Thoracic endovascular aortic repair for the ascending aorta: experience and pitfalls

Plichta, Ryan P.; Hughes, G. Chad

doi:10.21037/jovs.2018.03.01

Cited by 23 publications

(18 citation statements)

References 18 publications

(39 reference statements)

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“…In the present study, all patients underwent aortic repair surgery via sternotomy. Although endovascular stent graft technology is a developing modality that offers an alternative treatment option for selected high-risk patients with ascending aortic disease, including ATAAD 27,28 , it is not feasible for every patient because of the individual differences in the vascular anatomy affected by aortic dissection. Furthermore, the evidence of its long-term durability is lacking.…”

Section: Discussionmentioning

confidence: 99%

Surgical outcomes analysis in patients with uncomplicated acute type A aortic dissection: a 13-year institutional experience

Lin

See

Tseng

et al. 2020

Sci Rep

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This retrospective study aimed to clarify the short-term and mid-term outcomes of and prognostic factors for patients who underwent surgical repair for uncomplicated acute type A aortic dissection (ATAAD). Between January 2007 and June 2019, 603 consecutive patients underwent ATAAD repair at our institution. According to patients’ preoperative presentations and imaging studies, uncomplicated ATAAD was found in 276 (45.8%) patients by excluding preoperative complicated factors. Patients with uncomplicated ATAAD were classified into the survivor (n = 243) and non-survivor (n = 33) groups. Clinical features, surgical information, and postoperative complications were compared. Three-year survival and freedom from reoperation rates for survivors were analyzed using the Kaplan–Meier actuarial method. The in-hospital surgical mortality rate of uncomplicated ATAAD patients was 11.9%. The non-survivor group had a higher rate of postoperative malperfusion-related complications, and a multivariate analysis revealed that repeat surgery, retrograde cerebral perfusion, and intraoperative extracorporeal membrane oxygenation support were predictors of in-hospital mortality. In the survivor group, 3-year cumulative survival and freedom from aortic reoperation rates were 89.6% (95% confidence interval [CI] 84.8–92.9%) and 83.1% (95% CI 76.8–87.7%), respectively. In conclusion, uncomplicated and complicated ATAAD rates were similar; the short-term and mid-term surgical outcomes in patients with uncomplicated ATAAD were generally acceptable.

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Section: Discussionmentioning

confidence: 99%

Surgical outcomes analysis in patients with uncomplicated acute type A aortic dissection: a 13-year institutional experience

Lin

See

Tseng

et al. 2020

Sci Rep

View full text Add to dashboard Cite

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“…As ascending aorta endovascular treatment involves several challenges and potential catastrophic complications [10] , these procedures should be done in a hybrid room, with cardiopulmonary bypass available, as well as transesophageal echocardiogram and transvenous pacemaker, and by a surgical team well trained on both procedures (conventional and endovascular) [11] .…”

Section: Introductionmentioning

confidence: 99%

Endovascular Treatment of the Ascending Aorta: is this the Last Frontier in Aortic Surgery?

Saadi¹,

Tagliari²,

Almeida³

2019

Braz J Cardiovasc Surg

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Regardless the successful treatment of the descending aorta with endovascular prosthesis, for the ascending aorta segment, because of several anatomic and physiologic issues, this technique has been considered an alternative only for high-risk or inoperable patients. Despite restricted indications, hundreds of treatments have been performed worldwide, demonstrating its safety and reproducibility if it is done in high-quality centers. Therefore, understanding patients’ selection criteria and technique limitations are critical to its application.

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“…Although average follow-up time was just 17.2 months, all-cause mortality in this analysis was 15.2% and aortarelated mortality was 5% (14). Since the publication of this review in 2018, there have been at least four additional case reports or case series published on the topic of endovascular repair of the ascending aorta (including our series of 13 patients treated in 2018 and 2019) (6,(15)(16)(17). While knowledge is currently limited by small, singleinstitution case series and a lack of long-term follow-up data, initial reports of endovascular repair of the ascending aorta in high-risk patients have yielded low mortality and excellent results (6,(17)(18)(19).…”

Section: Advent Of An Endovascular Approach For High Risk Patientsmentioning

confidence: 79%

Thoracic endovascular aortic repair for type A aortic dissection: a promising option for inoperable patients

Boyajian¹,

Ghazi²,

Kolesnik³

et al. 2021

J Vis Surg

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Acute type A aortic dissection (AAAD) is a surgical emergency that carries a grave prognosis if not diagnosed early and treated rapidly. The standard of care for patients presenting with AAAD is median sternotomy and open surgical repair of the ascending aorta. However, many patients with AAAD are determined to be too high-risk for open surgery due to malperfusion, shock, advanced age, or severe comorbidities. Inoperable patients are traditionally managed medically and experience high mortality. In recent years, the use of Thoracic Endovascular Aortic Repair (TEVAR) as an endovascular option for otherwise inoperable patients has been reported by several major aortic centers across the globe. Operative mortality in patients receiving TEVAR for AAAD is superior to conservative medical management only. Long-term follow-up data is limited, but early case series have reported positive outcomes, favorable aortic remodeling, and few complications. The anatomic features of the ascending aorta and lack of a commercial graft designed specifically for deployment in this area are the major challenges to this treatment approach. In this review article, we summarize the current state of ascending TEVAR for AAAD repair, explain our own methodology for patient selection and surgical technique, and discuss the future direction of endovascular repair of AAAD in "inoperable" patients.

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Thoracic endovascular aortic repair for the ascending aorta: experience and pitfalls

Cited by 23 publications

References 18 publications

Surgical outcomes analysis in patients with uncomplicated acute type A aortic dissection: a 13-year institutional experience

Surgical outcomes analysis in patients with uncomplicated acute type A aortic dissection: a 13-year institutional experience

Endovascular Treatment of the Ascending Aorta: is this the Last Frontier in Aortic Surgery?

Thoracic endovascular aortic repair for type A aortic dissection: a promising option for inoperable patients

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