible for the study. Of these, 89 patients received haemodialysis preoperatively. The patients were divided into 6 groups according to their preoperative estimated glomerular filtration rate and dialysis status for comparison. Preoperative and postoperative data were examined using a multivariable regression model. RESULTS The overall surgical mortality rates of non-Chronic Kidney Disease (CKD) (estimated glomerular filtration rate >60 ml/min/1.73 m2), stage 3A, stage 3B, stage 4, stage 5 CKD and dialysis patients were 2.6%, 3.1%, 6.8%, 11.6%, 16.7% and 13.5%, respectively. After risk adjustment, dialysis was shown to be strongly associated with surgical mortality (odds ratio 4.39 and 95% confidence interval 2.22-8.72) and have a trend to be associated with postoperative stroke (odds ratio 2.02, 95% confidence interval 1.00-4.10, P = 0.051) when compared to the non-CKD group. As predictors of mortality, male sex, peripheral arterial disease, preoperative liver dysfunction and impaired left ventricular function were identified. CONCLUSIONS The Japanese nationwide database revealed the outcomes of aortic arch replacement in dialysis patients. Appropriate counselling and an alternative strategy should be considered for such patients with multiple risks for mortality.
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Affiliation(s)
- Yoshiaki Saito
- Thoracic and Cardiovascular Surgery, Hirosaki University Graduate School of Medicine, Aomori, Japan
| | - Hiroyuki Yamamoto
- Department of Healthcare Quality Assessment, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.,Japan Cardiovascular Surgery Database Organization, Tokyo, Japan
| | - Ikuo Fukuda
- Thoracic and Cardiovascular Surgery, Hirosaki University Graduate School of Medicine, Aomori, Japan
| | - Hiroaki Miyata
- Department of Healthcare Quality Assessment, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.,Japan Cardiovascular Surgery Database Organization, Tokyo, Japan
| | - Masahito Minakawa
- Thoracic and Cardiovascular Surgery, Hirosaki University Graduate School of Medicine, Aomori, Japan
| | - Noboru Motomura
- Japan Cardiovascular Surgery Database Organization, Tokyo, Japan
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