Catheter-based treatment of the dissected ascending aorta: a systematic review
| Autor: | Ludwig K. von Segesser, Francesco Maisano, Changtian Wang, Enrico Ferrari |
|---|---|
| Přispěvatelé: | University of Zurich |
| Rok vydání: | 2020 |
| Předmět: |
Pulmonary and Respiratory Medicine
medicine.medical_specialty Catheters medicine.medical_treatment 610 Medicine & health Aorta Thoracic 030204 cardiovascular system & hematology 11171 Cardiocentro Ticino Blood Vessel Prosthesis Implantation 03 medical and health sciences 0302 clinical medicine medicine.artery Ascending aorta medicine Humans Stroke Aorta Aged Retrospective Studies Cause of death Aged 80 and over Aortic dissection Framingham Risk Score Aortic Aneurysm Thoracic business.industry Endovascular Procedures Stent General Medicine Middle Aged medicine.disease 10020 Clinic for Cardiac Surgery Surgery Catheter Treatment Outcome 030228 respiratory system Stents Cardiology and Cardiovascular Medicine business |
| Zdroj: | European Journal of Cardio-Thoracic Surgery. 59:80-91 |
| ISSN: | 1873-734X 1010-7940 |
| DOI: | 10.1093/ejcts/ezaa238 |
| Popis: | Summary OBJECTIVES Type A aortic dissection requires immediate surgical repair. Despite improvements in surgery and anaesthesia, there is still a considerable risk when high-risk patients are concerned. Less invasive endovascular treatments are under evaluation. We investigated the current status of catheter-based treatment for type A aortic dissection with the entry tear located in the ascending aorta. METHODS A PubMed search was supplemented by searching through bibliographies and key articles. Demographics, risk score, stent graft detail, access route, mortality, cause of death, complications, reinterventions and follow-up data were extracted and analysed. RESULTS Thirty-one articles (7 retrospective reports; 24 case reports/series) were included in the study. In total, 104 patients (mean age 71 ± 14 years) received endovascular treatment for acute (63) or chronic (41) type A dissection. A history of a major cardiac or aortic operation was present in 29 patients. The mean EuroSCORE II was 30 ± 20 in 4 reports. A total of 114 stent grafts were implanted: ‘off-the-shelf’, 65/114; custom made, 12/114; and modified, 7/114. Hospital complications included intraprocedural conversion to open surgery (2/104), stroke (2/104), coronary stenting (2/104), early endoleak (9/104) and repeat aortic endovascular treatment for endoleak (5/104). Hospital mortality was 10% (intraoperative death 2/104). Mean duration of follow-up time was 21 ± 21 months (range 1–81 months); follow-up data were available for 86 patients: 10 patients died of non-aortic-related causes; reintervention for aortic disease (endovascular repair or open surgery) was performed in 8 patients. CONCLUSIONS Catheter-based ascending aorta repair for type A aortic dissection with the entry tear in the ascending aorta can be considered in carefully selected high-risk patients. Further analysis and specifically designed devices are required. |
| Databáze: | OpenAIRE |
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