Transapical Deployment of Thoracic Stent Graft for Ascending Aorta Coronary Bypass Pseudoaneurysm in a Patient with Prosthetic Aortic Valve

Abstract

The authors describe the transapical deployment of a thoracic endograft to exclude a saphenous vein graft proximal anastomotic pseudoaneurysm following coronary artery bypass grafting (CABG) in a 63-year-old male with a prosthetic aortic valve. A standard thoracic endograft has been deployed via transapical access after percutaneous transluminal coronary angioplasty of the native vessel perfused by the patent CABG. The procedure was uneventful; an 8-month computed tomography scan showed complete exclusion of the pseudoaneurysm with patency of supra-aortic trunks.

Thoracic endovascular aortic repair for an ascending aortic pseudoaneurysm

“…Pseudoaneurysms of the ascending aorta rarely arise from the cannulation sites of catheters or the proximal anastomosis of venous grafts for coronary artery bypass grafting. 1 , 2 In our patient, the pseudoaneurysm arose from the stump of a side branch of a prosthesis. This is considered rare and not previously reported.…”

“…The length of the ascending aorta from the sinotubular junction to the innominate artery varies from 5 to 10 cm, with most being between 6 and 7 cm. 2 , 4 Most commercially available endoprostheses have a minimum covered length of 10 cm. For these cases, the aortic extension cuff of an infrarenal endovascular system might be more suitable.…”

“…Other endovascular treatments for ascending aorta pathology include endoprostheses delivered through the left ventricular apex, embolization using a septal occluder device, and debranching thoracic endovascular aortic repair. 2 , 3 These treatments may be complicated and have the possibility of a left ventricular aneurysm, embolization with technical failures, instances of minor leakage, and end leakage. Therefore, we believe our treatment option to be reasonable.…”

Transapical Antegrade Ascending Aorta Stent-Grafting: Going Through the Front Door

“…The second patient was a 63-year-old male who underwent AVR, mitral valve repair, and double coronary bypass grafting (left internal mammary artery to left anterior descending coronary artery and saphenous vein to diagonal). 7 About 6 months later the patient underwent a routine echocardiography that showed a 6.5 cm aneurysm of the ascending aorta. A CTA was performed and it showed the presence of a 70 mm pseudoaneurysm originating from the proximal anastomosis between the venous graft and the ascending aorta (Fig.…”