Current options and recommendations for the treatment of thoracic aortic pathologies involving the aortic arch: an expert consensus document of the European Association for Cardio-Thoracic surgery (EACTS) and the European Society for Vascular Surgery (ESVS)

Czerny, Martin; Schmidli, Jürg; Adler, Sabine; Berg, Jos C. van den; Bertoglio, Luca; Carrel, Thierry; Chiesa, Roberto; Clough, Rachel E.; Eberle, Balthasar; Etz, Christian D.; Grabenwöger, Martin; Haulon, Stéphan; Jakob, Heinz; Kari, Fabian A.; Mestres, Carlos A.; Pacini, Davide; Resch, Timothy; Rylski, Bartosz; Schoenhoff, Florian; Shrestha, Malakh; Tengg-Kobligk, Hendrik von; Tsagakis, Konstantinos; Wyss, Thomas R.; Eacts,

doi:10.1093/ejcts/ezy313

Cited by 385 publications

(282 citation statements)

References 229 publications

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“…Use of a frozen elephant trunk may be of particular interest in retrograde ATAAD, with a primary entry downstream of the arch, or when the true lumen is severely compressed with risk of-or manifest-malperfusion to subsequent endarteries (mesenteric, renal, iliac, etc.). Use of hybrid frozen elephant trunk techniques are recently discussed in detail [77,78], noting an increased prevalence of spinal cord ischemic injury, but also with documented excellent outcomes in dedicated units [79].…”

Section: Technical Aspects Of Surgical Repairmentioning

confidence: 99%

Acute type A aortic dissection – a review

Guðbjartsson

Ahlsson

Geirsson

et al. 2019

Scandinavian Cardiovascular Journal

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Acute type A aortic dissection (ATAAD) is still one of the most challenging diseases that cardiac surgeons encounter. This review is based on the current literature and includes the results from the Nordic Consortium for Acute Type-A Aortic Dissection (NORCAAD) database. It covers different aspects of ATAAD and concentrates on the outcome of surgical repair. The diagnosis is occasionally delayed, and ATAAD is usually lethal if prompt repair is not performed. The dynamic nature of the disease, the variation in presentation and clinical course, and the urgency of treatment require significant attentiveness. Many surgical techniques and perfusion strategies of varying complexity have been described, ranging from simple interposition graft to total arch replacement with frozen elephant trunk and valve-sparing root reconstruction. Although more complex techniques may provide long-term benefit in selected patients, they require significant surgical expertise and experience. Short-term survival is first priority so an expedited operation that fits in with the surgeon's level of expertise is in most cases appropriate. ARTICLE HISTORY Definitions and classification systemsDissection of the aorta occurs when the aortic media is separated, usually by pulsatile flow that penetrates the intimal layer of the aortic wall [14] (Figure 1(b)). This allows blood to flow between the layers of the aortic wall, forcing the layers apart, creating a false lumen parallel to the native (i.e. true) aortic lumen (Figure 1(b)). Consequently, the false lumen can propagate in both directions from the tear of intima and affect most of its distal branches, including the coronary, cerebral, and mesenteric arteries [15]. Another-but less common-CONTACT Tomas Gudbjartsson

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Section: Technical Aspects Of Surgical Repairmentioning

confidence: 99%

Acute type A aortic dissection – a review

Guðbjartsson

Ahlsson

Geirsson

et al. 2019

Scandinavian Cardiovascular Journal

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“…3e5 Fenestrated/branched and parallel stent grafts are strategies used increasingly for LSA revascularisation. 4 Currently fenestrated/branched stent grafts are available as custom made devices only, while off the shelf fenestrated/branched stent graft solutions are being developed. Parallel grafts are available off the shelf and can be used for emergency or urgent repair.…”

Section: Introductionmentioning

confidence: 99%

Haemodynamics of Different Configurations of a Left Subclavian Artery Stent Graft for Thoracic Endovascular Aortic Repair

Tricarico

Tran‐Son‐Tay

Laquian

et al. 2020

European Journal of Vascular and Endovascular Surgery

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WHAT THIS PAPER ADDS Technologies allowing endografting in the aortic arch are in active clinical trials with various configurations of branch stent graft design. A systematic computational fluid dynamic analysis was carried out to quantitatively evaluate the haemodynamic characteristics of stenting within the left subclavian artery (LSA). The results showed that a shorter extension of the LSA branch stent graft into the aortic lumen up to 5 mm has a smaller risk of potential thrombus generation; a longer extension could lead to thrombus formation impacting outcomes. These findings may help optimise the deployment and design of the stent graft system for treating aortic pathologies involving arch branches. Objective: Branched stent grafts represent a viable option for left subclavian artery (LSA) revascularisation in patients treated by thoracic endovascular aortic repair (TEVAR) for Zone 2 lesions. This study investigated the haemodynamic performance of different LSA branched stent graft configurations as potential determinants of thrombotic and stroke risks. Methods: A three dimensional aortic arch geometry extracted from post-operative computed tomography images of a TEVAR patient using a single LSA branched aortic endograft was modified in silico to obtain ten potential LSA branched stent graft configurations: five down facing (0e5 e 10 mm aortic protrusion with 10e12 mm internal diameter), four curved (30e60 with antegrade/retrograde orientation), and one LSA orifice misalignment. The 0 mm down facing stent graft was considered base configuration. Computational fluid dynamic analyses were performed to identify differences in pressure, energy, and wall shear stress (WSS) based parameters. Results: Total pressure drop and energy loss variations among configurations were not greater than 5 mmHg (6% of mean arterial pressure) and 5.7 mW (0.7% of cardiac power), respectively. Protrusions up to 5 mm created clinically insignificant flow disturbances. However, stent graft protrusions further into the aortic lumen created more complex haemodynamics, characterised by larger energy loss and more prominent flow recirculation. Protrusion greater than 5 mm into the lumen was associated with larger areas of elevated maximum WSS (>20 Pa) along the outer surface of the branched stent graft. Conclusion: Arterial haemodynamic characteristics are affected by LSA branched stent graft configurations, with pressure drops and energy losses likely to be clinically insignificant. The length of the stent graft protrusion into the aortic lumen generated the largest haemodynamic variations in the aortic system. Protrusions up to 5 mm have smaller risk of potential thrombus generation. Conversely, larger protrusions into the aortic lumen showed more disturbed haemodynamics, suggesting a greater risk of potential thrombus formation, which may be clinically important over time.

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“…Close to 90% of aortic aneurysms (AAs) are found in the abdominal aorta, where the typical clinical diameter threshold for an aneurysm is 30 mm, although individual anatomy may vary, and women can have smaller baseline diameters [2]. The aneurysmal size criteria in thoracic aorta differ somewhat from those in abdominal aorta, and are dependent on the site of the lesion [3,4]. The prevalence of abdominal AA (AAA) is lower than 4% for people (≥65 years old) in Europe [5].…”

Section: Aortic Aneurysm Diseasementioning

confidence: 99%

Long noncoding RNAs in key cellular processes involved in aortic aneurysms

Trenner

Boon

et al. 2020

Atherosclerosis

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This current review covers studies that have identified long non-coding RNAs in aortic aneurysm development and progression. • We separately discuss transcripts and mechanisms of importance to thoracic as well as abdominal aortic aneurysms. • Functional data on lncRNAs being identified are highlighted. • Some have been studied in human as well as experimental models of the disease pathology.

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Current options and recommendations for the treatment of thoracic aortic pathologies involving the aortic arch: an expert consensus document of the European Association for Cardio-Thoracic surgery (EACTS) and the European Society for Vascular Surgery (ESVS)

Abstract: Current options and recommendations for the treatment of thoracic aortic pathologies involving the aortic arch: an expert consensus document of the European Association for Cardio-Thoracic surgery (EACTS) and the European Society for Vascular Surgery (ESVS).

Cited by 385 publications

References 229 publications

Acute type A aortic dissection – a review

Acute type A aortic dissection – a review

Haemodynamics of Different Configurations of a Left Subclavian Artery Stent Graft for Thoracic Endovascular Aortic Repair

Long noncoding RNAs in key cellular processes involved in aortic aneurysms

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