Endovascular treatment of the ascending aorta using a combined transapical and transfemoral approach

Grieshaber, Philippe; Nink, Nadine; Roth, Peter; Elzien, Meshal; Böning, Andreas; Koshty, Ahmed

doi:10.1016/j.jvs.2017.10.046

Cited by 5 publications

(5 citation statements)

References 11 publications

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“…At the completion of the review, 31 studies were included (19 case reports and 12 case series), describing a total of 92 patients who underwent ascending aortic endovascular repair for TAAD (Figure 1). 13,22‐51 The selected studies were published between 2000 and 2019.…”

Section: Resultsmentioning

confidence: 99%

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

et al. 2020

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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.

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Section: Resultsmentioning

confidence: 99%

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

et al. 2020

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“…Due to bad femoral access and the size of the introducer (24 Fr), we decided on a transapical approach 4 . Deployment of the endograft in the ascending aorta can be challenging and requires precise placement.…”

Section: Discussionmentioning

confidence: 99%

“…His 19 day long in-hospital stay in intensive care unit was necessary due to his severe morbidities and the need for invasive ventilation for post-operative pulmonary congestion. The patient was discharge from the hospital after 30 days with a quality of life equivalent to the previous state, an open sternotomy with a cardiopulmonary bypass would have further complicated his recovery with possible additional complications 1 , 4 …”

Section: Discussionmentioning

confidence: 99%

A ruptured penetrating atherosclerotic ulcer of the ascending aorta: a case report of an endovascular repair with extending the length of the aortic coverage by debranching the innominate artery

Chenesseau

Barral

Piquet

et al. 2019

European Heart Journal - Case Reports

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Background An endovascular approach to the management of a ruptured plaque in the ascending aorta may be an alternative to open surgery in high-risk patients. This option may become inevitable due to the number of elderly patients unfit for open cardiac surgery. There are very few stent grafts able to fit the ascending aorta and in emergency cases, most medical teams have been limited to current thoracic aortic endografts, the shortest of which measure 10 cm. Case summary We report a case of an endovascular repair of a ruptured penetrating atherosclerotic ulcer of the ascending aorta. The patient was considered for open cardiac surgery but was evaluated at a high mortality risk based on his age, his medical history, and significant calcifications on his aorta. Our vascular surgical team decided then to perform an endovascular repair with extending the length of the aortic coverage by debranching the innominate artery. Discussion Endovascular treatment of an acute ruptured aorta is feasible in high-risk patients with thoracic endovascular stent grafts and coverage of the innominate artery. Endovascular treatment of the ascending aorta is at its infancy and in need of further research. New stent grafts designed for the ascending aorta are in progress and should increase the numbers of interventions in the years to come.

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“…To further support this statement, a mock circulation loop experiment, similar to that of Rozencwajg and colleagues, with different cannulation strategies and flow conditions paired with CFD analyses might provide additional insight. 42 Lastly, current ECMO circuits do not have any integrated sensors that allow for direct autoregulation of physiological processes. A future perspective might be to embed sensors and microprocessors as seen in the total artificial heart by CARMAT.…”

Section: Computational Fluid Dynamic Analysismentioning

confidence: 99%

“…Om deze bevinding verder te ondersteunen, kan een zogenaamd 'mock circulation loop experiment' worden verricht, vergelijkbaar met dat van Rozencwajg en collega's. 42 Hierin kunnen verschillende canulatie strategieën en hemodynamische condities worden vergeleken in combinatie met CFD-analyses om zo tot verdere inzichten te komen. Ten slotte hebben huidige ECMO-circuits geen geïntegreerde sensoren die directe autoregulatie van fysiologische processen mogelijk maken.…”

Section: Computational Fluid Dynamic Analyseunclassified

A multidisciplinary approach to improve cardiovascular surgery care

Ahmed¹

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Up to 10% of acute type A aortic dissection 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 type A aortic dissection. MethodsA literature search was conducted, using MEDLINE and PubMed databases according to PRISMA guidelines, updated until January 2020. Articles were selected if they reported on endovascular repair of DeBakey type I and II aortic dissections. The exclusion criteria were: retrograde type A dissection, hybrid procedures, combined outcome reporting of mixed aortic pathologies (e.g. (pseudo)aneurysm, intramural hematoma). ResultsA total of 31 articles, of which 19 were case reports and 12 case series, describing a total of 92 patients, were included. Median follow-up was 6 months for case reports and 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%). ConclusionThis review not only demonstrates that endovascular repair in the setting of isolated type A aortic dissection 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. Endovascular ascending aortic repair in type A dissection: a systematic review Author Year Indication Mean age Gender Comorbidities Relevant surgical history Significant aortic insufficiency Hospital stay (days) Average follow-up (months)

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Endovascular treatment of the ascending aorta using a combined transapical and transfemoral approach

Cited by 5 publications

References 11 publications

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

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

A ruptured penetrating atherosclerotic ulcer of the ascending aorta: a case report of an endovascular repair with extending the length of the aortic coverage by debranching the innominate artery

A multidisciplinary approach to improve cardiovascular surgery care

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