Transcardiac Endograft Delivery for Endovascular Treatment of the Ascending Aorta

Abstract

TSA, TFA, and TAA to the ascending aorta are feasible for endograft delivery to the ascending aorta in a porcine model. Transient hemodynamic instability in TSA and TAA recovered to near preoperative values. TAA appeared technically easier.

Complete Antegrade Transapical Deployment of a Branched Aortic Arch Endograft

“…Cannulating the IA from the antegrade transapical route was technically easier as compared to the retrograde transfemoral route as performed in previous studies. [15][16][17] These findings cannot be directly transferred to the human situation, as percutaneous transapical access in pigs is simplified by the median position of the left ventricular apex, which allows subxiphoid puncture under fluoroscopy. In a clinical setting, a mini thoracotomy is required for this access route, which may add to the operating time and complexity of the procedure.…”

“…[15][16][17] A Swan-Ganz catheter was inserted via a 7-F sheath in the right jugular vein for monitoring of central venous pressure (CVP), pulmonary arterial pressure (PAP), and calculation of After median laparotomy, the aorta was punctured, and a 7-F sheath was inserted into the abdominal aorta just distal to the renal arteries. The sidearm of this 7-F sheath was used for arterial blood gas analyses.…”

“…At each measurement point, approximately 5×10 6 15-µm-diameter FMs (Molecular Probes, Eugene, Oregon) were injected into the left atrium during withdrawal of a reference blood sample via the abdominal aorta as previously described. [15][16][17]19 At the end of the experiments, the pigs were euthanized. One animal was studied with postmortem computed tomography angiography (CTA) with air as a contrast agent for representative quality control.…”

“…In our previous experimental studies, 15–17 antegrade transcardiac access routes were successfully evaluated for endograft delivery in the ascending aorta and for antegrade side branch access. The aims of the present study were to describe and evaluate the technique for introducing a single-branch arch endograft through an antegrade transapical access in a porcine model and to assess hemodynamic changes as well as myocardial and cerebral blood flow before and after deployment.…”

Aneurysmen des Aortenbogens: Interventionelle Therapie

“…Bei stark gewundener Aorta descendens kann ein transfemoraler Zugang unmöglich sein. In tierexperimentellen Untersuchungen wurde der transseptale Zugang (via Punktion der V. femoralis) und der transapikale Zugang (via Freilegung oder Punktion des rechten Ventrikels) für den antegraden Zugang zum Aortenbogen untersucht (Wipper et al 2012(Wipper et al , 2013(Wipper et al , 2015. Es zeigte sich, dass beide Zugangswege möglich sind, aber der transapikale Zugangsweg dem transseptalen vorzuziehen ist und die gebranchte Aortenbogenversorgung auf diesem Wege möglich ist (s.…”