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Debranching solutions in endografting for complex thoracic aortic dissections.

Goksel OS, Guven K, Karatepe C, Gok E, Acunas B, Cinar B, Alpagut U - Arq. Bras. Cardiol. (2014)

Bottom Line: There were no early to midterm endoleaks.The median follow-up was 20 ± 8 months with patency rate of 100%.Various debranching solutions for different complex scenarios of the aortic arch serve as less invasive procedures than conventional open surgery enabling safe and effective treatment of this highly selected subgroup of patients with complex aortic pathologies.

View Article: PubMed Central - PubMed

Affiliation: Cardiovascular Surgery, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey.

ABSTRACT

Background: Conventional surgical repair of thoracic aortic dissections is a challenge due to mortality and morbidity risks.

Objectives: We analyzed our experience in hybrid aortic arch repair for complex dissections of the aortic arch.

Methods: Between 2009 and 2013, 18 patients (the mean age of 67 ± 8 years-old) underwent hybrid aortic arch repair. The procedural strategy was determined on the individual patient.

Results: Thirteen patients had type I repair using trifurcation and another patient with bifurcation graft. Two patients had type II repair with replacement of the ascending aorta. Two patients received extra-anatomic bypass grafting to left carotid artery allowing covering of zone 1. Stent graft deployment rate was 100%. No patients experienced stroke. One patient with total debranching of the aortic arch following an acute dissection of the proximal arch expired 3 months after TEVAR due to heart failure. There were no early to midterm endoleaks. The median follow-up was 20 ± 8 months with patency rate of 100%.

Conclusion: Various debranching solutions for different complex scenarios of the aortic arch serve as less invasive procedures than conventional open surgery enabling safe and effective treatment of this highly selected subgroup of patients with complex aortic pathologies.

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Related in: MedlinePlus

Preoperative digital subtraction angiography of the patient with ascending aortaand thoracic aortic dissection (a). Note that the distance between left carotidartery and the left subclavian artery is almost 1 centimeter and that left carotidartery and brachiocephalic truncus ostia are almost at the same level. A type IIarch repair is anticipated to allow safe endografting on Z0. CAT scan of the samepatient following ascending aortic replacement (b).
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f03: Preoperative digital subtraction angiography of the patient with ascending aortaand thoracic aortic dissection (a). Note that the distance between left carotidartery and the left subclavian artery is almost 1 centimeter and that left carotidartery and brachiocephalic truncus ostia are almost at the same level. A type IIarch repair is anticipated to allow safe endografting on Z0. CAT scan of the samepatient following ascending aortic replacement (b).

Mentions: From 2009 to present, 10 patients with a history of ascending aortic repair for an acutetype A dissection, 7 patients with complex type B aortic dissection and 1 patient acuteaortic arch dissection with initial tear at the level of brachiocephalic trunk underwenthybrid aortic arch repair. Endografting was performed on the following day of thedebranching procedure in all patients except for the type A dissection patients in whoman ascending aortic repair with debranching of the supraaortic branches and TEVAR threeweeks later when indicated. The mean aneurysmal diameter was 64 ± 5.29millimeters (Table 1). All patients werefollowed prospectively. All received cerebrospinal fluid pressure monitoring anddrainage system on a routine basis. 13 patients had a standard type I arch repair withdebranching of the all three supraaortic vessels with a trifurcation graft (Figure 1). One patient had a bifurcation graftanastomosed to ascending aorta in an end-to side fashion as the aortic arch was highlydilated and left subclavian artery was unreachable through median sternotomy, thus anadditional left caroticosubclavian bypass was performed (Figures 2 a and b.). This latterpatient also had an aberrant right subclavian artery, which was the main determinant forconversion from conventional open arch repair to a hybrid approach. Two patients hadascending aortic aneurysm in addition to type B dissection with thoracic aorticdiameters 62 and 66 millimeters, respectively. Type II arch repair was performed inthese two patients with replacement of ascending aorta and the hemiarch withtri-branched 24-mm Dacron graft (Hemashield Platinum,Woven Double Velour; BostonScientific Corporation, Wayne, NJ, USA) prior to retrograde TEVAR on the following day.One of the latter patients also had aortic valve replacement during ascending aortareplacement (Figure 3).


Debranching solutions in endografting for complex thoracic aortic dissections.

Goksel OS, Guven K, Karatepe C, Gok E, Acunas B, Cinar B, Alpagut U - Arq. Bras. Cardiol. (2014)

Preoperative digital subtraction angiography of the patient with ascending aortaand thoracic aortic dissection (a). Note that the distance between left carotidartery and the left subclavian artery is almost 1 centimeter and that left carotidartery and brachiocephalic truncus ostia are almost at the same level. A type IIarch repair is anticipated to allow safe endografting on Z0. CAT scan of the samepatient following ascending aortic replacement (b).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4150667&req=5

f03: Preoperative digital subtraction angiography of the patient with ascending aortaand thoracic aortic dissection (a). Note that the distance between left carotidartery and the left subclavian artery is almost 1 centimeter and that left carotidartery and brachiocephalic truncus ostia are almost at the same level. A type IIarch repair is anticipated to allow safe endografting on Z0. CAT scan of the samepatient following ascending aortic replacement (b).
Mentions: From 2009 to present, 10 patients with a history of ascending aortic repair for an acutetype A dissection, 7 patients with complex type B aortic dissection and 1 patient acuteaortic arch dissection with initial tear at the level of brachiocephalic trunk underwenthybrid aortic arch repair. Endografting was performed on the following day of thedebranching procedure in all patients except for the type A dissection patients in whoman ascending aortic repair with debranching of the supraaortic branches and TEVAR threeweeks later when indicated. The mean aneurysmal diameter was 64 ± 5.29millimeters (Table 1). All patients werefollowed prospectively. All received cerebrospinal fluid pressure monitoring anddrainage system on a routine basis. 13 patients had a standard type I arch repair withdebranching of the all three supraaortic vessels with a trifurcation graft (Figure 1). One patient had a bifurcation graftanastomosed to ascending aorta in an end-to side fashion as the aortic arch was highlydilated and left subclavian artery was unreachable through median sternotomy, thus anadditional left caroticosubclavian bypass was performed (Figures 2 a and b.). This latterpatient also had an aberrant right subclavian artery, which was the main determinant forconversion from conventional open arch repair to a hybrid approach. Two patients hadascending aortic aneurysm in addition to type B dissection with thoracic aorticdiameters 62 and 66 millimeters, respectively. Type II arch repair was performed inthese two patients with replacement of ascending aorta and the hemiarch withtri-branched 24-mm Dacron graft (Hemashield Platinum,Woven Double Velour; BostonScientific Corporation, Wayne, NJ, USA) prior to retrograde TEVAR on the following day.One of the latter patients also had aortic valve replacement during ascending aortareplacement (Figure 3).

Bottom Line: There were no early to midterm endoleaks.The median follow-up was 20 ± 8 months with patency rate of 100%.Various debranching solutions for different complex scenarios of the aortic arch serve as less invasive procedures than conventional open surgery enabling safe and effective treatment of this highly selected subgroup of patients with complex aortic pathologies.

View Article: PubMed Central - PubMed

Affiliation: Cardiovascular Surgery, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey.

ABSTRACT

Background: Conventional surgical repair of thoracic aortic dissections is a challenge due to mortality and morbidity risks.

Objectives: We analyzed our experience in hybrid aortic arch repair for complex dissections of the aortic arch.

Methods: Between 2009 and 2013, 18 patients (the mean age of 67 ± 8 years-old) underwent hybrid aortic arch repair. The procedural strategy was determined on the individual patient.

Results: Thirteen patients had type I repair using trifurcation and another patient with bifurcation graft. Two patients had type II repair with replacement of the ascending aorta. Two patients received extra-anatomic bypass grafting to left carotid artery allowing covering of zone 1. Stent graft deployment rate was 100%. No patients experienced stroke. One patient with total debranching of the aortic arch following an acute dissection of the proximal arch expired 3 months after TEVAR due to heart failure. There were no early to midterm endoleaks. The median follow-up was 20 ± 8 months with patency rate of 100%.

Conclusion: Various debranching solutions for different complex scenarios of the aortic arch serve as less invasive procedures than conventional open surgery enabling safe and effective treatment of this highly selected subgroup of patients with complex aortic pathologies.

Show MeSH
Related in: MedlinePlus