Reference : Thoracic endovascular aortic repair (TEVAR) in proximal (type A) aortic dissection: R...
Scientific journals : Article
Human health sciences : Surgery
Thoracic endovascular aortic repair (TEVAR) in proximal (type A) aortic dissection: Ready for a broader application?
Nienaber, Christoph A. [> >]
Sakalihasan, Natzi mailto [Université de Liège > Département des sciences cliniques > Biologie pathologique des parois artérielles >]
Clough, Rachel E. [> >]
Aboukoura, Mohamed [> >]
Mancuso, Enrico [> >]
Yeh, James S. M. [> >]
Defraigne, Jean-Olivier mailto [Université de Liège > Département des sciences cliniques > Chirurgie cardio-vasculaire et thoracique >]
Cheshire, Nick [> >]
Rosendahl, Ulrich Peter [> >]
Quarto, Cesare [> >]
Pepper, John [> >]
Journal of Thoracic and Cardiovascular Surgery
Yes (verified by ORBi)
United States
[en] 3D reconstruction ; TEVAR ; aortic repair ; endovascular scaffold ; stent-graft ; type A aortic dissection
[en] 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.
Copyright (c) 2016 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

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