Zone zero hybrid arch exclusion versus open total arch replacement

Preventza, Ourania; Tan, Corinne W.; Orozco-Sevilla, Vicente; Euhus, Caleb J.; Coselli, Joseph S.

doi:10.21037/acs.2018.04.03

Cited by 25 publications

(11 citation statements)

References 53 publications

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“…Another advantage of the Siena graft is the creation of a reliable proximal neck or landing zone for subsequent endovascular/surgical repair in lesions involving the distal arch with low procedural morbidity and a reduced rate of neurologic complications. 27 This expanded ET concept means that lesions traditionally requiring thoracoabdominal incisions (and possibly circulatory arrest) are amenable to treatment through median sternotomy (29% of patients in this series). Our experience in dissection patients demonstrates that redirecting the arterial flow into the true lumen, resolving the arch reentries by arch replacement, and using the distal “soft” portion of the graft to cover lesions on the proximal part of the flap in the descending aorta, can result in the spontaneous thrombosis of the false lumen (19 patients with chronic dissection in this cohort).…”

Section: Discussionmentioning

confidence: 99%

Arch replacement with collared elephant trunks: The Siena approach

et al. 2021

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Objective: To illustrate our experience and results in patients with diffuse aneurysmal disease treated with arch replacement using the Siena collared graft, a device designed in 2002 to improve the elephant trunk technique. Results of the first step surgical implant and the subsequent treatment strategies, with extensive use of endovascular techniques, are reported.Methods: All aortic arch-replacement procedures using the Siena graft between February 2002 and January 2020 were retrospectively analyzed for early and late clinical outcomes.Results: Of 146 patients (54 women, 36.9%) with a median age of 69.1 years (interquartile range 58.4-75.0 years), 55 (37.6%) had acute/chronic dissection with false lumen aneurysmal dilatation, 91 (62.3%) had degenerative aneurysms, 45 (30.8%) were redo operations, and 14 (9.5%) had connective tissue disease. First-stage outcomes: 10.9% 30-day mortality (n ¼ 16); 5.4% stroke (n ¼ 8, 6 disabling, 2 nondisabling; 3 fatal); and 0.6% paraplegia. Outcomes for 113 second-stage procedures (77.3%, n ¼ 97 endovascular [66.4%], n ¼ 16 surgical [10.9%]) were 5.3% and 8.8% 30-day and 180-day mortality; no stroke; 10.6% paraplegia. Median followup was 5.7 years (range: 0-18.02 years) median survival was 16.65 years (95% lower confidence limit, 10.06 years) with no significant difference between aneurysm and dissection patients. Freedom from further treatment was 87.0% (95% confidence interval, 79.9%-94.7%) at 5 years and 71.4% (95% confidence interval, 71.4%-84.7%) at 10 years; median time to reintervention was 2.59 years (interquartile range, 0.52-5.20 years) with no difference (P ¼ .22) between dissection and aneurysm groups.Conclusions: Siena collared graft represents a reliable platform for the treatment of diffuse aneurysmal disease. This device offers the flexibility required in the treatment of extended aortic lesions and guarantees the choice of the most appropriate approach for treatment completion. In this context, the availability of hybrid grafts has not modified the role of this device in arch surgery. (JTCVS Techniques 2021;6:13-27) Three steps of a "delayed frozen" elephant trunk approach.

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Section: Discussionmentioning

confidence: 99%

Arch replacement with collared elephant trunks: The Siena approach

et al. 2021

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“…In addition, the mortality rates of zone 0 landing TEVAR were 5% to 12% in previous studies, which is considered high. 1,4,[8][9][10][11][12][13] The fenestrated and the chimney graft technique were prevalently used for their minimal invasiveness and have substituted for the hybrid TEVAR procedure. The fenestrated devices are perforated in the cervical branch of the stent-graft that helps sustain blood flow to those areas.…”

Section: Discussionmentioning

confidence: 99%

“…In addition, the mortality rates of zone 0 landing TEVAR were 5% to 12% in previous studies, which is considered high. 1 , 4 , 8 , 9 , 10 , 11 , 12 , 13 …”

Section: Discussionmentioning

confidence: 99%

Early and midterm results of thoracic endovascular aortic repair using a branched endograft for aortic arch pathologies: A retrospective single-center study

et al. 2020

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Background: Zone 0 landing hybrid thoracic endovascular aortic repair (TEVAR) includes a few moderately invasive surgical procedures. To reduce invasiveness, TE-VAR with a branched aortic arch stent-graft can be considered. This study aimed to elucidate the effectiveness of performing TEVAR using a Bolton (Bolton Medical, Inc, Sunrise, Fla) branched endograft by analyzing early and midterm results.Methods: We enrolled 28 patients (mean age, 78.4 years) who underwent TEVAR with the Bolton branched endograft in Osaka University Hospital between October 2012 and June 2018 with a mean follow-up period of 4.0 years. Double-side and single-side branched devices were used in 24 (85.7%) and 4 (14.3%) patients, respectively.Results: All procedures were successful; no cases of endoleak or conversion to open repair were noted during the 30-day postoperative period. The perioperative stroke rate was 14.3% (4 out of 28); midterm stroke was not detected. All patients with perioperative stroke had atheroma grade !2 in the brachiocephalic artery. No type 1a endoleak was reported during the early or midterm results. The cumulative survival rate, aorta-related death-free rate, and aortic event-free survival rate at 5 years were 80.8%, 95.8%, and 81.6%, respectively. Conclusions:We achieved satisfactory early and midterm results by using a Bolton branched endograft for high-risk patients with arch pathologies except for high postoperative stroke. Although this treatment method is associated with postoperative stroke, performing strict evaluation of atheroma may prevent such complication. By preventing intraoperative stroke, TEVAR with this custom-made Bolton branched endograft may be considered a less-invasive treatment. (JTCVS Techniques 2020;4:17-25) Schematic of thoracic endovascular repair using the Bolton branched endograft. CENTRAL MESSAGEEarly and midterm results of thoracic endovascular aortic repair using a Bolton branched endograft show that preoperative strict atheroma evaluation is important for preventing postoperative stroke. PERSPECTIVEWhen using a custom-made Bolton branched endograft, it is essential to prevent perioperative stroke. The development of perioperative stroke may be prevented by performing a strict preoperative evaluation of atheroma. By preventing perioperative stroke, thoracic endovascular aortic repair using a custom-made Bolton branched endograft may become a less-invasive treatment.

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“…In contrast, type II and III "hybrid" aortic arch repair require circulatory support and/or circulatory arrest with selective antegrade cerebral perfusion to perform conventional graft replacement of the ascending aorta and/ or the transverse arch, respectively. This type of intervention is optimized by using pre-constituted, multibranched grafts with the supra-aortic branches already incorporated in a hemodynamically favorable geometry on the main body of the prosthesis (17,26,27).…”

Section: Arch Debranchingmentioning

confidence: 99%

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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Zone zero hybrid arch exclusion versus open total arch replacement

Cited by 25 publications

References 53 publications

Arch replacement with collared elephant trunks: The Siena approach

Arch replacement with collared elephant trunks: The Siena approach

Early and midterm results of thoracic endovascular aortic repair using a branched endograft for aortic arch pathologies: A retrospective single-center study

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

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