Total Arch Repair Using Supra-Aortic Debranching Technique With Banding of the Ascending Aorta for Endovascular Stent Graft Fixation

Uchida, Naoshige; Katayama, Kosuke; Takahashi, Shinya; Sueda, Taijiro

doi:10.1016/j.avsg.2012.08.003

Cited by 8 publications

(2 citation statements)

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“…It could be argued that the transapical approach adds to the complexity of the procedure, increasing perioperative morbidity and mortality. 18 In one case wrapping of an aneurysm was combined with a debranching procedure, similar to the approach used by Uchida et al 22 to combine banding of the aneurysmal ascending aorta with supra-aortic debranching for stentgraft fixation. The bifurcated Dacron graft was sutured to the aorta after partial clamping with a side-biting clamp, Continuous data are presented as the mean ± standard deviation (range); categorical data are given as the number.…”

Section: Discussionmentioning

confidence: 99%

“…In one case wrapping of an aneurysm was combined with a debranching procedure, similar to the approach used by Uchida et al 22 to combine banding of the aneurysmal ascending aorta with supra-aortic debranching for stent-graft fixation. The bifurcated Dacron graft was sutured to the aorta after partial clamping with a side-biting clamp, followed by stent-grafting of the ascending aorta and zone 1.…”

Section: Discussionmentioning

confidence: 99%

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Endovascular Hybrid Repair of True Ascending Aortic Aneurysms Using Double Graft Wrapping to Prepare a Landing Zone for Ascending Aortic Stent-Graft Placement: A Cohort Study

et al. 2019

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Purpose: To describe a hybrid procedure that avoids cardiopulmonary bypass to treat patients with true ascending aortic aneurysms without a suitable proximal landing zone for endovascular repair. Material and Methods: Thirteen consecutive patients (mean age 75.9±6.5 years; 8 women) with true ascending aortic aneurysms were treated with the endovascular hybrid repair of true aortic aneurysms (EHTA) approach, which consists of a conventional sternotomy with double wrapping of the ascending aorta followed by staged stent-graft placement. Via sternotomy, a polypropylene mesh trimmed to downsize the aneurysm is placed around the dilated ascending aorta and sutured to the adventitia. A similarly trimmed polytetrafluoroethylene graft is placed loosely around the first wrap to avoid adhesions and secure the proximal landing zone. There is no need for cardiopulmonary bypass. A few days later, a standard thoracic stent-graft is deployed via either a transaxillary or transfemoral access; chimney or bypass grafts are used as needed to revascularize the supra-aortic vessels. Results: The ascending aortic diameter was reduced from a mean 5.7 cm (range 4.8–6.5) to 3.9 cm (range 3.2–4.3) after wrapping. The mean interval between surgery and stent-graft placement was 5 days. In this interval, 2 patients with significant reduction in the diameter of the ascending aorta elected to forego placement of a stent-graft. Of the 11 patients who underwent the full hybrid EHTA procedure, the ascending aortic stent-graft was combined with a chimney graft in the innominate artery in 4 cases. In 1 patient, a supra-aortic debranching procedure using a bifurcated Dacron graft to the innominate and left common carotid arteries was performed after wrapping with the polypropylene mesh. There was no mortality or neurological complication. A sternal wound infection required a prolonged hospital stay. At a mean follow-up of 13.8 months (range 3–24), there has been no death, type I endoleak, or sign of aneurysm enlargement on imaging. Conclusion: This technique permits complete endovascular exclusion of an ascending aortic aneurysm in a less invasive approach than standard open repair. Although this is only a small cohort of patients without long-term follow-up, it seems that this hybrid procedure is associated with low morbidity and mortality. It offers a beating-heart approach to treat true ascending aortic aneurysms in selected high-risk patients.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%