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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.
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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.)
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Ahmad W, Wegner M, Dorweiler B. Meta-analysis and meta-regression of the total endovascular aortic repair in aortic arch. VASA 2023; 52:175-185. [PMID: 36891664 DOI: 10.1024/0301-1526/a001061] [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: 03/10/2023]
Abstract
Background: The total endovascular repair of the aortic arch is becoming more and more an acceptable alternative to the open repair in selected patients. The aim of the present study is to perform a meta-analysis of the available data on the outcomes of the various endovascular techniques used to treat the pathologies in this challenging anatomical area. Patients and methods: An extensive electronic search in PubMed/MEDLINE, Science Direct Databases, and the Cochrane Library was conducted. All papers published up to January 2022 on the endovascular techniques in the aortic arch (chimney-thoracic endovascular aortic repair (ChTEVAR), fenestrated/branched grafts as custom made devices (CMD) and surgeon modified TEVAR (SM TEVAR) providing information about at least one of the essential outcomes defined in the inclusion criteria. Results: Out of the 5078 studies found through the search in the databases and registers, 26 studies with a total number of patients of 2327 with 3497 target vessels were included in the analysis. The studies reported a high technical success rate with an estimated proportion of 95.8% (95% CI, 93-97.6%). Moreover, the pooled estimation of the early type Ia/III endoleak was 8.1% (95% CI, 5.4-12.1%). The pooled mortality was 4.6% (95 CI, 3.2-6.6%) with a significant heterogeneity and the stroke had an estimated proportion (major and minor combined) of 4.8% (95% CI, 3.5-6.6%). A meta-regression analysis showed no significant variation between the groups in mortality (P=.324) showed however a significant difference between the therapeutic methods regarding stroke P<.001 (lower rate in ChTEVAR and SM vs. CMD). Conclusions: The present meta-analysis could demonstrate good short- and long-term outcomes of the multiple total endovascular repair methods used in the aortic arch.
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Affiliation(s)
- Wael Ahmad
- Department of Vascular and Endovascular Surgery-University of Cologne, Faculty of Medicine and University Hospital Cologne, Germany
| | - Moritz Wegner
- Department of Vascular and Endovascular Surgery-University of Cologne, Faculty of Medicine and University Hospital Cologne, Germany
| | - Bernhard Dorweiler
- Department of Vascular and Endovascular Surgery-University of Cologne, Faculty of Medicine and University Hospital Cologne, Germany
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Luehr M, Wahlers T. The long road to excellence in aortic surgery: Practice. Adopt. Repeat. Eur J Cardiothorac Surg 2021; 60:976-977. [PMID: 34037745 DOI: 10.1093/ejcts/ezab257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Maximilian Luehr
- Department of Cardiothoracic Surgery, Heart Center, University of Cologne, Cologne, Germany
| | - Thorsten Wahlers
- Department of Cardiothoracic Surgery, Heart Center, University of Cologne, Cologne, Germany
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Liakopoulos OJ, Ahmad W. Commentary: Hybrid repair of acute type A aortic dissection with visceral malperfusion syndrome-endovascular first! JTCVS Tech 2021; 7:27-28. [PMID: 34318196 PMCID: PMC8311450 DOI: 10.1016/j.xjtc.2021.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 12/30/2020] [Accepted: 01/04/2021] [Indexed: 11/25/2022] Open
Affiliation(s)
- Oliver J. Liakopoulos
- Department of Cardiac Surgery, Kerckhoff-Clinic Bad Nauheim, Campus Kerckhoff, University of Giessen, Bad Nauheim, Germany
- Address for reprints: Oliver J. Liakopoulos, MD, Department of Cardiac Surgery, Kerckhoff-Clinic Bad Nauheim, Campus Kerckhoff, University of Giessen, Benekestr. 2-8, 61231 Bad Nauheim, Germany.
| | - Wael Ahmad
- Department of Vascular and Endovascular Surgery, University Hospital of Cologne, Cologne, Germany
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