Commentary: New Low-Profile Zenith Alpha Stent-Graft for the Treatment of Thoracic Aortic Disease

A Single-Center Experience With Total Percutaneous Implantation of a Low-Profile Thoracic Aortic Stent-Graft

“…In addition, aside from the low-profile nature, the ZTA stent-graft comes with a pre-curved introduction system that, together with the proximal bare-stent and barbed wires, allows for easier and more accurate deployments, optimizing inner wall apposition, thus reducing the risk of bird-beak configuration and associated type 1 endoleaks, although this seeming advantage remains to be validated in patients with challenging arch anatomy. 16 Second, our current study found worse early postoperative outcomes in patients with ruptured aorta and in those with a high sheath to access vessel ratio. Ruptured aorta and emergency repair have been extensively studied in the literature and are well known to be associated with worse postoperative outcomes, especially in the short term, mostly due to the perioperative hemodynamic instability.…”

“…In addition, aside from the low-profile nature, the ZTA stent-graft comes with a pre-curved introduction system that, together with the proximal bare-stent and barbed wires, allows for easier and more accurate deployments, optimizing inner wall apposition, thus reducing the risk of bird-beak configuration and associated type 1 endoleaks, although this seeming advantage remains to be validated in patients with challenging arch anatomy. 16…”

“…Although all of these studies, including our current article, show a trend toward promising outcomes after ZTA stent-graft implantation in the short and midterms, the long-term results still remain unclear, and the durability of the stent-graft has been an issue of concern in the literature. 16 It is thought that the modifications to the graft material needed to achieve the low-profile delivery system may be a limitation to the long-term efficacy and safety of the stent-graft as it may expose to greater risk of late kinking and obstruction with their associated morbimortality. 16 It is, however, noteworthy to mention that Beropoulis et al, 13 in their series of 44 patients followed up for a minimum of 60 months, reported an ongoing clinical success rate of 84% after 5 years, with no surgical reconversion, no aneurysmal rupture, 4% rate of sac expansion, 6% type I and III endoleaks, and 4 (9%) aneurysm-related deaths.…”

“…16 It is thought that the modifications to the graft material needed to achieve the low-profile delivery system may be a limitation to the long-term efficacy and safety of the stent-graft as it may expose to greater risk of late kinking and obstruction with their associated morbimortality. 16 It is, however, noteworthy to mention that Beropoulis et al, 13 in their series of 44 patients followed up for a minimum of 60 months, reported an ongoing clinical success rate of 84% after 5 years, with no surgical reconversion, no aneurysmal rupture, 4% rate of sac expansion, 6% type I and III endoleaks, and 4 (9%) aneurysm-related deaths. The authors concluded on favorable long-term outcomes despite technical alterations to reduce device profile.…”