Comparison of the Outcomes of Total Endovascular Aortic Arch Repair Between Branched Endograft and Chimney Endograft Technique in Zone 0 Landing

Kudo, Teruo; Kuratani, Toru; Shirakawa, Yukitoshi; Shimamura, Kazuo; Kin, Keiwa; Sakamoto, Tomohiko; Shijo, Takayuki; Watanabe, Yoshiki; Masada, Kazuhiro; Sakaniwa, Ryoto; Sawa, Yoshiki

doi:10.1177/15266028211059912

Cited by 12 publications

(23 citation statements)

References 29 publications

(53 reference statements)

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“…Less common pathologies included PAU (52 cases), IMHs (7 cases), and pseudoaneurysms (25 cases). Sixteen cases that needed re-intervention Tazaki et al 18 Shang et al 19 Kudo et al 36 Li et al 37 Zhang et al 38 after previous TEVAR had presented loss of proximal sealing and endoleak type Ia. 14,17,27,31,35 To provide a more precise presentation of the outcomes, the total cohort will be separated into 2 axes: CMD techniques and non-CMD techniques.…”

Section: Resultsmentioning

confidence: 99%

Systematic Review on Customized and Non-customized Device Techniques for the Endovascular Repair of the Aortic Arch

et al. 2022

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Purpose: Open repair remains the standard of care for aortic arch pathologies. However, endovascular management became an attractive alternative for high-risk patients. This study aimed to assess the outcomes of the available endovascular techniques for aortic arch pathology management. Materials and Methods: A search of the English literature (2000–2022) using PubMed, EMBASE, via Ovid, and CENTRAL databases (February 1, 2022) was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Studies reporting on patients with aortic arch pathologies managed with custom-made devices ([CMDs] fenestrated or branched thoracic endovascular aortic repair [F/BTEVAR]) and non-CMDs (parallel graft or surgeon-modified FTEVAR) were eligible. Studies reporting on hybrid or open repair were excluded. Studies’ quality was assessed using the Newcastle-Ottawa Scale. Primary outcomes were technical success, 30 day mortality, and cerebrovascular events (CVEs). Secondary outcomes were re-intervention and mortality during follow-up. Results: Thirty studies (2135 patients) were included. Treatment indications were mainly dissections (652 cases [48.0%, 652/1358]; 90 type A, 506 type B; 364 acute, 163 chronic) and aneurysms (46.9%, 582/1239). Five studies (211 patients) reported on FTEVAR and 10 (388 patients) on BTEVAR. For FTEVAR, technical success rate was 98.3%. Thirty-day mortality was 3.8% and CVE rate was 12.3%. Ten deaths (9.7%) and 19 re-interventions (9%) were recorded during follow-up (24 months). Regarding BTEVAR, technical success rate was 98.7%, and 30 day mortality and CVE rates were 5.4% and 11.0%, respectively. During follow-up (27 months), 64 deaths (18.7%) and 33 re-interventions (9.6%) were recorded. Parallel graft technique was reported in 11 studies (901 patients). Technical success rate was 76.4%. Thirty-day mortality was 3.9% and 32 (4.3%) CVEs were recorded. Thirty-five deaths (4.4%) and 43 re-interventions (5.5%) were reported during follow-up (27 months). Surgeon-modified FTEVAR was described in 5 studies (635 patients). Technical success rate was 91.6%. At 30 days, 15 deaths (2.3%) and 22 CVEs (3.5%) were recorded. During follow-up (19 months), 26 deaths (4.2%) and 21 re-interventions (3.6%) were detected. Conclusions: Endovascular arch repair presented a variable technical success; >95% for F/BTEVAR; ≤90% for non-CMDs. Acceptable 30 day mortality rates were reported. Cerebrovascular event rates ranged up to 10%. These findings, adjacent to the estimated midterm mortality and re-interventions, set the need for further improvement. Clinical Impact Endovascular arch repair gains popularity as a valuable alternative, especially in patients considered unfit for open repair. According the available literature, any endovascular technique, including custom-made or off-the-shelf solutions, may be applied successfully, with acceptable early mortality. However, the perio-operative cerebrovascular event rate is still an issue, indicating the need for further advancements.

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Section: Resultsmentioning

confidence: 99%

Systematic Review on Customized and Non-customized Device Techniques for the Endovascular Repair of the Aortic Arch

et al. 2022

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“…The technique presented here for the endovascular treatment of AAo diseases, based on TEVAR and TAVI procedures, is specially indicated to treat type A acute aortic syndrome (TAAS) in patients considered unsuitable for open surgery due to high or prohibitive risk because of advanced age, weak condition, important comorbidities, patient refusal, or multiple cardiothoracic interventions. 3,5 Similar to the endovascular repair of the complex aortic arch, 12 the first step of the proposed technique is the precise study of the case mainly based on the findings obtained by angio-CT. Considering the Ishimaru classification modified by Roselli et al, 10 zone 0 of the aorta is subdivided into 3 sectors: zone 0A (from aortic valve to CO), zone 0B (from CO to the level of AAo that is crossed by the right pulmonary artery), and zone 0C (from that level to the ostium of the BCA).…”

Section: Discussionmentioning

confidence: 99%

“…Similar to the endovascular repair of the complex aortic arch, 12 the first step of the proposed technique is the precise study of the case mainly based on the findings obtained by angio-CT. Considering the Ishimaru classification modified by Roselli et al, 10 zone 0 of the aorta is subdivided into 3 sectors: zone 0A (from aortic valve to CO), zone 0B (from CO to the level of AAo that is crossed by the right pulmonary artery), and zone 0C (from that level to the ostium of the BCA).…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2023

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Purpose: Ascending aorta (AAo) acute pathology still has an open-surgery indication with a high mortality rate associated to cardiopulmonary bypass and circulatory arrest. In these cases, the endovascular aortic approach could be an excellent option. The aim of the present study is to detail an optimized technique for the endovascular treatment of AAo diseases, based on thoracic endovascular aortic repair (TEVAR) and transcatheter aortic valve implantation (TAVI) procedures. Technique: The procedure implies the usual preparation for TEVAR and TAVI implants. A transient pacemaker lead is necessary to deliver the prosthesis under “rapid pacing.” As in the TAVI technique, a final high-support guidewire is placed at the left ventricle. The proximal landing zone is the sinotubular junction (zone 0B). Transesophageal echocardiography is essential to ensure aortic valve function and patency in coronary arteries during the delivery. To assess a potential occlusion of the brachiocephalic artery, a guidewire is positioned in the descending aorta from the axillary artery. Finally, a noncovered stent is implanted to stabilize the AAo prosthesis. Conclusion: The technique presented here can standardize a safe and reproducible procedure to endovascular repair of AAo diseases. However, new devices specifically designed for the AAo could facilitate the transcatheter approach. Clinical Impact Ascending aorta acute pathology still has an open-surgery indication with high mortality rate associated to cardiopulmonary bypass and circulatory arrest. Moreover, near 30% of patients are not considered suitable for surgery because of age, critical situation or the presence of severe comorbidities. The present study provides a detailed and optimized technique for the endovascular treatment of ascending aorta disease, based on TEVAR and TAVI procedures.

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“…Further, a greater stroke rate was associated with treated aortic arch lesions in zones 0 and 1 (13.3% vs 2.9% for the others, P = 0.006). Especially, TEVAR with proximal landing zone 0 has a high risk of stroke [ 19 ], and our study did not include TEVAR with total debranching bypass to avoid this bias issue. Additionally, this study cohort in both groups was limited to the patients who were treated due to degradative TAA, excluding aortic pathologies of aortic dissection, aortic rupture, pseudoaneurysm, trauma, infection, thoraco-abdominal aortic aneurysm and re-TEVAR, to verify comparison in patients with and without LPSG.…”

Section: Discussionmentioning

confidence: 99%

Lower-profile stent graft reduces the risk of embolism during thoracic endovascular aortic repair in shaggy aorta

Seike

Masada

Fukuda

et al. 2023

Interdisciplinary CardioVascular and Thoracic Surgery

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OBJECTIVES This study aimed to reveal the association between lower-profile stent graft and embolism during thoracic endovascular aortic repair for non-dissecting distal arch and descending thoracic aortic aneurysm. METHODS This study reviewed data of 35 patients who underwent thoracic endovascular aortic repair with lower-profile stent graft (27 males; age: 77 ± 9.2 years) and 312 who underwent thoracic endovascular aortic repair with conventional-sized stent graft (247 males; age: 77 ± 7.4 years) from 2009 to 2021. RESULTS The rate of total embolic events was significantly lower in lower-profile stent graft group (0/35 [0%]) than the conventional-sized stent graft group (34/312 [11.2%]) (p = 0.035). Shaggy aorta (odds ratio: 5.220; p < 0.001) were identified as positive embolic event predictors. The rate of total embolic events in 68 patients with shaggy aorta (12 in lower-profile stent graft/56 in conventional-sized stent graft) was significantly lower in the lower-profile stent graft group (0/12 [0%]) than the conventional-sized stent graft group (19/56 [34%]) (p = 0.015). The rate of total embolic events in 279 patients with the non-shaggy aorta (23 in lower-profile stent graft/256 in conventional-sized stent graft) reveals no difference between the two groups (0 [0%]/16 [6.3%]) (p = 0.377). CONCLUSIONS Lower-profile stent graft usage could reduce embolism in thoracic endovascular aortic repair, and the difference was more pronounced in patients with the shaggy aorta. Lower-profile stent graft might be beneficial in preventing embolism in thoracic endovascular aortic repair for patients with a shaggy aorta.

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Comparison of the Outcomes of Total Endovascular Aortic Arch Repair Between Branched Endograft and Chimney Endograft Technique in Zone 0 Landing

Cited by 12 publications

References 29 publications

Systematic Review on Customized and Non-customized Device Techniques for the Endovascular Repair of the Aortic Arch

Systematic Review on Customized and Non-customized Device Techniques for the Endovascular Repair of the Aortic Arch

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

Lower-profile stent graft reduces the risk of embolism during thoracic endovascular aortic repair in shaggy aorta

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