Total endovascular arch repair: Initial experience in BolognaCentral MessagePerspective
Objectives: In the last few years, fenestrated, branched, or scalloped custom grafts have become available for aortic arch repair. Open surgery is the gold standard, but arch thoracic endovascular aortic repair (TEVAR) is indicated for high-risk patients. We focused on total endovascular aortic arch...
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Elsevier
2024-12-01
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| Series: | JTCVS Techniques |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666250724003602 |
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| author | Luca Di Marco, MD, PhD Chiara Nocera, MD, PhD Francesco Buia, MD Francesco Campanini, MD Domenico Attinà, MD Giacomo Murana, MD Luigi Lovato, MD Davide Pacini, MD, PhD |
| author_facet | Luca Di Marco, MD, PhD Chiara Nocera, MD, PhD Francesco Buia, MD Francesco Campanini, MD Domenico Attinà, MD Giacomo Murana, MD Luigi Lovato, MD Davide Pacini, MD, PhD |
| author_sort | Luca Di Marco, MD, PhD |
| collection | DOAJ |
| description | Objectives: In the last few years, fenestrated, branched, or scalloped custom grafts have become available for aortic arch repair. Open surgery is the gold standard, but arch thoracic endovascular aortic repair (TEVAR) is indicated for high-risk patients. We focused on total endovascular aortic arch replacement with a zone 0 or zone 1 landing zone to describe its short- and long-term outcomes. Methods: We retrospectively analyzed patients who underwent arch TEVAR with a zone 0 or zone 1 landing zone at our center. We then performed a Kaplan-Meier analysis for survival and freedom from reintervention at follow-up. Results: From May 2017 to November 2023, 15 patients underwent elective arch TEVAR, having been deemed unfit for open surgery. Mean age was 74.7 ± 7.8 years. The most frequent procedure was fenestrated endovascular aortic repair with a left carotid-subclavian bypass (LCSB) (6; 40%), followed by double-branched graft with LCSB (5; 33.3%) and triple-branched graft (2; 13.3%) and scalloped graft with LCSB (2; 13.3%). There was 1 in-hospital death (6.7%). Perioperative stroke occurred in 2 cases (13.3%). Mean follow-up (FU) time was 16.4 ± 15.1 months. There were 3 deaths at FU, all for noncardiovascular causes, and 1 stroke at FU. One patient required further stenting of the brachiocephalic trunk for a type III endoleak. Survival at 12 months was 87.5% and freedom from reintervention was 85.7%. Conclusions: Total endovascular aortic arch repair with custom-made prosthesis is a safe and effective procedure in patients with prohibitive surgical risk. Stroke remains the main complication with significant rates. |
| format | Article |
| id | doaj-art-9a3367fc5a0b47d9b10a28ac3ab5b588 |
| institution | Kabale University |
| issn | 2666-2507 |
| language | English |
| publishDate | 2024-12-01 |
| publisher | Elsevier |
| record_format | Article |
| series | JTCVS Techniques |
| spelling | doaj-art-9a3367fc5a0b47d9b10a28ac3ab5b5882025-08-20T03:38:26ZengElsevierJTCVS Techniques2666-25072024-12-01281710.1016/j.xjtc.2024.08.025Total endovascular arch repair: Initial experience in BolognaCentral MessagePerspectiveLuca Di Marco, MD, PhD0Chiara Nocera, MD, PhD1Francesco Buia, MD2Francesco Campanini, MD3Domenico Attinà, MD4Giacomo Murana, MD5Luigi Lovato, MD6Davide Pacini, MD, PhD7Cardiac Surgery Unit, Department of Medical and Surgical Sciences, DIMEC, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Department of Medical and Surgical Sciences, DIMEC, University of Bologna, Bologna, Italy; Address for reprints: Luca Di Marco, MD, PhD, Division of Cardiac Surgery, Cardio-Thoraco-Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico di Sant’Orsola, Via Massarenti 9, Bologna, 40138, Italy.Cardiac Surgery Unit, Department of Medical and Surgical Sciences, DIMEC, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, ItalyPediatric and Adult CardioThoracic and Vascular, Oncohematologic and Emergency Radiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, ItalyCardiac Surgery Unit, Department of Medical and Surgical Sciences, DIMEC, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, ItalyPediatric and Adult CardioThoracic and Vascular, Oncohematologic and Emergency Radiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, ItalyCardiac Surgery Unit, Department of Medical and Surgical Sciences, DIMEC, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, ItalyPediatric and Adult CardioThoracic and Vascular, Oncohematologic and Emergency Radiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, ItalyCardiac Surgery Unit, Department of Medical and Surgical Sciences, DIMEC, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Department of Medical and Surgical Sciences, DIMEC, University of Bologna, Bologna, ItalyObjectives: In the last few years, fenestrated, branched, or scalloped custom grafts have become available for aortic arch repair. Open surgery is the gold standard, but arch thoracic endovascular aortic repair (TEVAR) is indicated for high-risk patients. We focused on total endovascular aortic arch replacement with a zone 0 or zone 1 landing zone to describe its short- and long-term outcomes. Methods: We retrospectively analyzed patients who underwent arch TEVAR with a zone 0 or zone 1 landing zone at our center. We then performed a Kaplan-Meier analysis for survival and freedom from reintervention at follow-up. Results: From May 2017 to November 2023, 15 patients underwent elective arch TEVAR, having been deemed unfit for open surgery. Mean age was 74.7 ± 7.8 years. The most frequent procedure was fenestrated endovascular aortic repair with a left carotid-subclavian bypass (LCSB) (6; 40%), followed by double-branched graft with LCSB (5; 33.3%) and triple-branched graft (2; 13.3%) and scalloped graft with LCSB (2; 13.3%). There was 1 in-hospital death (6.7%). Perioperative stroke occurred in 2 cases (13.3%). Mean follow-up (FU) time was 16.4 ± 15.1 months. There were 3 deaths at FU, all for noncardiovascular causes, and 1 stroke at FU. One patient required further stenting of the brachiocephalic trunk for a type III endoleak. Survival at 12 months was 87.5% and freedom from reintervention was 85.7%. Conclusions: Total endovascular aortic arch repair with custom-made prosthesis is a safe and effective procedure in patients with prohibitive surgical risk. Stroke remains the main complication with significant rates.http://www.sciencedirect.com/science/article/pii/S2666250724003602endovascularaortic archstent graftsTEVARBEVARFEVAR |
| spellingShingle | Luca Di Marco, MD, PhD Chiara Nocera, MD, PhD Francesco Buia, MD Francesco Campanini, MD Domenico Attinà, MD Giacomo Murana, MD Luigi Lovato, MD Davide Pacini, MD, PhD Total endovascular arch repair: Initial experience in BolognaCentral MessagePerspective JTCVS Techniques endovascular aortic arch stent grafts TEVAR BEVAR FEVAR |
| title | Total endovascular arch repair: Initial experience in BolognaCentral MessagePerspective |
| title_full | Total endovascular arch repair: Initial experience in BolognaCentral MessagePerspective |
| title_fullStr | Total endovascular arch repair: Initial experience in BolognaCentral MessagePerspective |
| title_full_unstemmed | Total endovascular arch repair: Initial experience in BolognaCentral MessagePerspective |
| title_short | Total endovascular arch repair: Initial experience in BolognaCentral MessagePerspective |
| title_sort | total endovascular arch repair initial experience in bolognacentral messageperspective |
| topic | endovascular aortic arch stent grafts TEVAR BEVAR FEVAR |
| url | http://www.sciencedirect.com/science/article/pii/S2666250724003602 |
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