Antegrade transcardiac access to the aortic arch for implantation of mating stent-grafts in branched arch endografting is feasible in a porcine model with reversible impact on hemodynamic measures during deployment. Transapical access was technically easier, with shorter operating and fluoroscopy times.
TSA, TFA, and TAA to the ascending aorta are feasible for endograft delivery to the ascending aorta in a porcine model. Transient hemodynamic instability in TSA and TAA recovered to near preoperative values. TAA appeared technically easier.
A 53-year-old woman with Loeys-Dietz syndrome developed progressive subclavian artery aneurysm and common carotid artery dissection. She was treated successfully by plugging and coiling of the subclavian aneurysm and its side branches after combined cervical debranching using standard carotid-axillary bypass and Gore Hybrid Vascular Graft for vertebral revascularization. Follow-up control (4 weeks) documented patent debranching, and only minimal residual flow in the subclavian aneurysm. The described off-label use for sutureless cerebral revascularisation of the vertebral artery might be a fast, simple, and reliable solution for cervical debranching in selective challenging patients. Further studies are necessary to evaluate side effects and durability.
Background: There is growing evidence that paravalvular regurgitation after transcatheter aortic valve implantation impairs long-term survival. We aimed to identify CTderived parameters associated with postprocedural regurgitation. Methods: One hundred and forty-three preprocedural computed tomography data sets of patients who had undergone CoreValve (Medtronic, Inc.) implantation with the 26mm (nϭ58) and the 29mm (nϭ85) prosthesis between 06/2007 and 09/2010 were analysed retrospectively. The ellipticity of the aortic annulus was defined as the ratio of the maximum and minimum diameter. Annulus size was measured by perimeter and area. The degree of calcifications in the three sinuses was assessed. Prosthesis-annulus oversizing was calculated by the perimeter of the prosthesis in relation to annulus perimeter. The degree of aortic regurgitation and depth of prosthesis implantation was assessed from the intraprocedural angiography. Results: Thirty-eight patients (26.6%) had an angiographic AIϾ°I. The t-test revealed a significantly larger perimeter (82.1Ϯ8.6mm vs 78.8Ϯ6.9mm, pϭ0.037) and annulus area (5.2Ϯ1.1cm 2 vs 4.7Ϯ0.8cm 2 , pϭ0.031), a significantly higher degree of calcification of the right, left and non-coronary cusp (total calcium 1222Ϯ794 vs 699Ϯ493, pϽ0.001), and significantly less oversizing (6.1Ϯ7.4% vs 11.5Ϯ7.6%, pϭ0.001) in patients with an AIϾ°I, while the ellipticity of the annulus and implantation depth were not associated with AI. Regression analysis revealed calcification of the left coronary cusp (pϭ0.020) and less oversizing (pϭ0.014) as significant independent predictors for an AIϾ°I. Kaplan Meier survival analysis showed an insignificant trend towards a better 1-year survival in patients with an AIՅ°I (83.0% vs 77.5%, pϭ0.118). Conclusions: Aortic regurgitation after transcatheter valve implantation can be predicted by CT measurements. Our data support the evidence of impaired survival in patients with an AI larger than grade I. As a large annulus anatomy and amount of calcification are unmodifiable variables more valve sizes might be needed to better fit all anatomies. According to our data, an oversizing of at least 10% should be attempted for CoreValve implantation.Background: Diabetes mellitus (DM) is involved in aortic stenosis development, with a negative impact on immediate and long term outcome after surgical aortic replacement. Accordingly, while DM is not part of the Euroscore, it has been integrated to the STS score. The impact of DM on post transcatheter aortic valve replacement (TAVR) outcome is unknown. Methods: 3195 consecutive patients were enrolled between January 2010 and October 2011 in 33 centers. Before discharge, a perivalvular AR grade Ն 2 by transthoracic echocardiography was considered significant. Mean follow-up was 302Ϯ164 days. Results: 25.8% of the population had DM. Compared to non-DM patients, DM patients were younger (81.0Ϯ6.7 vs 83.3Ϯ7.3 years, pϽ0.0001), more likely men (55.3% vs 49.5%, pϭ0.005), with a higher BMI (27.9Ϯ5.1 vs 25.4Ϯ4.7 kg/m2, pϽ0.0001), a ...
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