Catheter-based treatment of the dissected ascending aorta: a systematic review

Wang, Changtian; Segesser, Ludwig Karl von; Ferrari, Enrico

doi:10.1093/ejcts/ezaa238

Cited by 4 publications

(2 citation statements)

References 41 publications

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“…22 Since then, most reports have been single cases or small series. 23–27 Lu and colleagues 28 first described their experience of ascending stent graft repairs in 15/41(37%) patients who presented with ascending dissection and were deemed too high risk for surgery over a two-year period; 5 were described as acute and 10 as chronic. They described their mid-term follow-up experience (mean 72 months) in the same 15 patients 16 years later, but reclassified the patients as one acute, seven subacute, and seven chronic 29 because the definitions of dissection timing had evolved.…”

Section: Discussionmentioning

confidence: 99%

ARISE: First-In-Human Evaluation of a Novel Stent Graft to Treat Ascending Aortic Dissection

et al. 2022

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Background: Operative mortality for type A aortic dissection is still 10–20% at centers of excellence. Additionally, 10–20% are not considered as viable candidates for open surgical repair and not offered life-saving emergency surgery. ARISE is a multicenter investigation evaluating the novel GORE® Ascending Stent Graft (ASG; Flagstaff, AZ). Objective: The purpose of this study is to assess early feasibility of using these investigational devices to treat ascending aortic dissection. Methods: This a prospective, multicenter, non-randomized, single-arm study that enrolls patients at high surgical risk with appropriate anatomical requirements based on computed tomography imaging at 7 of 9 US sites. Devices are delivered transfemorally under fluoroscopic guidance. Primary endpoint is all-cause mortality at 30 days. Secondary endpoints include major adverse cardiovascular and cerebrovascular events (MACCE) at 30 days, 6 months, and 12 months. Results: Nineteen patients were enrolled with a mean age of 75.7 years (range 47–91) and 11 (57.9%) were female. Ten (52.6%) had DeBakey type I disease, and the rest were type II. Sixteen (84.2%) of the patients were acute. Patients were treated with safe access, (7/19 (36.8%) percutaneous, 10/19 (52.6%) transfemoral, 2/19 (10.5%) iliac conduit), delivery, and deployment completed in all cases. Median procedure time was 154 mins (range 52–392) and median contrast used was 111 mL (range 75–200). MACCE at 30 days occurred in 5 patients including mortality 3/19 (15.8%), disabling stroke in 1/19 (5.3%), and myocardial infarction in 1/19 (5.3%). Conclusion: Results from the ARISE early feasibility study of a specific ascending stent graft device to treat ascending aortic dissection are promising.

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Section: Discussionmentioning

confidence: 99%

ARISE: First-In-Human Evaluation of a Novel Stent Graft to Treat Ascending Aortic Dissection

et al. 2022

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“…That is, if the aortic wall is fragile and injured, the frozen elephant trunk stent is inserted into the descending aorta to strengthen it. [7][8][9] In the management of existing endografts, the appearance of a new tear in the fragile aortic wall during endograft removal must be considered, so in most cases, these endografts are left in place, and the frozen elephant trunk technique is omitted; however, the bare spring of the proximal endograft would be removed to create an appropriate distal plane. [6,7,10] However, the surgical management of RTAD after TEVAR for TAAD has seldom been reported.…”

Section: Discussionmentioning

confidence: 99%

Bentall procedure for retrograde type A dissection after endovascular repair in type A aortic dissection: A case report

Liu

Yan

et al. 2022

Medicine

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Rationale: The management of retrograde type A dissection (RTAD) after thoracic endovascular aortic repair (TEVAR) for type A aortic dissection (TAAD) has rarely been reported. We report the management of RTAD after TEVAR with in situ fenestration for TAAD.Patient concerns: A 59-year-old man with TAAD had undergone TEVAR with in situ fenestration 4 months prior to presenting to our emergency room complaining of acute chest and back pain. Computed tomography angiography showed RTAD starting from the proximal endograft and extending to the aortic root. Diagnosis:The patient was diagnosed with RTAD.Interventions: We performed only the Bentall procedure, and the patient did not require total arch replacement. We removed the bare spring of the proximal endograft and anastomosed the prosthetic graft with the endograft and the native ascending aortic wall.Outcomes: The postoperative course was uneventful, and the patient remained asymptomatic for 3 years after surgery. Computed tomography angiography at the 3-year follow-up showed no perivalvular or anastomotic leakage.Lessons: RTAD after TEVAR for TAAD was safely and effectively treated by anastomosing the prosthetic graft with the endograft and the native ascending aortic wall instead of total arch replacement.

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Endovascular treatment of the dissected proximal aortic arch: a systematic review

Wang

Segesser

Berdajs

et al. 2021

Interactive CardioVascular and Thoracic Surgery

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OBJECTIVES Surgical repair of aortic dissection involving the proximal aortic arch is associated with higher morbidity and mortality, in particular when elderly high-risk patients are concerned. Endovascular treatments for this disease are under evaluation and some reports exist. We investigated the current use of catheter-based treatments for the dissected proximal aortic arch repair. METHODS We searched in PubMed and MEDLINE databases up to the end of June 2020 for studies on endovascular treatment of the dissected proximal aortic arch. Data on demographic, procedure and stent graft (SG) details, access route, mortality with cause of death, complications and follow-up were extracted. A systematic review on the employed technology, procedure and outcome was performed. RESULTS A total number of 15 articles (13 retrospective reports and 2 case reports) were deemed eligible and were included in the study. In total, 140 patients (mean age: 56.7 years in 106 cases) received endovascular treatments for the dissected proximal aortic arch (unspecific aortic dissection: 14; acute and subacute type A aortic dissection: 88; chronic type A aortic dissection: 23; type B aortic dissection with retrograde type A dissection: 15). The procedure strategy included unspecific thoracic endovascular aorta repair (TEVAR) (n = 8), TEVAR + supra-aortic debranching (n = 2), TEVAR + cervical bypass (n = 8), TEVAR + periscope SG (n = 12), TEVAR + chimney graft (n = 8), TEVAR + branched SG (n = 21) and TEVAR + fenestration (n = 81). Procedural success rate was 95.6% for 116 reported cases. Complications included endoleaks (postoperative: 2; late: 5), stroke (n = 4), late SG-induced new entry (n = 3) and new false lumen formation (n = 1). Hospital mortality was 5% (6 cases) in 13 reports (120 patients). The mean follow-up time was 26.2 ± 29.4 months and 2 patients died during follow-up. CONCLUSIONS As an alternative to surgery for high-risk patients with a dissected proximal aortic arch, the endovascular treatment seems to be promising in highly selected cases. Further studies with long-term results and specifically designed devices are required to standardize this approach.

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Catheter-based treatment of the dissected ascending aorta: a systematic review

Cited by 4 publications

References 41 publications

ARISE: First-In-Human Evaluation of a Novel Stent Graft to Treat Ascending Aortic Dissection

ARISE: First-In-Human Evaluation of a Novel Stent Graft to Treat Ascending Aortic Dissection

Bentall procedure for retrograde type A dissection after endovascular repair in type A aortic dissection: A case report

Endovascular treatment of the dissected proximal aortic arch: a systematic review

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