Endovascular repair of the ascending aorta: the last frontier.

Different pathologies of the ascending aorta (AA), including aneurysms, acute and chronic dissections, and pseudoaneurysms, have been treated with open surgical repair with very good results, especially at aortic centers of excellence. There is, however, a subset of patients for whom open surgery is considered to pose high or prohibitive risk. These patients can benefit from a less invasive approach with catheters and wires, percutaneous techniques and stent grafts. However, the existing technology was developed to treat descending thoracic aortic pathologies; it is not approved for use in the AA by the US Food and Drug Administration (FDA). The devices used for the descending thoracic aorta (DTA) have certain size and design limitations that make their application to the AA cumbersome at times. As a result, custom-made endografts have been used to treat pathologies in the AA, although their use is feasible only in elective procedures. In addition, the AA has specific anatomic and physiologic characteristics that raise concerns about the long-term durability of the current technology. In this review, we outline the limitations, challenges and current status of endovascular technology to treat pathologies of the AA.

Informations de copyright

2022 Annals of Cardiothoracic Surgery. All rights reserved.

Déclaration de conflit d'intérêts

Conflicts of Interest: Dr. OP serves as a consultant for W. L. Gore and Associates and for Terumo Aortic. She has also received travel expenses paid by Medtronic, Inc., and Cook Medical in the past. Dr. JSC consults for, receives royalties and a departmental educational grant from, and participates in clinical trials for Terumo Aortic; consults and participates in clinical trials for Medtronic, Inc., and W.L. Gore & Associates; and participates in clinical trials for Abbott Laboratories, Edwards Lifesciences, and CytoSorbents. The other authors have no conflicts of interest to declare.