Total Endovascular Aortic Arch Repair: From Dream to Reality

D’Onofrio, Augusto; Caraffa, Raphael; Cibin, Giorgia; Antonello, Michele; Gerosa, Gino

doi:10.3390/medicina58030372

Cited by 8 publications

(4 citation statements)

References 24 publications

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“…In recent years, various surgical techniques have been formulated to simplify the c-TAR and proved to have encouraging outcomes ( 17 ). For instance, the triple-branched stent graft technique, which truly made the surgical procedure easier, time-saving and less invasive ( 18 ).…”

Section: Discussionmentioning

confidence: 99%

Simplified total arch reconstruction with a stented graft for extended aortic arch dilation

Zheng¹,

Yu²,

Lin³

et al. 2023

J Thorac Dis

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Background: Reconstruction of the aortic arch and its three supra-aortic vessels remains a great surgical challenge with postoperative complications. We present a simplified total arch reconstruction with a modified stent graft (s-TAR) and compared its operative outcomes with conventional total arch replacement (c-TAR).Methods: This retrospective analysis of prospectively collected data from all consecutive patients who had ascending aortic aneurysm with extended aortic arch dilation and underwent simultaneous ascending aorta replacement and aortic arch reconstruction with the s-TAR or c-TAR between 2018 and 2021. The indication for intervention was maximum diameter of ascending aorta >55 mm and aortic arch in zone II >35 mm.Results: A total of 84 patients were analyzed: 43 in the s-TAR group and 41 in the c-TAR group. No inter-group differences were found for sex, age, comorbidities, or EuroSCORE II results. All patients were successfully treated with s-TAR or c-TAR, and none died intraoperatively. Cardiopulmonary bypass, selective cerebral perfusion, and lower-body circulatory arrest time were significantly shorter in the s-TAR group, which also had a lower incidence of prolonged ventilation and transient neurologic dysfunction. No patient in either group experienced permanent neurologic dysfunction. The incidence of recurrent laryngeal nerve injury and paraplegia was markedly increased in the c-TAR group; however, no such events were observed in the s-TAR group. Both perioperative blood loss and the incidence of reoperation for bleeding were significantly lower in the s-TAR group. The in-hospital mortality rate was 0% in the s-TAR group and 4.9% in the c-TAR group. The s-TAR group had significantly shorter ICU stay and lower total hospitalization costs. Conclusions:The s-TAR technique is a safe and effective alternative for total arch reconstruction with shorter operation time, lower rate of postoperative complications and lower total hospitalization costs compared with c-TAR.

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Section: Discussionmentioning

confidence: 99%

Simplified total arch reconstruction with a stented graft for extended aortic arch dilation

Zheng¹,

Yu²,

Lin³

et al. 2023

J Thorac Dis

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“…Thoracic endovascular aortic repair (TEVAR) combined with carotid-to-subclavian artery bypass is an appropriate option for certain patients [ 6 ]. For those requiring full arch replacement but who are unsuitable for open surgery, also total endovascular arch repair (TER) should be considered [ 11 ]. Finding the best strategy represents a major challenge, especially in the case of emergency interventions.…”

Section: Demands On the Surgeon In Aortic Arch Surgerymentioning

confidence: 99%

Training in Aortic Arch Surgery as a Blueprint for a Structured Educational Team Approach: A Review

Discher,

Kreibich,

Berger

et al. 2023

Medicina

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Background and objectives: The treatment of pathologies of the aortic arch is a complex field of cardiovascular surgery that has witnessed enormous progress recently. Such treatment is mainly performed in high-volume centres, and surgeons gain great experience in mastering potential difficulties even under emergency circumstances, thereby ensuring the effective therapy of more complex pathologies with lower complication rates. As the numbers of patients rise, so does the need for well-trained surgeons in aortic arch surgery. But how is it possible to learn surgical procedures in a responsible way that, in addition to surgical techniques, also places particular demands on the overall surgical management such as perfusion strategy and neuro-protection? This is why a good training programme teaching young surgeons without increasing the risk for patients is indispensable. Our intention was to highlight the most challenging aspects of aortic arch surgery teaching and how young surgeons can master them. Materials and Methods: We analysed the literature to find out which methods are most suitable for such teaching goals and what result they reveal when serving as teaching procedures. Results: Several studies were found comparing the surgical outcome of young trainees with that of specialists. It was found that the results were comparable whether the procedure was performed by a specialist or by a trainee assisted by the specialist. Conclusions: We thus came to the conclusion that even for such a complex type of intervention, the responsible training of young surgeons by experienced specialists is possible. However, it requires a clear strategy and team approach to ensure a safe outcome for the patient.

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“…The management of aortic arch dissection, alternatively known as non-A non-B aortic dissection, poses a complex challenge for cardiac surgeons. Conventional open surgery remains the standard treatment approach for this condition, which typically involves deep hypothermic circulatory arrest with selective cerebral perfusion [1]. However, in selected high-risk patients, thoracic endovascular aortic arch replacement (TEVAR) with isolated or two-branched stent grafts has been introduced into clinical practice [2,3].…”

mentioning

confidence: 99%

“…Conventional open surgery remains the standard treatment approach for this condition, which typically involves deep hypothermic circulatory arrest with selective cerebral perfusion [1]. However, in selected high-risk patients, thoracic endovascular aortic arch replacement (TEVAR) with isolated or two-branched stent grafts has been introduced into clinical practice [2,3]. Despite this, the complete TEVAR procedure with triple-branched stent graft in acute arch dissection involving an entry tear in the aortic arch has not yet been described.…”

mentioning

confidence: 99%

Total endovascular repair of an aortic arch using a triple-branched graft in acute non-A non-B aortic dissection

Burysz¹,

Milnerowicz²,

Bartuś

et al. 2023

Kardiol Pol

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Total Endovascular Aortic Arch Repair: From Dream to Reality

Cited by 8 publications

References 24 publications

Simplified total arch reconstruction with a stented graft for extended aortic arch dilation

Simplified total arch reconstruction with a stented graft for extended aortic arch dilation

Training in Aortic Arch Surgery as a Blueprint for a Structured Educational Team Approach: A Review

Total endovascular repair of an aortic arch using a triple-branched graft in acute non-A non-B aortic dissection

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