Anatomical Feasibility Study on Novel Ascending Aortic Endograft With More Proximal Landing Zone for Treatment of Type A Aortic Dissection

Abstract

ObjectiveType A aortic dissection (TAAD) is associated with high morbidity and mortality, and open surgery is the best treatment option. Development of endovascular repair devices for TAAD will benefit patients deemed unfit for open surgery. In this study, we performed a thorough investigation of anatomical features in Asian patients with TAAD to learn about the patient eligibility of a novel ascending aortic endograft technique.MethodsComputed tomography angiography (CTA) images of TAAD cases in our institution from January 2015 to November 2021 were reviewed, and three-dimensional reconstructions were performed with the Endosize software (Therenva, Rennes, France). Anatomic structures including length measured along centerline and greater/lesser curvature, ascending aorta/aortic root dimensions, as well as location of entry tear and extent of dissection were analyzed.ResultsA total of 158 patients were included [median age 58 years, interquartile range (IQR), 30–76 years; 115 males, 72.8%]. In 99 (62.7%) of the cases, entry tear was distal to the sinotubular junction (STJ). In 106 (67.1%) of the cases, the pathology proximally extended into the aortic root, which was intramural hematoma in 37 (23.4%) of the cases, and the aortic root was free from the pathology in 52 (32.9%) of the cases. The median distance from the STJ to the proximal edge of the ostium of the innominate artery (IA) measured along the centerline was 65 mm (IQR 58–74 mm). The median distance from the distal edge of the higher coronary ostium to the STJ was 7.95 mm (IQR 5.625–10.9 mm). The bare metal stent part was set between the edge of the higher coronary ostium and the STJ. In our series, 63 (39.9%) of the cases had this distance >10 mm. The relative difference was <20% between the STJ and the proximal edge of the ostium of the IA in 92 (58.2%) of the cases. Ascending aorta radius of curvature was 52.2 mm (IQR 43.7–63.7 mm).ConclusionsOur study demonstrates that 56.3% of the TAAD cases would be amenable to endovascular repair by the novel ascending aortic endograft, with sufficient landing zone free of the dissected aorta.

Endovascular Technique for Ascending Aorta Repair Based on TEVAR and TAVI Procedures

“…The median length of the normal AAo, measured from the annulus to the proximal edge of the ostium of the BCA, is 81.20 mm (interquartile range [IQR] 76.90-86.20 mm) and 109.4 mm (IQR 118.3-105.3 mm) in patients with TAAD. 22 The length from the STJ to the proximal edge of the ostium of the BCA has been measured in different TAAD cohorts, with a median of 65 mm (IQR 58-74 mm) 23 and 78 mm (IQR 52-113 mm) 24 and a mean of 78.5 mm ± 18.2 mm 25 in the centreline and a median of 84 mm (IQR 76.3-98.8 mm) 23 and a mean of 95.5 mm ± 20.9 mm 25 along the greater curvature. The length of the prosthesis has to be sufficient to cover the dissection entry tear in the AAo, expand the true lumen, minimize the risk of occlusion of the CA or the BCA, and allow normal functioning of the aortic valve.…”