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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

Perioperative angiogram of the patient with patent graft from right subclavianartery to left common carotid artery. Note that the false lumen in the thoracicaorta does not receive contrast-filling (a). Postoperative CAT scan of the patient(b).
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f04: Perioperative angiogram of the patient with patent graft from right subclavianartery to left common carotid artery. Note that the false lumen in the thoracicaorta does not receive contrast-filling (a). Postoperative CAT scan of the patient(b).

Mentions: The remaining two patients had complicated type B aortic dissection with the initialtear involving subclavian artery in both patients. Both patients also had severe chronicobstructive lung disease with low functional capacity. Sternotomy was thus avoided andalternative debranching techniques were adopted to allow Z1 coverage. A right subclavianto left carotid artery bypass was performed in one of these patients (Figure 4). A carotid-carotid and bypass was performedin the other. Left subclavian bypass was not performed in the latter two patients.Neither developed adverse neurological events or stroke.


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)

Perioperative angiogram of the patient with patent graft from right subclavianartery to left common carotid artery. Note that the false lumen in the thoracicaorta does not receive contrast-filling (a). Postoperative CAT scan of the patient(b).
© Copyright Policy - open-access
Related In: Results  -  Collection

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

f04: Perioperative angiogram of the patient with patent graft from right subclavianartery to left common carotid artery. Note that the false lumen in the thoracicaorta does not receive contrast-filling (a). Postoperative CAT scan of the patient(b).
Mentions: The remaining two patients had complicated type B aortic dissection with the initialtear involving subclavian artery in both patients. Both patients also had severe chronicobstructive lung disease with low functional capacity. Sternotomy was thus avoided andalternative debranching techniques were adopted to allow Z1 coverage. A right subclavianto left carotid artery bypass was performed in one of these patients (Figure 4). A carotid-carotid and bypass was performedin the other. Left subclavian bypass was not performed in the latter two patients.Neither developed adverse neurological events or stroke.

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