Thoracic Endovascular Aortic Repair (TEVAR) in Proximal (Type A) Aortic Dissection: Ready for a Broader Application?
| Autor: | Ulrich Rosendahl, James S.M. Yeh, Enrico Mancuso, Jean-Olivier Defraigne, Mohamed Aboukoura, John Pepper, Rachel E. Clough, Nicholas J.W. Cheshire, Christoph A. Nienaber, Natzi Sakalihasan, Cesare Quarto |
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| Jazyk: | angličtina |
| Rok vydání: | 2016 |
| Předmět: |
Male
Pulmonary and Respiratory Medicine medicine.medical_specialty Aorta Thoracic Computed tomography 030204 cardiovascular system & hematology Prosthesis Design Aortic repair 03 medical and health sciences Imaging Three-Dimensional 0302 clinical medicine Euroscore ii medicine.artery Ascending aorta medicine Brachiocephalic artery Humans 030212 general & internal medicine Aged Retrospective Studies Aged 80 and over Surgical repair Aortic dissection Aortic Aneurysm Thoracic medicine.diagnostic_test business.industry Endovascular Procedures Thoracic Surgical Procedures medicine.disease Surgery Aortic Dissection Treatment Outcome Early results cardiovascular system Feasibility Studies Female Stents Radiology Tomography X-Ray Computed Cardiology and Cardiovascular Medicine business Follow-Up Studies |
| Zdroj: | Nienaber, C A, Sakalihasan, N, Clough, R E, Aboukoura, M, Mancuso, E, Yeh, J S M, Defraigne, J-O, Cheshire, N, Rosendahl, U P, Quarto, C & Pepper, J 2016, ' Thoracic Endovascular Aortic Repair (TEVAR) in Proximal (Type A) Aortic Dissection: Ready for a Broader Application? ', Journal of Thoracic and Cardiovascular Surgery . https://doi.org/10.1016/j.jtcvs.2016.07.078 |
| Popis: | Objective Thoracic endovascular aortic repair (TEVAR) has demonstrated encouraging results and is gaining increasing acceptance as a treatment option for aortic aneurysms and dissections. Yet, its role in managing proximal aortic pathologies is unknown—this is important because in proximal (Stanford type A) aortic dissections, 10% to 30% are not accepted for surgery and 30% to 50% are technically amenable for TEVAR. We describe our case series of type A aortic dissections treated by using TEVAR. Methods Between year 2009 and 2016, 12 patients with acute, subacute, or chronic type A aortic dissection with the proximal entry tear located between the coronaries and brachiocephalic artery were treated with TEVAR at 3 centers. Various stent-graft configurations were used to seal the proximal entry tear in the ascending aorta under rapid pacing. Results A total of 12 patients (9 male, 3 female), mean age 81 ± 7 years, EuroSCORE II 9.1 ± 4.5, underwent TEVAR for the treatment of type A aortic dissection. Procedural success was achieved in 11 of 12 patients (91.7%). There was 1 minor stroke and 1 intraprocedural death. No additional deaths were reported at 30 days. At 36 months, there were 4 further deaths (all from nonaortic causes). The mean survival of these 4 deceased was 23 months (range 15-36 months). Follow-up computed tomography demonstrated favorable aortic remodeling. Conclusions TEVAR is feasible and reveals promising early results in selected patients with type A aortic dissection who are poor candidates for surgical repair. The current iteration of stent-graft technology, however, needs to be adapted to features specific to the ascending aorta. |
| Databáze: | OpenAIRE |
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