Endovascular ascending aortic repair in type A dissection: A systematic review

Abstract

Purpose: Up to 10% of acute type A aortic dissection (TAAD) patients are deemed unfit for open surgical repair, exposing these patients to high mortality rates. In recent years, thoracic endovascular aortic repair has proven to be a promising alternative treatment modality in specific cases. This study presents a comprehensive overview of the current state of catheter-based interventions in the setting of primary TAAD. Methods: A literature search was conducted, using MEDLINE and PubMed databases according to PRISMA guidelines, updated until January 2020. Articles were selected if they reported on the endovascular repair of DeBakey Type I and II aortic dissections. The exclusion criteria were retrograde type A dissection, hybrid procedures, and combined outcome reporting of mixed aortic pathologies (e.g., pseudoaneurysm and intramural hematoma). Results: A total of 31 articles, out of which 19 were case reports and 12 case series, describing a total of 92 patients, were included. The median follow-up was 6 months for case reports and the average follow-up was 14 months for case series. Overall technical success was 95.6% and 30-day mortality of 9%. Stroke and early endoleak rates were 6% and 18%, respectively. Reintervention was required in 14 patients (15%). Conclusion: This review not only demonstrates that endovascular repair in the setting of isolated TAAD is feasible with acceptable outcomes at short-term follow-up, but also underlines a lack of mid-late outcomes and reporting consistency. Studies with longer follow-up and careful consideration of patient selection are required before endovascular interventions can be widely introduced.

Coronary Artery Involvement in Type A Aortic Dissection: Fate of the Coronaries

“…Further appraisal of our current coronary repair techniques is vital. In a systematic review of 31 studies, only 1 reported the concomitant use of percutaneous coronary intervention (PCI) in addition to TAAD repair [21]. Despite this, PCI can yield significant benefit to patients who are deemed unsuitable for surgical repair, such as those with advanced age, significant comorbidities, and those with neurological deficits.…”

Protocol for Guo’s aortIc Arch recoNstrucTion: a prospective, multicentre and single-arm study to evaluate the safety and efficacy of the WeFlow-Arch modular inner branch stent-graft system for aortic arch lesions (GIANT study)

“…[6][7][8] The current clinical evidence indicates that procedural complications, namely, cerebral ischaemia, endoleak and retrograde dissection, are associated with endograft design and a complicated procedure. [9][10][11][12] To address the stated challenges, several innovative dedicated stent-grafts for total endovascular aortic arch repair have been developed, namely, the Inoue outer branched stent-graft, 9 13 Najuta fenestrated stentgraft, 14 15 Cook two-inner branch endograft, 16 17 Bolton inner double-branch endoprosthesis 18 19 and Endospan NEXUS stent-graft. 20 21 However, there is no ideal endovascular solution to the ascending aorta/aortic arch challenge that can completely exclude the aortic arch pathology, avoid embolic stroke and preserve perfusion of the supra-aortic multi-branches without surgical debranching of the supra-aortic branches or a complex endovascular procedure.…”

The ascending aorta and arch in the sights of transcatheter therapy: A time for reappraisal

“…However, the article from Ahmed et al 2 in this issue reveals the incipient but steady venturing of transcatheter therapies in this so far untouchable domain of cardiovascular surgery.…”

“…Stroke and early endoleak rates were 6% and 18%, respectively. Two patients (2%) required intraoperative conversion to open surgery, and reintervention was required in 14 patients (15%), of which four patients underwent endovascular repair and five patients underwent open repair 2 …”