Simplified total aortic arch replacement with an in situ stent graft fenestration technique for acute type A aortic dissection

Hu, Xiaoping; Wang, Zhiwei; Ren, Zhigang; Hu, Rui; Wu, Hongbing

doi:10.1016/j.jvs.2017.01.030

Cited by 9 publications

(7 citation statements)

References 24 publications

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“…We compared studies performed only in patients with spinal cord coverage T8 or beyond or 15 cm or greater stent length (n ¼ 6, 201 patients), 15,23,[32][33][34]42 with studies performed only in patients with stent length equal to 10 cm (n ¼ 19, 1634 patients). 15,[17][18][19]21,22,24,25,27,28,33,35,37,[40][41][42]45,46 The patients Figure E1).…”

Section: Subgroup Analysismentioning

confidence: 99%

“…When we compared studies performed only in patients with acute type A aortic dissection (n ¼ 12, 1300 patients) 21,23,25,[27][28][29][30]35,37,41,46,47 with studies performed only in patients with nonacute type A dissection and aneurysm (n ¼ 14, 741 patients), 14,15,17,19,22,[24][25][26]34,40,[42][43][44][45] we found the following results: The pooled mortality rate was 9.2% (95% CI, 6.9-12.4) in the patients with acute type A and 7.6% (95% CI, 4.9-11.4) in the patients with nonacute dissection and aneurysm (P ¼ .46). The pooled rate of stroke in these 2 groups was 9.3% (95% CI, 4.5-18.5) and 6.6% (95% CI, 3.1-13.5) (P ¼ .51), and the pooled rate of SCI was 2.4% (95% CI, 1.3-4.2) and 5.2% (95% CI, 3.1-8.5) (P ¼ .05), respectively ( Figure E2).…”

Section: Acute Type a Versus Nonacute Type A And Aneurysmmentioning

confidence: 99%

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Neurologic complications after the frozen elephant trunk procedure: A meta-analysis of more than 3000 patients

Preventza

Liao

Olive

et al. 2020

The Journal of Thoracic and Cardiovascular Surgery

173

136

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Objective: The frozen elephant trunk technique's safety regarding spinal cord ischemia has been questioned. We used a meta-analysis to determine the rates of adverse neurologic events and mortality. Methods:We searched PubMed/Medline, Embase, Scopus, and Cochrane databases (inception to April 2018) to identify studies of neurologic events after the frozen elephant trunk procedure. Separate meta-analyses were conducted with random-effects models to assess frozen elephant trunk associations with spinal cord ischemia, stroke, operative mortality, and all adverse events combined. Subgroup analyses compared outcomes in patients with acute versus nonacute type A dissection and aneurysm and with different extents of coverage.Results: Thirty-five studies (total N ¼ 3154) met inclusion criteria. The pooled rates of the outcomes of interest were 4.7% (95% confidence interval, 3.5-6.2) for spinal cord ischemia, 7.6% (95% confidence interval, 5.0-11.5) for stroke, and 8.8% (95% confidence interval, 7.0-10.9) for operative mortality. The spinal cord ischemia event rate was higher with stent length 15 cm or greater or coverage to T8 or beyond than with stent length of 10 cm (11.6% vs 2.5%, P<.001). Adverse event rates in patients with acute type A aortic dissection versus nonacute dissection or aneurysm were as follows: mortality 9.2% versus 7.6% (P ¼ .46), stroke 9.3% versus 6.6% (P ¼ .51), and overall adverse events 22.0% versus 16.5% (P ¼ .41). Conclusions:As the frozen elephant trunk procedure becomes more popular, accurate data regarding outcomes are vital. We associated the frozen elephant trunk technique with (nonsignificantly) more adverse events overall in acute type A dissection cases. Stent length of 10 cm was associated with significantly less risk of spinal cord ischemia. Using a stent 15 cm or greater or coverage extending to T8 or farther should be avoided. (J Thorac Cardiovasc Surg 2020;160:20-33) 35 Studies 3154 Patients 4.7% SCI 7.6% Stroke 8.8% Mortality Extent of SC Coverage Dissection (Type A or DeBakey Type I) / Aneurysm, Nondissection Overall Adverse Event (Mortality / Stroke / SCI) ≥ 15 cm stent length / Coverage at or distal to T8 (6 studies / 201 patients)From the

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Section: Subgroup Analysismentioning

confidence: 99%

Section: Acute Type a Versus Nonacute Type A And Aneurysmmentioning

confidence: 99%

Neurologic complications after the frozen elephant trunk procedure: A meta-analysis of more than 3000 patients

Preventza

Liao

Olive

et al. 2020

The Journal of Thoracic and Cardiovascular Surgery

173

136

View full text Add to dashboard Cite

show abstract

“…Out of the 48 studies selected: 10 [ 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 ] described outcomes in chimney procedures, 13 [ 1 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 ] with the use of fenestrated devices, 9 [ 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 ] focused on in situ fenestration outcomes, 14 [ 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 ] on branched devices, one study compared fenestrated and branched devices [ 48 ], and one compared in situ fenestration and the chimney technique [ 49 ].…”

Section: Resultsmentioning

confidence: 99%

Type 1A Endoleak after TEVAR in the Aortic Arch: A Review of the Literature

Scurto

Peluso

Pascucci

et al. 2022

JPM

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Aortic arch repair is a challenging intervention. Open surgical repair is still considered the gold standard, but in high-risk patients, it is not always a reasonable option, making endovascular approaches an enticing, when not the only available, alternative for treatment. The strategies more commonly adopted are surgical supra-aortic trunk (SAT) rerouting followed by deployment of a standard thoracic endoprosthesis, chimney techniques, custom-made scalloped, fenestrated, and branched devices, and in situ or physician-modified fenestrations. If we excluded techniques involving SAT rerouting where the arch anatomy is surgically modified in order to make deployment in the aortic arch of a standard thoracic endoprosthesis possible, in the other techniques, one or more SATs are incorporated in the thoracic endoprosthesis. In these cases, no matter what solution is adopted, because of the morphology of the aorta at this level, achieving an ideal sealing is extremely difficult, and endovascular treatments of the arch are burdened by an increased risk of type IA endoleaks. PubMed, EMBASE, and Cochrane Library were searched. We identified 1277 records. After reading titles, abstracts, and full texts, we excluded 1231 records. Exclusion criteria were low-quality evidence, abstracts, case reports, conference presentations, reviews, editorials, and expert opinions. A total of 48 studies were included, for a total of 3114 patients. A type IA endoleak occurred in 248 patients (7.7%) with a mean incidence of 18.8% in chimney procedures, 4.8% and 3%, respectively, in fenestrated and branched devices, and 2.2% in in situ fenestration. We excluded from our analysis scalloped technology that is used when the target vessel originates from a healthy landing zone and represents a different anatomical setting. Type IA endoleaks are a concern with all types of endovascular aortic arch repair, and they can compromise the outcomes of the procedure. The rate of type IA endoleaks appears to be significantly higher in chimney procedures. In order to maximize sealing, whenever possible, endovascular repair of the arch should be achieved with custom-made fenestrated devices. However, chimney configurations are still a valuable solution particularly in the emergency setting, although in such a procedure, to guarantee accurate postoperative management and follow-up, an imaging protocol could be useful.

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“…Various techniques exist to create the fenestrations in implanted polyethylene terephthalate (PET) and polytetrafluroethylene (PTFE) vascular grafts, and one of the simplest ones is the use of a steerable catheter . Furthermore, the holes made in the main graft to allow blood to flow into branching vessels may enable the deployment of grafts into the secondary vessels.…”

Section: Physical Phenomenamentioning

confidence: 99%

In Situ Generated Medical Devices

Cohn

Sloutski

Elyashiv

et al. 2019

Adv Healthcare Materials

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Medical devices play a major role in all areas of modern medicine, largely contributing to the success of clinical procedures and to the health of patients worldwide. They span from simple commodity products such as gauzes and catheters, to highly advanced implants, e.g., heart valves and vascular grafts. In situ generated devices are an important family of devices that are formed at their site of clinical function that have distinct advantages. Among them, since they are formed within the body, they only require minimally invasive procedures, avoiding the pain and risks associated with open surgery. These devices also display enhanced conformability to local tissues and can reach sites that otherwise are inaccessible. This review aims at shedding light on the unique features of in situ generated devices and to underscore leading trends in the field, as they are reflected by key developments recently in the field over the last several years. Since the uniqueness of these devices stems from their in situ generation, the way they are formed is crucial. It is because of this fact that in this review, the medical devices are classified depending on whether their in situ generation entails chemical or physical phenomena.

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Simplified total aortic arch replacement with an in situ stent graft fenestration technique for acute type A aortic dissection

Cited by 9 publications

References 24 publications

Neurologic complications after the frozen elephant trunk procedure: A meta-analysis of more than 3000 patients

Neurologic complications after the frozen elephant trunk procedure: A meta-analysis of more than 3000 patients

Type 1A Endoleak after TEVAR in the Aortic Arch: A Review of the Literature

In Situ Generated Medical Devices

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