with men. Gender-specific consideration might be required in patients undergoing lower extremity revascularization. A higher treatment threshold may be warranted in considering intervening on women with symptomatic peripheral arterial disease owing to the increased risks of postprocedural mortality and complications.
was deployed. Left ventricular function and aortic valve integrity were assessed in all animals through left ventricular angiography, at necropsy, and three were selected for dynamic intracardiac echocardiography during the entire procedure.Results: Transapical deployment of the branched endograft was successful in all animals (six of six). One pig developed ventricular fibrillation before side-branch cannulation and was euthanized. Antegrade brachiocephalic trunk cannulation was successful in the remaining five animals. Mean blood pressure decreased from 41.8 6 9.4 to 38.7 6 9.6 mm Hg (P < .001) with sheath crossing of the aortic valve and returned to baseline following sheath removal (40.4 6 16 mm Hg). Mean heart rate rose throughout the procedure from 67 6 13 to 95 6 36 (P < .001) and remained elevated at completion of the experiment. Intracardiac echocardiography demonstrated no abnormalities in cardiac function before or after implantation in the surviving five animals and mild to moderate aortic regurgitation with sheath crossing that returned to baseline after sheath removal. Ventricular closure was hemostatic in five of five pigs, and postoperative necropsy demonstrated no gross damage to the aortic valve, myocardium, or aorta in any of the six animals.Conclusions: Transapical branched endograft delivery with antegrade branch cannulation is feasible, is well tolerated, and does not significantly influence hemodynamic or cardiac parameters in an animal model.
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