Hybrid multistep approach to mega-aortic syndrome: the Lupiae technique

Esposito, Giampiero; Pennesi, Matteo; Bichi, Samuele; Patrini, Davide; Pellegrino, Pasquale; Redaelli, Marianna; Poloni, Camillo; Gerometta, Piersilvio; Gentinetta, Franco; Cappabianca, Giangiuseppe

doi:10.1093/ejcts/ezu102

Cited by 14 publications

(11 citation statements)

References 21 publications

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“…Hybrid aortic repair using an endovascular technique has emerged as an alternative to the conventional twostage elephant trunk technique. 3,10) Recently, Roselli et al reported that the high rate of endoleaks for the endovascular completion in patients who have already undergone conventional elephant trunk technique. 10) This reason is possibly due to the free-floating design of the original version of the elephant trunk.…”

Section: Discussionmentioning

confidence: 99%

“…Giant cell aortitis (GCA) is an uncommon cause of thoracic aortic aneurysms, which often involve the aorta from the aortic root through the arch, extending to the thoracoabdominal aorta, the so-called mega-aortic syndrome (MAS). [1][2][3] We performed a two-stage hybrid repair, combining open and endovascular techniques, to treat MAS due to GCA in a heart failure patient with severe aortic regurgitation.…”

Section: Introductionmentioning

confidence: 99%

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Hybrid Repair for Mega-Aortic Syndrome due to Giant Cell Aortitis in a Heart Failure Patient

Inoue

Fujita

Kino

et al. 2020

Annals of Vascular Diseases

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The present report describes a case of mega-aortic syndrome accompanied with severe aortic regurgitation in a 75-year-old man who underwent a two-stage hybrid repair. Intraoperative pathologic findings at the first repair, consisting of Bentall operation and total arch replacement with a Lupiae graft, aided the identification of the giant cell aortitis. Despite complicating hemorrhagic stroke, steroid therapy was initiated and endovascular repair was subsequently completed. Over more than 2 years of follow-up, the patient continued steroid therapy and is doing well without any reintervention.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Hybrid Repair for Mega-Aortic Syndrome due to Giant Cell Aortitis in a Heart Failure Patient

Inoue

Fujita

Kino

et al. 2020

Annals of Vascular Diseases

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“…Hybrid aortic repair with antegrade supra-aortic and renovisceral debranching from ascending aorta and 94% at 28 months, 6 and 8 years, have been reported with this procedure (6)(7)(8)(9). A three-year estimated survival rate of 83%; freedom of type I endoleak and reintervention of 100% and 78%, respectively, have been also reported (10).…”

Section: Introductionmentioning

confidence: 86%

Hybrid aortic repair with antegrade supra-aortic and renovisceral debranching from ascending aorta

et al. 2017

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Aortic dissection is a life threatening condition. Hybrid repair has been described for the treatment of complex aortic pathology such as thoracoabdominal aortic aneurysms (TAAA) and type A and B dissections, although open and total endovascular repair are also possible. Open surgery is still associated with substantial perioperative morbi-mortality rates, thus less invasive techniques such as endovascular repair and hybrid procedures can achieve good results in centers with experience. We present the case of a patient with a chronic type B dissection and TAAA degeneration that was treated in a single stage hybrid procedure with antegrade supra-aortic and renovisceral debranching from the ascending aorta and TEVAR. At threeyear follow up, the patient is free of intervention-related complications. J Thorac Dis 2017;9(Suppl 6):S539-S543 jtd.amegroups.com and 94% at 28 months, 6 and 8 years, have been reported with this procedure (6-9). A three-year estimated survival rate of 83%; freedom of type I endoleak and reintervention of 100% and 78%, respectively, have been also reported (10). A similar technique was previously described by Torsello et al., using three bifurcated Dacron grafts for an antegrade thoracic and renovisceral debranching (11). Case presentationA 68-year-old female was admitted to the Emergency Department due to severe back and chest pain with concomitant loss of consciousness. Her clinical records showed a past medical history of hypertension, Paget's disease, cholecystectomy, appendectomy and a known chronic type B aortic dissection that was under follow-up at another center. The emergency angio-CT (computed tomography), showed a 6 cmc TAAA, due to a chronic type B dissection with involvement from Zone 0 of the aortic arch, extending to the right common iliac artery and to the left hypogastric artery. The celiac trunk and the right renal artery were also dissected, with all the renovisceral vessels arising from the true lumen.Initially the patient was transferred to the intensive care unit (ICU) for monitoring and blood pressure control. Seventy-two hours later, surgical treatment was decided because of the persistence of symptoms and difficult blood pressure control. An antegrade supra-aortic and renovisceral debranching was decided from ascending aorta due to extensive aortic disease with significant calcification at the renovisceral level and taking into account that the infrarenal aorta and both iliac arteries were not suitable as inflow sites. Under general anaesthesia and with cerebrospinal fluid (CSF) drainage, a median sternotomy was performed, allowing control of the ascending aorta and supra-aortic vessels. With tangential aortic clamping a 16×8 mm bifurcated Dacron graft was sutured to the ascending aorta with downward orientation of its limbs (Figure 1). From the main body of this bifurcated graft, a 10mm Dacron tube was used to debranch the brachiocephalic trunk performing a distal termino-terminal anastomosis. A 8mm Dacron graft was used to create a Y shaped graft, which ...

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“…We previously proposed a MAS classification (3,4) according to the distal extent of the aneurysms, with MAS type I aneurysms terminating above the coeliac trunk, MAS type II aneurysms terminating between coeliac trunk and the renal arteries (RA), and MAS type III aneurysms terminating below the RA (Figure 1). The focus of this report is on MAS type III patients.…”

Section: Introductionmentioning

confidence: 99%

“…This proximal landing zone can be used to complete the repair of a residual descending aorta aneurysm with a TEVAR. Results of this procedure for aortic dissections and thoracic aneurysms are well established (3,4,6).…”

Section: Introductionmentioning

confidence: 99%

Hybrid three-stage repair of mega-aortic syndrome with the Lupiae technique: 10-year results

Esposito¹,

Cappabianca²,

Beghi³

et al. 2018

Ann. Cardiothorac. Surg.

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Three-stage hybrid repairs using the Lupiae technique can be safely performed in MAS type III patients. Short intervals between the stages should mitigate the risk of rupture during the waiting periods and may enhance patient compliance, but to achieve this, the burden and the complexity of the first stage must be carefully weighted. Our strategy improves the long-term survival of these patients compared to their natural history and is less invasive than an open repair. The adoption of Dacron landing zones appears to be associated with very low rates of reintervention due to endoleaks.

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Hybrid multistep approach to mega-aortic syndrome: the Lupiae technique

Abstract: These results evidence that the Lupiae technique is a safe and effective option for the treatment of patients with MAS, achieving the complete exclusion of thoraco-abdominal aneurysms and of the residual false lumen in patients with acute aortic dissections.

Cited by 14 publications

References 21 publications

Hybrid Repair for Mega-Aortic Syndrome due to Giant Cell Aortitis in a Heart Failure Patient

Hybrid Repair for Mega-Aortic Syndrome due to Giant Cell Aortitis in a Heart Failure Patient

Hybrid aortic repair with antegrade supra-aortic and renovisceral debranching from ascending aorta

Hybrid three-stage repair of mega-aortic syndrome with the Lupiae technique: 10-year results

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