Endovascular stent grafting for ascending aorta diseases

Baikoussis, Nikolaos G; Antonopoulos, Constantine N.; Papakonstantinou, Nikolaos; Argiriou, Mihalis; Geroulakos, George

doi:10.1016/j.jvs.2017.07.064

Cited by 51 publications

(77 citation statements)

References 40 publications

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“…The need for an alternative treatment becomes even more relevant when considering that more than 20% of the patients with type A aortic dissection (TAAD) are deemed inoperable [4] . In this context, ascending TEVAR could have potential advantages, such as absence of thoracotomy incision and need for partial or total extracorporeal circulatory support, as well as lower hospital morbidity rates and shorter length of hospital stay when compared to open surgery [5,6] . This was already well established on our initial experience [7] (Figures 1 and 2).…”

Section: Introductionmentioning

confidence: 99%

Endovascular Treatment of the Ascending Aorta: is this the Last Frontier in Aortic Surgery?

Saadi¹,

Tagliari²,

Almeida³

2019

Braz J Cardiovasc Surg

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Regardless the successful treatment of the descending aorta with endovascular prosthesis, for the ascending aorta segment, because of several anatomic and physiologic issues, this technique has been considered an alternative only for high-risk or inoperable patients. Despite restricted indications, hundreds of treatments have been performed worldwide, demonstrating its safety and reproducibility if it is done in high-quality centers. Therefore, understanding patients’ selection criteria and technique limitations are critical to its application.

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Section: Introductionmentioning

confidence: 99%

Endovascular Treatment of the Ascending Aorta: is this the Last Frontier in Aortic Surgery?

Saadi¹,

Tagliari²,

Almeida³

2019

Braz J Cardiovasc Surg

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“…For example, ascending aortic endovascular stent grafts have been used in select high-risk patients with Stanford Type A aortic dissection and five such cases were done at the highest volume hospital during the 4-year study period. 13 14 15 All five patients survived to hospital discharge and there were no strokes observed. For these cases, percutaneous common femoral arterial access is obtained and a 10-cm endovascular stent graft is brought retrograde via the descending thoracic aorta into the proximal ascending aorta near the intimal tear.…”

Section: Discussionmentioning

confidence: 92%

Clinical Practice Variation and Outcomes for Stanford Type A Aortic Dissection Repair Surgery in Maryland: Report from a Statewide Quality Initiative

et al. 2020

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Background Stanford Type A aortic dissection repair surgery is associated with high mortality and clinical practice remains variable among hospitals. Few studies have examined statewide practice variation. Methods Patients who had Stanford Type A aortic dissection repair surgery in Maryland between July 1, 2014 and June 30, 2018 were identified using the Maryland Cardiac Surgery Quality Initiative (MCSQI) database. Patient demographics, comorbidities, surgery details, and outcomes were compared between hospitals. We also explored the impact of arterial cannulation site and brain protection technique on outcome. Results A total of 233 patients were included from eight hospitals during the study period. Seventy-six percent of surgeries were done in two high-volume hospitals (≥10 cases per year), while the remaining 24% were done in low-volume hospitals. Operative mortality was 12.0% and varied between 0 and 25.0% depending on the hospital. Variables that differed significantly between hospitals included patient age, the percentage of patients in shock, left ventricular ejection fraction, creatinine level, arterial cannulation site, brain protection technique, tobacco use, and intraoperative blood transfusion. The percentage of patients who underwent aortic valve repair or replacement procedures differed significantly between hospitals (p < 0.001), although the prevalence of moderate-to-severe aortic insufficiency was not significantly different (p = 0.14). There were no significant differences in clinical outcomes including mortality, renal failure, stroke, or gastrointestinal complications between hospitals or based on arterial cannulation site (all p > 0.05). Patients who had aortic cross-clamping or endovascualr repair had more embolic strokes when compared with patients who had hypothermic circulatory arrest (p = 0.03). Conclusion There remains considerable practice variation in Stanford Type A aortic dissection repair surgery within Maryland including some modifiable factors such as intraoperative blood transfusion, arterial cannulation site, and brain protection technique. Continued efforts are needed within MCSQI and nationally to evaluate and employ the best practices for patients having acute aortic dissection repair surgery.

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“…In a few cases, TEVAR has been performed for TAAD and other pathology affecting the ascending aorta. [15][16][17] However, these studies have reported limited indications for TEVAR in patients with TAAD. The procedure is challenging, and the results are uncertain.…”

Section: Discussionmentioning

confidence: 99%

Clinical outcome of acute thoracic aortic syndrome in nonagenarians

Arakawa¹,

Okamura²,

Miyagawa³

et al. 2020

Asian Cardiovasc Thorac Ann

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Background Decision-making regarding the operability of thoracic aortic disease in nonagenarian patients remains controversial because outcomes of open surgical repair of the thoracic aorta are unclear. We investigated the surgical and nonsurgical outcomes of acute thoracic aortic syndrome treatment in nonagenarians. Methods After evaluating data in our institute from April 2016 to March 2020, we included 10 nonagenarians who needed surgical intervention on the thoracic aorta via a median sternotomy for acute thoracic aortic syndrome. The mean age of the cohort was 91.9 ± 2.1 years. Five patients underwent open surgical repair of the thoracic aorta (surgical group), and 5 refused surgery (nonsurgical group). All patients in the surgical group performed activities of daily living independently, with a mean clinical frailty scale of 3.2 ± 0.4. The surgical group included 4 patients with type A aortic dissection and one with a ruptured thoracic aortic aneurysm. Hemiarch replacement was performed in 3 patients and total arch replacement in 2. The mean follow-up period was 17.8 ± 5.1 months. Results Hospital mortality rates were 0% in the surgical and 80% in the nonsurgical group. The mean length of hospitalization was 28.4 ± 6.7 days in the surgical group. The 1-year survival rates were 100% in the surgical group and 20% in the nonsurgical group. Conclusion Open surgical repair for acute thoracic aortic syndrome via median sternotomy is a reasonable treatment option even in nonagenarians. Involvement of family members is important for decision-making to devise the optimal treatment strategy (surgical vs. medical).

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Endovascular stent grafting for ascending aorta diseases

Abstract: TEVAR in the ascending aorta seems to be safe and feasible for selected patients with various aortic diseases, although larger studies are required.

Cited by 51 publications

References 40 publications

Endovascular Treatment of the Ascending Aorta: is this the Last Frontier in Aortic Surgery?

Endovascular Treatment of the Ascending Aorta: is this the Last Frontier in Aortic Surgery?

Clinical Practice Variation and Outcomes for Stanford Type A Aortic Dissection Repair Surgery in Maryland: Report from a Statewide Quality Initiative

Clinical outcome of acute thoracic aortic syndrome in nonagenarians

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