Open Thoracoabdominal Aortic Repair in Patients With Heritable Aortic Disease in the GenTAC Registry

Frankel, William C.; Song, Howard K.; Milewski, Rita K.; Shalhub, Sherene; Pugh, Norma; Eagle, Kim A.; Roman, Mary J.; Pyeritz, Reed E.; Maslen, Cheryl L.; Ravekes, William; Milewicz, Dianna M.; Coselli, Joseph S.; Asch, Federico M.; Bavaria, Joseph E.; Desvigne‐Nickens, Patrice; Devereux, Richard B.; Dietz, Harry C.; Habashi, Jennifer; Holmes, Kathryn W.; Kröner, Barbara; LeMaire, Scott A.; McDonnell, Nazli B.; Morris, Shaine A.; Prakash, Siddharth K.; Shohet, Ralph V.; Silberbach, G. Michael; Tolunay, Hatice; Tseng, Hung; Weinsaft, Jonathan W.

doi:10.1016/j.athoracsur.2019.08.047

Cited by 16 publications

(5 citation statements)

References 25 publications

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“…Latz and colleagues reported similar findings of 90% freedom from reintervention at 10 years (11). In general, there appears a low risk of late graft infection; however, patients with heritable thoracic aortic disease are prone to late patch aneurysms and pseudoaneurysms (33,35). Our study comparing 726 reoperative and 2,653 non-reoperative TAAA repairs found no difference in early operative risk (35).…”

Section: Discussionsupporting

confidence: 79%

Narrative review: open surgery for thoracoabdominal aortic aneurysm—is it still a horrible surgery?

Kothari¹,

Weldon²,

Köksoy³

et al. 2022

J Vis Surg

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With the introduction of endovascular stent graft technology, options are available for treating patients with thoracoabdominal aortic aneurysms (TAAAs). However, open repair, despite its invasiveness, is still considered the gold standard for managing TAAA. Because this operation necessitates a large incision and is associated with life-threatening operative risk and serious life-altering postoperative complications such as paraplegia and renal failure, open repair may be described with ominous adjectives such as terrifying or horrible. Even large-volume centers of excellence have a relatively high incidence of mortality and morbidity, which contributes to the serious reputation of this surgery. However, over the years, steps have been taken to help mitigate risks in open repair, including the use of left heart bypass, cerebrospinal fluid drainage, cold renal perfusion, and reimplantation of intercostal and lumbar arteries, and early outcomes have generally improved. Late durability of open repair is well established. Endovascular repair of less complex descending thoracic aortic aneurysms is widely considered a good alternative to open surgical repair;notably, these are aneurysms that do not involve the visceral arteries. Experimental endovascular approaches for repairing TAAAs are emerging, but a substantial subset of patients may remain better suited for open repair because of anatomic and other limitations as well as some significant risks that are associated with endovascular repair. Endovascular repair of aneurysms involving visceral branches may be challenging even with fenestrated or branched endovascular graft technology. For many patient groups undergoing TAAA repair, protective adjuncts and overall durability have imparted significant benefits and support the continued need for open repair, making it far from a horrible surgery.

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Section: Discussionsupporting

confidence: 79%

Narrative review: open surgery for thoracoabdominal aortic aneurysm—is it still a horrible surgery?

Kothari¹,

Weldon²,

Köksoy³

et al. 2022

J Vis Surg

Self Cite

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“…Patients with LDS undergo multiple aortic procedures during their lifetime, which renders them high risk for re-interventions. 2 , 7 LDS is less frequent than Marfan syndrome and other hereditary aortopathies. In addition, patients tend to present younger.…”

Section: Discussionmentioning

confidence: 94%

“…Late treatment failure was also low at 5%. 7 Annual surveillance with CT or MRI is mandated in LDS patients, 5 with up to 88% survival at 10 years. 4 …”

Section: Discussionmentioning

confidence: 99%

“…In addition, patients tend to present younger. 2 , 7 , 8 An endovascular only approach is possible when surgical grafts form both the proximal and distal landing zones but is associated with an up to 30% rate of retrograde dissection and 40% requiring stent graft explant. 2 A hybrid approach (reported literature summarised in Table 1 ) can be employed to reduce peri-operative morbidities especially those involving redo thoracotomy.…”

Section: Discussionmentioning

confidence: 99%

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Hybrid Repair of a Thoraco-abdominal Aortic Aneurysm Associated with Loeys-Dietz Syndrome

Naiem

Doonan

Steinmetz

2021

EJVES Vascular Forum

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Introduction Loeys-Dietz syndrome (LDS) is a genetic syndrome caused by mutations in transforming growth factor beta receptors (TGFBR) 1 and 2. It can manifest with craniofacial, musculoskeletal, cognitive abnormalities, and vascular pathologies including early onset aortic root aneurysms, extensive aortic dissections, and TAAA. Open repair is considered the gold standard treatment but carries morbidity risks, especially in patients with multiple previous aortic procedures. Endovascular treatment is associated with treatment failure when used in the native aorta, because of inherent wall weakness precluding seal. This case report adds to the available literature on hybrid treatment of LDS associated aortic pathologies. Report This is the report of staged hybrid TAAA treatment in a 24 year old male patient with multiple previous aortic procedures via sternotomy and thoracotomy. Retrograde infrarenal aortic visceral debranching was performed using 14 mm by 7 mm bifurcated Dacron grafts. These emerged from the limbs of an 18 mm by 9 mm bifurcated Dacron graft in an aortobi-iliac reconstruction. This was followed by staged thoracic endovascular aortic repair (TEVAR) seven days later using three endografts (26 mm–22 mm × 150 mm distal, 30 mm × 200 mm bridging, then 32 mm × 100 mm proximal). The endograft landed in an old thoracic aortic graft proximally and the new infrarenal aortic graft distally. Follow up at 11 months showed patency and no sac expansion. Conclusion Hybrid TAAA repair was a valid treatment option in this patient with LDS and multiple previous aortic procedures. It minimised the morbidity of revision surgery and mitigated potential treatment failure by achieving an endovascular seal in surgical grafts. Short term surveillance showed no complications. Limitations to making recommendations include lack of long term follow up.

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“…Although some studies have reported high rates of morbidity and mortality with open distal aortic repair, particularly when analyzing regional or national registries, centers of excellence provide excellent results for open repair for patients with HTAD. 7 In the GenTAC registry, operative mortality following open thoracoabdominal aortic repair in patients with HTAD was 1.3% 7 ; Coselli and colleagues 8 reported an operative mortality of 4% in patients with Marfan syndrome undergoing distal aortic repair for dissection.…”

mentioning

confidence: 99%

Commentary: Endovascular repair in Marfan syndrome: Viable bailout but not ready for prime time

Rocha

Ouzounian

Fremes

2023

The Journal of Thoracic and Cardiovascular Surgery

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Open Thoracoabdominal Aortic Repair in Patients With Heritable Aortic Disease in the GenTAC Registry

Cited by 16 publications

References 25 publications

Narrative review: open surgery for thoracoabdominal aortic aneurysm—is it still a horrible surgery?

Narrative review: open surgery for thoracoabdominal aortic aneurysm—is it still a horrible surgery?

Hybrid Repair of a Thoraco-abdominal Aortic Aneurysm Associated with Loeys-Dietz Syndrome

Commentary: Endovascular repair in Marfan syndrome: Viable bailout but not ready for prime time

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