P137. Feasibility of Endovascular Arch Repair After Surgery For Type A Acute Aortic Dissection: Insights for A Lifetime Management of Aortic Dissection
Presented During: POD Abstracts (Available for viewing in the exhibit hall for the duration of the meeting)
"Tor Vergata" University of Rome, Rome, Italy
Roma, Rome
Italy - Contact Me
Professor of Cardiac Surgery at the University of Padova, Italy
Main interests: valve surgery, aortic surgery (open and endovascular), micro-invasive cardiac surgery, new technologies
Thursday, April 25, 2024: 5:38 PM - 7:00 PM
Sheraton Times Square
Room: Central Park
Description
Objective: Aim of this retrospective, multicenter study was to assess feasibility of endovascular repair of the aortic arch (Ar-TEVAR), with proximal landing in zone 0, in patients with a history of surgery for type A acute aortic dissection (TAAAD) and to identify reasons for infeasibility, particularly those modifiable during the first operation (e.g. short ascending graft) in order to enhance Ar-TEVAR feasibility rate.
Methods: We analyzed data from patients who underwent surgery for TAAAD at two centers from 1/2012 to 9/2023. Study devices were: a single-branch, off-the-shelf, dual module system (SB) and a double-branch, custom-made device (DB). Inclusion criteria were: ascending and/or hemiarch replacement (with no reimplantation of any supra-aortic vessel) at first operation; pre-discharge angio-CT scan available and of good quality, showing residual dissection of the aortic arch. Primary endpoint was the evaluation of Ar-TEVAR feasibility with the study devices; secondary endpoint was the identification of the causes of infeasibility overall and separately for the two study devices. Feasibility was assessed according to the anatomical requirements of each device provided by the manufacturers.
Results: Study population included 119 patients. Overall, Ar-TEVAR feasibility was 49.6% (59 patients). Ar-TEVAR with SB and DB devices was feasible in 38 (31.9%) and in 42 (35.3%), respectively (Figure 1). Reasons for infeasibility with the SB devices were: unsuitable proximal landing zone and unsuitable supra-aortic vessels in 39 (48.1%) and in 45 (55.6%) patients, respectively. Reasons for infeasibility with the DB devices were: unsuitable proximal landing zone and unsuitable supra-aortic vessels in 53 (68.8%) and in 45 (58.4%) patients, respectively. Notably, a short ascending graft was the reason for infeasibility in 33 (27.7%) and in 37 (31.1%) patients with the SB and the DB grafts, respectively. If these patients had received a longer ascending graft, overall feasibility would have been as high as 70.6% (84 patients).
Conclusions: Ar-TEVAR with SB and DB devices is feasible in nearly half of patients with a history of surgery for TAAAD. A short ascending graft made one third of patients unsuitable. With an appropriate ascending graft, feasibility would have increased to two thirds of patients. Lifetime management of patients with TAAAD commences at the time of the first operation with appropriate operative planning and optimal surgical strategy
Authors
Augusto D'Onofrio (1), Raphael Caraffa (2), Giorgia Cibin (3), Domenico Crea (4), Alberto Bortolato (5), Domenico Mangino (6), Michele Antonello (7), Michele Piazza (4), Gino Gerosa (8)
Institutions
(1) Padova, Padova, -, (2) N/A, N/A, (3) Policlinico Universitario, Rovigo, Italy, (4) University of Padova, PADOVA, NA, (5) Azienda Università Ospedale Padova, Padova, VA, (6) Azienda ULSS 3 Serenissima, Mogliano Veneto, Italy, (7) University of Padova, Padova, AL, (8) N/A, Padova, Italy
Methods: We analyzed data from patients who underwent surgery for TAAAD at two centers from 1/2012 to 9/2023. Study devices were: a single-branch, off-the-shelf, dual module system (SB) and a double-branch, custom-made device (DB). Inclusion criteria were: ascending and/or hemiarch replacement (with no reimplantation of any supra-aortic vessel) at first operation; pre-discharge angio-CT scan available and of good quality, showing residual dissection of the aortic arch. Primary endpoint was the evaluation of Ar-TEVAR feasibility with the study devices; secondary endpoint was the identification of the causes of infeasibility overall and separately for the two study devices. Feasibility was assessed according to the anatomical requirements of each device provided by the manufacturers.
Results: Study population included 119 patients. Overall, Ar-TEVAR feasibility was 49.6% (59 patients). Ar-TEVAR with SB and DB devices was feasible in 38 (31.9%) and in 42 (35.3%), respectively (Figure 1). Reasons for infeasibility with the SB devices were: unsuitable proximal landing zone and unsuitable supra-aortic vessels in 39 (48.1%) and in 45 (55.6%) patients, respectively. Reasons for infeasibility with the DB devices were: unsuitable proximal landing zone and unsuitable supra-aortic vessels in 53 (68.8%) and in 45 (58.4%) patients, respectively. Notably, a short ascending graft was the reason for infeasibility in 33 (27.7%) and in 37 (31.1%) patients with the SB and the DB grafts, respectively. If these patients had received a longer ascending graft, overall feasibility would have been as high as 70.6% (84 patients).
Conclusions: Ar-TEVAR with SB and DB devices is feasible in nearly half of patients with a history of surgery for TAAAD. A short ascending graft made one third of patients unsuitable. With an appropriate ascending graft, feasibility would have increased to two thirds of patients. Lifetime management of patients with TAAAD commences at the time of the first operation with appropriate operative planning and optimal surgical strategy
Authors
Augusto D'Onofrio (1), Raphael Caraffa (2), Giorgia Cibin (3), Domenico Crea (4), Alberto Bortolato (5), Domenico Mangino (6), Michele Antonello (7), Michele Piazza (4), Gino Gerosa (8)
Institutions
(1) Padova, Padova, -, (2) N/A, N/A, (3) Policlinico Universitario, Rovigo, Italy, (4) University of Padova, PADOVA, NA, (5) Azienda Università Ospedale Padova, Padova, VA, (6) Azienda ULSS 3 Serenissima, Mogliano Veneto, Italy, (7) University of Padova, Padova, AL, (8) N/A, Padova, Italy
Presentation Duration
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