Endovascular exclusion of the entire aortic arch with branched stent-grafts after surgery for acute type A aortic dissection.
AAD, type A acute aortic dissection
ASG, aortic arch stent-grafting
BCT, brachiocephalic trunk
CT, computed tomography
LCCA, left common carotid artery
LSA, left subclavian artery
RCCA, right common carotid artery
aortic arch
endovascular therapy
Journal
JTCVS techniques
ISSN: 2666-2507
Titre abrégé: JTCVS Tech
Pays: United States
ID NLM: 101768546
Informations de publication
Date de publication:
Sep 2020
Sep 2020
Historique:
received:
13
04
2020
revised:
13
04
2020
accepted:
16
04
2020
entrez:
28
7
2021
pubmed:
28
4
2020
medline:
28
4
2020
Statut:
epublish
Résumé
The treatment of residual pathology of the aortic arch after surgical repair for type A acute dissection (AAD) represents a therapeutic challenge. Recently, new branched endovascular devices have expanded the possibility of aortic arch stent-grafting (ASG) with proximal landing in zone 0. The aim of this retrospective, single-center study was to evaluate outcomes of patients with a history of surgical repair for AAD undergoing ASG with branched devices. We analyzed patients undergoing ASG after treatment for type AAD with 2 different branched devices: Nexus (dual-module, single branch, off-the-shelf) and RelayBranch (single-module, dual branch, custom-made). Before ASG, surgical bypass of supra-aortic vessels was performed according to patient's anatomy and to the selected device. All patients underwent clinical and computed tomography scan evaluation before hospital discharge, at 6 months, and on a yearly basis thereafter. From March 2017 to April 2019, 4 consecutive patients underwent ASG after surgery for AAD at our institution. Mean time from surgery for AAD to ASG was 20 months. Mean age at the time of ASG was 72 years. Nexus and Relay were implanted in 2 patients each. All patients survived and were successfully discharged. Mean intensive care unit stay and hospital stay were 3 and 19 days, respectively. We did not observe any major adverse events. At a mean follow-up of 28 months, all patients are alive and computed tomography scans showed good anatomic results with no endoleaks. This preliminary experience shows that ASG after surgery for AAD is feasible and provides encouraging clinical and anatomic early results.
Sections du résumé
BACKGROUND
BACKGROUND
The treatment of residual pathology of the aortic arch after surgical repair for type A acute dissection (AAD) represents a therapeutic challenge. Recently, new branched endovascular devices have expanded the possibility of aortic arch stent-grafting (ASG) with proximal landing in zone 0. The aim of this retrospective, single-center study was to evaluate outcomes of patients with a history of surgical repair for AAD undergoing ASG with branched devices.
METHODS
METHODS
We analyzed patients undergoing ASG after treatment for type AAD with 2 different branched devices: Nexus (dual-module, single branch, off-the-shelf) and RelayBranch (single-module, dual branch, custom-made). Before ASG, surgical bypass of supra-aortic vessels was performed according to patient's anatomy and to the selected device. All patients underwent clinical and computed tomography scan evaluation before hospital discharge, at 6 months, and on a yearly basis thereafter.
RESULTS
RESULTS
From March 2017 to April 2019, 4 consecutive patients underwent ASG after surgery for AAD at our institution. Mean time from surgery for AAD to ASG was 20 months. Mean age at the time of ASG was 72 years. Nexus and Relay were implanted in 2 patients each. All patients survived and were successfully discharged. Mean intensive care unit stay and hospital stay were 3 and 19 days, respectively. We did not observe any major adverse events. At a mean follow-up of 28 months, all patients are alive and computed tomography scans showed good anatomic results with no endoleaks.
CONCLUSIONS
CONCLUSIONS
This preliminary experience shows that ASG after surgery for AAD is feasible and provides encouraging clinical and anatomic early results.
Identifiants
pubmed: 34317796
doi: 10.1016/j.xjtc.2020.04.009
pii: S2666-2507(20)30200-5
pmc: PMC8302916
doi:
Types de publication
Journal Article
Langues
eng
Pagination
1-8Informations de copyright
© 2020 The Authors.
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