Current options and recommendations for the use of thoracic endovascular aortic repair in acute and chronic thoracic aortic disease: an expert consensus document of the European Society for Cardiology (ESC) Working Group of Cardiovascular Surgery, the ESC Working Group on Aorta and Peripheral Vascular Diseases, the European Association of Percutaneous Cardiovascular Interventions (EAPCI) of the ESC and the European Association for Cardio-Thoracic Surgery (EACTS)

Abstract

Since its clinical implementation in the late nineties, thoracic endovascular aortic repair (TEVAR) has become the standard treatment of several acute and chronic diseases of the thoracic aorta. While TEVAR has been embraced by many, this disruptive technology has also stimulated the continuing evolution of open surgery, which became even more important as late TEVAR failures do need open surgical correction justifying the need to unite both treatment options under one umbrella. This fact shows the importance of—in analogy to the heart team—aortic centre formation and centralization of care, which stimulates continuing development and improves outcome . The next frontier to be explored is the most proximal component of the aorta—the aortic root, in particular in acute type A aortic dissection—which remains the main challenge for the years to come. The aim of this document is to provide the reader with a synopsis of current evidence regarding the use or non-use of TEVAR in acute and chronic thoracic aortic disease, to share latest recommendations for a modified terminology and for reporting standards and finally to provide a glimpse into future developments.

Cardiac Surgery 2020 Reviewed

“…A working group of the European Association for Cardio-Thoracic Surgery published a consensus document on the classification of aortic dissections and current standards of therapy. 68 The authors present a scheme of different aortic zones relevant for decision-making in aortic surgery. In addition, they introduce the Type, Entry, Malperfusion (TEM) classification for aortic dissection.…”

Commentary: Endovascular repair in Marfan syndrome: Viable bailout but not ready for prime time

“…Thoracic endovascular aortic repair (TEVAR) has evolved to become standard of care for patients with degenerative aortic disease of the descending thoracic aorta, blunt aortic injury, and complicated type B aortic dissection (TBAD). 1 Advantages include ease of implantation, less surgical trauma and physiological derangements, and lower early morbidity and mortality compared with open distal aortic repair. 2 Nonetheless, TEVAR has been associated with an increased risk of aortic-related reinterventions.…”

“…3 Patients with hereditary thoracic aortic disorders (HTAD), including Marfan syndrome, are considered to have a relative contraindication for TEVAR. 1 Despite reasonable perioperative success, significant concerns arise in mid to late follow-up. Complications, including endoleak, aortic reintervention, stent migration, and retrograde type A dissection, all occur at substantially higher rates than in patients without HTAD.…”

The ascending aorta and arch in the sights of transcatheter therapy: A time for reappraisal

“…A pending issue is to determine which patient could most benefit from the emerging assorted array of therapeutic options, from surgical delay or permanent deferral of surgery to interventional transcatheter procedures with transfer to specialized centers 16,17 . Given the complexity of designing a randomized controlled trial in a disease with a multivariate presentation like type A AAD, a scoring system derived from a large dedicated database would be effective to predict the 30‐day mortality rate for patients undergoing surgery for type A AAD and provide recommendation for procedure selection 18 …”