Status of branched endovascular aortic arch repair

Bakel, Theodorus M. J. van; Beaufort, Hector W. de; Trimarchi, Santi; Marrocco-Trischitta, Massimiliano M.; Bismuth, Jean; Moll, Frans L.; Patel, Himanshu J.; Herwaarden, Joost A. van

doi:10.21037/acs.2018.03.13

Cited by 61 publications

(49 citation statements)

References 33 publications

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“…Because of its superior early and mid-term outcomes over open surgery, the use of TEVAR is rapidly increasing [2]. The treatment range for TEVAR is extending with endografts deployed more proximally into the aortic arch and in younger patients [3][4][5]. Current endografts are made of materials much stiffer than the native thoracic aorta [6,7].…”

Section: Introductionmentioning

confidence: 99%

Cardiac remodelling following thoracic endovascular aortic repair for descending aortic aneurysms

Bakel

Arthurs

Nauta

et al. 2018

European Journal of Cardio-Thoracic Surgery

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OBJECTIVES Current endografts for thoracic endovascular aortic repair (TEVAR) are much stiffer than the aorta and have been shown to induce acute stiffening. In this study, we aimed to estimate the impact of TEVAR on left ventricular (LV) stroke work (SW) and mass using a non-invasive image-based workflow. METHODS The University of Michigan database was searched for patients treated with TEVAR for descending aortic pathologies (2013–2016). Patients with available pre-TEVAR and post-TEVAR computed tomography angiography and echocardiography data were selected. LV SW was estimated via patient-specific fluid–structure interaction analyses. LV remodelling was quantified through morphological measurements using echocardiography and electrocardiographic-gated computed tomography angiography data. RESULTS Eight subjects were included in this study, the mean age of the patients was 68 (73, 25) years, and 6 patients were women. All patients were prescribed antihypertensive drugs following TEVAR. The fluid–structure interaction simulations computed a 26% increase in LV SW post-TEVAR [0.94 (0.89, 0.34) J to 1.18 (1.11, 0.65) J, P = 0.012]. Morphological measurements revealed an increase in the LV mass index post-TEVAR of +26% in echocardiography [72 (73, 17) g/m2 to 91 (87, 26) g/m2, P = 0.017] and +15% in computed tomography angiography [52 (46, 29) g/m2 to 60 (57, 22) g/m2, P = 0.043]. The post- to pre-TEVAR LV mass index ratio was positively correlated with the post- to pre-TEVAR ratios of SW and the mean blood pressure (ρ = 0.690, P = 0.058 and ρ = 0.786, P = 0.021, respectively). CONCLUSIONS TEVAR was associated with increased LV SW and mass during follow-up. Medical device manufacturers should develop more compliant devices to reduce the stiffness mismatch with the aorta. Additionally, intensive antihypertensive management is needed to control blood pressure post-TEVAR.

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Section: Introductionmentioning

confidence: 99%

Cardiac remodelling following thoracic endovascular aortic repair for descending aortic aneurysms

Bakel

Arthurs

Nauta

et al. 2018

European Journal of Cardio-Thoracic Surgery

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“…As occurred for pure ascending TEVAR, arch branched technology is constrained by anatomical landmarks, aortic sizing, and curvatures. While technical success was in the 84-100% range, mortality rate has been reported up to 20% and stroke rate up to 40% due to extensive manipulation in severely diseased aortas (10,(21)(22)(23). However, a significant reduction over time due to learning curve effects has been reported and the incidence of type 1a endoleak has also been reported as less than that after total debranching (10,24) ( Figure 6A,B).…”

Section: Branched Stent Graftmentioning

confidence: 97%

Art of operative techniques: treatment options in arch penetrating aortic ulcer

Lomazzi

Grassi

Domanin

et al. 2019

Ann. Cardiothorac. Surg.

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Penetrating aortic ulcer (PAU) of the arch has a focal extent which often represents an adequate anatomic target for thoracic endovascular aortic repair (TEVAR). However, the anatomic constraints represented by the supra-aortic vessels pose either clinical or technical challenges that increase when the PAU develops proximally in the arch. Currently, different types of endografts are commercially available and have been used to treat aortic arch lesions. These include branched/fenestrated endografts for a total endovascular approach, and standard devices that can be used in combination with open/hybrid surgical operations, with the aim to exploit the minimally invasive nature of TEVAR by extending the proximal landing zone when necessary. We describe several current techniques adopted in such settings.

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“…Endovascular repair of the ascending aorta and arch has been described in case reports, but there are ongoing trials investigating new devices specific for these anatomic zones. [34][35][36] The management of patients with acute type B aortic dissection (ATBAD) is based on complicated or uncomplicated patient presentations. Patients presenting with severe hypertension, persistent pain, malperfusion, or rupture are considered complicated.…”

Section: Aortic Dissectionmentioning

confidence: 99%

Thoracic Aortic Emergencies: Presenting Pathologies and Treatment Strategies

Sheeran

Zelickson

Wilkins

et al. 2020

Semin intervent Radiol

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Thoracic aortic emergencies reflect a wide range of etiologies, pathologic processes, and clinical presentations. Accurate identification with an appropriate treatment algorithm is best accomplished in a multidisciplinary setting with interventional radiologists, vascular surgeons, and cardiothoracic surgeons. While knowledge of thoracic stent graft equipment and technique is essential in the treatment of thoracic aortic emergencies, many clinical settings may employ alternative treatment techniques. This article will review the most common thoracic aortic emergencies and treatment strategies.

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Status of branched endovascular aortic arch repair

Cited by 61 publications

References 33 publications

Cardiac remodelling following thoracic endovascular aortic repair for descending aortic aneurysms

Cardiac remodelling following thoracic endovascular aortic repair for descending aortic aneurysms

Art of operative techniques: treatment options in arch penetrating aortic ulcer

Thoracic Aortic Emergencies: Presenting Pathologies and Treatment Strategies

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