Endovascular treatment of inoperable acute type A dissection via the transapical approach

Computed Tomography-Based Study Exploring the Feasibility of Endovascular Treatment of Type A Aortic Dissection in the Chinese Population

“…Furthermore, almost all the reports of successful endovascular treatment of TAAD employed the closest coronary artery as the landmark during the procedure. [6][7][8][9][10]17,18 We used major and minor anatomical criteria to define morphological suitability and difficulty for endovascular repair. Because there is no commercially available fenestrated or branched endograft currently that permits flow into the coronary arteries, we selected 20 mm as the minimum proximal length sufficient for the stent to seal the proximal entry tear.…”

“…The LCCA could then be opened for insertion of the stent. 10 Pinaud et al 17 chose the transapical approach, commonly used for TAVI, for endovascular treatment of TAAD due to the inaccessible peripheral vessels, butT Patients without an adequate distal sealing zone had the entry tear located near the aortic arch. In these cases, we could protect perfusion to the supra-aortic vessels by means of a branched endograft or transposition of the great vessels.…”

“…The LCCA could then be opened for insertion of the stent. 10 Pinaud et al 17 chose the transapical approach, commonly used for TAVI, for endovascular treatment of TAAD due to the inaccessible peripheral vessels, butT these alternatives might increase the rate of complications.…”

“…Furthermore, almost all the reports of successful endovascular treatment of TAAD employed the closest coronary artery as the landmark during the procedure. 6–10,17,18…”

Commentary: Endovascular Repair of the Ascending Aorta: Have We Reached the Moon?

“…Many of the cases presented in the literature are in fact subacute or chronic type A dissections where extension of the dissection is often limited to the ascending aorta (DeBakey type II). [8][9][10] Off-the-shelf dedicated tubular stent-grafts such as the Zenith Ascend are a step forward, but future type A devices will likely move beyond a short cylindrical design; they will cover the entire outer curve of the ascending aorta and deal with an aortic root most commonly dissected at least in the non-coronary sinus. In fact, there remains a long way before we reach the moon: combining TEVAR and transcatheter aortic valve intervention in a smooth and non-calcified aortic valve.…”