Descending endograft for DeBakey type 1 aortic dissection: pro

Berretta, Paolo; Eusanio, Marco Di

doi:10.21037/acs.2016.03.12

Cited by 4 publications

(4 citation statements)

References 45 publications

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“…“Empiric” stenting of the DTA for improved long-term remodeling of the DTA has been advocated for management of acute DeBakey Type-I aortic dissection. 15 16 17 Several single-institution retrospective studies, including ours, have shown technically tailored variations of this concept where stenting the DTA at the time of the arch procedure improves thoracic aortic remodeling. 17 18 19 20 21 Although these studies report excellent outcomes, hybrid arch procedures have not been directly compared with TAR in a prospective, randomized investigation.…”

Section: Discussionmentioning

confidence: 78%

National Outcomes of Elective Hybrid Arch Debranching with Endograft Exclusion versus Total Arch Replacement Procedures: Analysis of the Society of Thoracic Surgeons Adult Cardiac Surgery Database

et al. 2021

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Objective Hybrid arch procedures (arch vessel debranching with thoracic endovascular aneurysm repair [TEVAR] coverage of arch pathology) have been presented as an alternative to total arch replacement (TAR). But multicenter-based analyses of these two procedures are needed to benchmark the field and establish areas of improvement. Methods The Society of Thoracic Surgeons (STS) Adult Cardiac Surgery Database from July 2014 to December 2015 was queried for elective TAR and hybrid arch procedures. Demographics and operative characteristics were compared and stepwise variable selection was used to create a risk-set used for adjustment of all multivariable models. Results A total of 1,011 patients met inclusion criteria, 884 underwent TAR, and 127 had hybrid arch procedures. TAR patients were younger (mean age: 62.7 ± 13.3 vs. 66.7 ± 11.9 years; p = 0.001) and had less peripheral vascular disease (34.0 vs. 49.6%; p < 0.001) and preoperative dialysis (1.7 vs. 4.7%; p = 0.026), but similar history of stroke (p = 0.91)/cerebrovascular disease (p = 0.52). TAR patients had more concomitant procedures (60 vs. 34.6%; p < 0.0001). TAR patients had lower mortality (6.7 vs. 12.6%; p = 0.02), stroke (6.9 vs. 15%; p = 0.002), paralysis (1.8 vs. 7.1%; p = 0.002), renal failure (4.6 vs. 8.7%; p = 0.045), and STS morbidity (34.2 vs. 42.5%; p = 0.067). Composite mortality, stroke, and paralysis were significantly lower with TAR (11.5 vs. 25.2%; p = 0.0001). After risk adjustment, analysis showed hybrid arch procedures imparted an increased odds of mortality (odds ratio [OR] = 1.91, p = 0.046), stroke (OR = 2.3, p = 0.005), and composite endpoint of stroke or mortality (OR = 2.31, p = 0.0002). Conclusion TAR remains the gold standard for elective aortic arch pathologies. Despite risk adjustment, hybrid arch procedures were associated with increased risk of mortality and stroke, advocating for careful adoption of these strategies.

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Section: Discussionmentioning

confidence: 78%

National Outcomes of Elective Hybrid Arch Debranching with Endograft Exclusion versus Total Arch Replacement Procedures: Analysis of the Society of Thoracic Surgeons Adult Cardiac Surgery Database

et al. 2021

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“…Alongside the possibility of treating in a single step extensive aortic pathologies and lesions of the distal aortic arch and proximal descending aorta, FET repair is a valuable strategy in patients with acute aortic dissection especially in presence of complex primary tears, reentry and aortic rupture at the distal arch or proximal descending (5) or in case of visceral malperfusion sustained by compression of the true lumen (6,7). At mid-term, this approach can also sustain a positive distal aortic remodelling (8) characterised by a higher rate of false lumen thrombosis (8,9) and a reduction in descending thoracic aorta dilatation (5,8,9).…”

Section: Review Articlementioning

confidence: 99%

Normothermic frozen elephant trunk: our experience and literature review

Malvindi¹,

Alfonsi²,

Berretta³

et al. 2022

Cardiovasc Diagn Ther

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Background and Objective: The frozen elephant trunk (FET) technique has undoubtable advantages in treating complex and extensive disease of the aortic arch and the thoracic descending aorta. Despite several improvements in cardiopulmonary bypass conduction and surgical strategy, operative times and the institution of systemic circulatory arrest remain the main determinants of early mortality, cerebral/spinal cord injury and visceral organs dysfunction. We have conducted this review to highlight the recent technical advances in arch and FET surgery aiming at the reduction/avoidance of systemic circulatory arrest, and their impact on early outcomes.Methods: A literature search (from origin to January 2022), limited to publications in English, was performed on online platforms and database (PubMed, Google, ResearchGate). After a further review of associated or similar papers, we found 4 experiences, described by 11 peer-reviewed published papers, which focused on minimising or avoiding systemic circulatory arrest during total arch replacement plus stenting of the descending thoracic aorta.

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“…Acute DeBakey type I aortic dissections frequently present symptomatically at the time of dissection onset and have been associated with risks of aortic rupture, acute severe aortic regurgitation, and/or cardiac tamponade 1,2 . Classically, the treatment for an acute DeBakey type I aortic dissection is with an open surgical repair with an ascending aortic replacement, hemiarch replacement, zone 1 arch, zone 2 arch, and/or total arch replacement.…”

Section: Introductionmentioning

confidence: 99%