Hybrid and total endovascular repair of the aortic arch

Rudarakanchana, Nung; Jenkins, Michael

doi:10.1002/bjs.10713

Cited by 39 publications

(30 citation statements)

References 72 publications

(79 reference statements)

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“…Endovascular repair is the treatment of choice for aneurysms or dissections of the thoracic descending aorta. When the disease extends to the arch, endovascular treatment is not a good option in most cases 7 and open repair is challenging. The development of hybrid prostheses and the FET procedure [8][9][10] has simplified the surgical treatment of these pathologies, allowing either a single-stage open procedure, or facilitating an open or endovascular second stage 11,12 .…”

Section: Discussionmentioning

confidence: 99%

Single-center experience and evolution of technique with the E-vita Open prosthesis.

Maroto

Carnero

Cobiella

et al. 2020

Preprint

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Background: We report our experience in aortic arch repair with the E-vita Open hybrid prosthesis and describe the changes in our technique over time. Methods: Between October 2013 and December 2019, 56 patients underwent a total aortic arch replacement with the E-vita Open hybrid prosthesis. Main indications were thoracic aorta aneurysm (n=27) and acute type A aortic dissection (n=18). We analyze the technique and results in the overall series, and compare both between our early (Group I, 25 patients) and late experience (Group II, 31 patients). Results: Overall in-hospital mortality was 7.1% (4), and permanent stroke and spinal cord injury were 3.6% and 1.8% respectively. 15 patients (26.8%) underwent a planned second procedure on the distal aorta: 13 endovascular, 1 open and 1 hybrid. Survival at 1 and 3 years was 90.7% and 80.7%. Group II included more patients with acute dissection (45.2% vs 16%, p=0.02), a higher rate of bilateral cerebral perfusion (100% vs 64%, p<0.001), left subclavian artery perfusion during lower body circulatory arrest (87.1% vs 0%, p<0.001), early reperfusion (96.8% vs 40%, p<0.001), and zone 0-2 distal anastomosis (100% vs 72%, p=0.02). In-hospital mortality (3.2% vs 12%) and permanent stroke (0% vs 8%) tended to be lower in Group II. Conclusions: Total arch replacement with E-vita Open hybrid prosthesis in complex thoracic aorta disease is safe. One-stage treatment is feasible when pathology does not extend beyond the proximal descending thoracic aorta. In any case, it facilitates subsequent procedures on distal aorta if needed.

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Section: Discussionmentioning

confidence: 99%

Single-center experience and evolution of technique with the E-vita Open prosthesis.

Maroto

Carnero

Cobiella

et al. 2020

Preprint

View full text Add to dashboard Cite

show abstract

“…Endovascular repair is the treatment of choice for aneurysms or dissections of the thoracic descending aorta. When the disease extends to the arch, endovascular treatment is not a good option in most cases 6,7 and open repair is challenging. A hybrid approach has been proposed for those patients whose risk for conventional surgery is prohibitive.…”

Section: Discussionmentioning

confidence: 99%

Single‐center experience and evolution of technique with the E‐vita Open prosthesis

et al. 2020

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Background We report our experience in aortic arch repair with the E‐vita Open hybrid prosthesis and describe the changes in our technique over time. Methods Between October 2013 and December 2019, 56 patients underwent a total aortic arch replacement with the E‐vita Open hybrid prosthesis. The main indications were thoracic aorta aneurysm (n = 27) and acute type A aortic dissection (n = 18). We analyze the technique and results in the overall series, and compare both between our early (group I, 25 patients) and late experience (group II, 31 patients). Results Overall in‐hospital mortality was 7.1% (n = 4), and permanent stroke and spinal cord injury were 3.6% and 1.8%, respectively. Fifteen patients (26.8%) underwent a planned second procedure on the distal aorta: 13 endovascular, 1 open, and 1 hybrid. Survival at 1 and 3 years was 90.7% and 80.7%, respectively. Group II included more patients with acute dissection (45.2% vs 16%, P = .02), higher rates of bilateral cerebral perfusion (100% vs 64%, P < .001), left subclavian artery perfusion during lower body circulatory arrest (87.1% vs 0%, P < .001), early reperfusion (96.8% vs 40%, P < .001), and zone 0 to 2 distal anastomosis (100% vs 72%, P = .02). In‐hospital mortality (3.2% vs 12%) and permanent stroke (0% vs 8%) tended to be lower in group II. Conclusions Total arch replacement with E‐vita Open hybrid prosthesis in complex thoracic aorta disease is safe. One‐stage treatment is feasible when pathology does not extend beyond the proximal descending thoracic aorta. In any case, it facilitates subsequent procedures on distal aorta if needed.

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“…Please see Fig. 1 for details about the Ishimura zones in the aortic arch [8]. It is important to perform the procedure using advanced imaging to avoid excessive radiation, reduce contrast volume and ensure accurate device placement and vessel cannulation.…”

Section: Indications For Aortic Arch Interventionmentioning

confidence: 99%

Various Endoluminal Approaches Available for Treating Pathologies of the Aortic Arch

Anwar

Hamady

2020

Cardiovasc Intervent Radiol

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Open surgical repair of the aortic arch for degenerative aortic disease in an unfit patient is associated with significant morbidity and mortality. Endoluminal techniques have advanced over the last decade. Contemporary endovascular options including a hybrid approach (supra-aortic debranching and aortic stent graft), inner branched endograft, chimney stents, and scallop or fenestrated endografts are being used frequently as an alternative to open surgical arch repair. Understanding of the available endoluminal technology along with careful planning and effective teamwork is required to minimise complications associated with the endoluminal techniques, particularly neurological ones. Custom made techniques are superior to chimney or parallel technology in terms of their complications and durability. Integration of the protective devices such as embolic protection filters into stent design may reduce the risk of poor neurological sequelae. Long-term data are needed to assess the durability of these devices.

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Hybrid and total endovascular repair of the aortic arch

Abstract: Repair of aortic arch pathology presents a formidable challenge for endovascular technology. Open aortic arch repair remains the standard in younger, fitter patients, but endovascular technology and experience continue to evolve with encouraging early outcomes and expanding indications.

Cited by 39 publications

References 72 publications

Single-center experience and evolution of technique with the E-vita Open prosthesis.

Single-center experience and evolution of technique with the E-vita Open prosthesis.

Single‐center experience and evolution of technique with the E‐vita Open prosthesis

Various Endoluminal Approaches Available for Treating Pathologies of the Aortic Arch

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