Transapical thoracic endovascular aortic repair in aortic arch aneurysm through a pre-existent bioprosthetic aortic valve

Abstract

An 80-year-old man had undergone Y-graft replacement for ruptured abdominal aortic aneurysm followed by bioprosthetic aortic valve replacement. Follow-up computed tomography revealed a 65-mm aneurysm at the distal aortic arch. We selected endovascular surgery because of the patient's high-risk condition, and the extreme curvature of the 8-mm artificial blood vessels led us to adopt a transapical approach. No signs of deterioration of the bioprosthesis were noted, and the patient's hemodynamic condition remained stable during surgery. Transapical thoracic endovascular aortic repair through a pre-existent aortic bioprosthesis is an efficient alternative approach for treating aortic aneurysm, even after bioprosthetic aortic valve replacement.

Aortic arch repair with elephant trunk and TEVAR combination

“…Dada la elevada morbimortalidad y complejidad de la reparación de la patología del arco aórtico y la aorta torácica descendente, la innovación y el desarrollo de técnicas en los últimos años con el objetivo de disminuirla ha sido notable (10)(11)(12)(13). Pese a que la endoprótesis híbrida fue descrita inicialmente como técnica de "un solo tiempo" para la reparación completa del arco (5,6), diferentes estudios han evidenciado la frecuente necesidad de reparaciones posteriores (14)(15)(16).…”

“…The average time to TEVAR implantation was 13.5 weeks (6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20), with technical success of 100 %. A single device was implanted in 9 cases, with 10 % oversizing relative to the hybrid prosthesis.…”

“…No cases of paraplegia, stroke or perioperative death were observed. The average hospital stay length was 4 days (2-6) and the average follow-up after TEVAR was 17 months (9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25), survival at 24 months was 100 %.…”