P221. Multi-Vessel Arch Branch Ostial Stenosis: Outcome of Extra-Anatomical Bypasses
Presented During: POD Abstracts (Available for viewing in the exhibit hall for the duration of the meeting)
Quebec Heart & Lung University Institut, Division of Cardiac Surgery
Quebec, QC
Canada - Contact Me
Dr Francois Dagenais is a graduate from University of Montreal and Stanford University. He started his career at Institut Universitaire de Cardiologie et Pneumologie de Quebec in 2000. He has concentrated his clinical work in the field of aortic surgery; innovating in stent-grafting and complex repair of the thoracic aorta. His other clinical expertise are in mitral surgery and emerging percutaneous platforms. His research interests are in aortic surgery with over 250 peer review publications.
Thursday, April 25, 2024: 5:38 PM - 7:00 PM
Sheraton Times Square
Room: Central Park
Description
Objective: Symptomatic multivessel arch branch ostial stenosis (MVABS) is a rare condition. Operative technique remains controversial and few reports assess long-term outcome. We propose a strategy incorporating the use of aorto-axillary extra-anatomical bypass (AAEAB) grafts in the management of patients with symptomatic MVABS. Early and late outcomes are reported.
Methods: Since 2015, 8 consecutive patients with symptomatic (>2) MVABS were referred for operative treatment. All operations were conducted without cardiopulmonary bypass. A multi-branch dacron graft with a 12 or 14mm main branch anastomosed to the ascending aorta was initially constructed. The AAEAB (es) was (were) initially performed to increase cerebral perfusion through the posterior circulation. Subsequently, the most severe carotid artery was revascularized in an end to end fashion followed by revascularization of the other arch branch vessels. Patients were followed prospectively in a dedicated aortic clinic
Results: Mean age was 63,6±3,4yrs; 87,5% female. A mean of 3,1±0,8 bypasses/pt were performed; with right and left AAEAB in respectively 6 and 7 patients. No stroke or hospital death were encountered. One patient required a tracheostomy for 4 days owing to partial bilateral recurrent nerve palsy. At a mean of 3,6±3,2yrs, two patients died of non-vascular causes (80% 5-yr survival). Patients remained free of recurrent symptoms. Among 27 grafts, one carotid graft showed a stenosis requiring stenting 3 years postoperatively (85,7% 5-yr bypass patency; 100% patency of AAEAB grafts)
Conclusion: Operative treatment of symptomatic multivessel arch branch ostial offers excellent symptom relief. Use of AAEAB bypass is safe, enhances cerebral perfusion through the posterior circulation before revascularizing the carotid arteries. Mid-term outcome shows excellent clinical outcome with excellent graft patency.
Authors
Francois Dagenais (1), Rim Abdelli (2), Roxanne St-Louis (3), Eric Dumont (4)
Institutions
(1) Quebec Heart and Lung Insitute, Quebec, Quebec, (2) Quebec Heart and Lung Institute, Quebec, Qc, (3) Quebec Heart and Lung Institute, Quebec City, QC, (4) Quebec Heart and Lung Institute, Quebec, QC
Methods: Since 2015, 8 consecutive patients with symptomatic (>2) MVABS were referred for operative treatment. All operations were conducted without cardiopulmonary bypass. A multi-branch dacron graft with a 12 or 14mm main branch anastomosed to the ascending aorta was initially constructed. The AAEAB (es) was (were) initially performed to increase cerebral perfusion through the posterior circulation. Subsequently, the most severe carotid artery was revascularized in an end to end fashion followed by revascularization of the other arch branch vessels. Patients were followed prospectively in a dedicated aortic clinic
Results: Mean age was 63,6±3,4yrs; 87,5% female. A mean of 3,1±0,8 bypasses/pt were performed; with right and left AAEAB in respectively 6 and 7 patients. No stroke or hospital death were encountered. One patient required a tracheostomy for 4 days owing to partial bilateral recurrent nerve palsy. At a mean of 3,6±3,2yrs, two patients died of non-vascular causes (80% 5-yr survival). Patients remained free of recurrent symptoms. Among 27 grafts, one carotid graft showed a stenosis requiring stenting 3 years postoperatively (85,7% 5-yr bypass patency; 100% patency of AAEAB grafts)
Conclusion: Operative treatment of symptomatic multivessel arch branch ostial offers excellent symptom relief. Use of AAEAB bypass is safe, enhances cerebral perfusion through the posterior circulation before revascularizing the carotid arteries. Mid-term outcome shows excellent clinical outcome with excellent graft patency.
Authors
Francois Dagenais (1), Rim Abdelli (2), Roxanne St-Louis (3), Eric Dumont (4)
Institutions
(1) Quebec Heart and Lung Insitute, Quebec, Quebec, (2) Quebec Heart and Lung Institute, Quebec, Qc, (3) Quebec Heart and Lung Institute, Quebec City, QC, (4) Quebec Heart and Lung Institute, Quebec, QC
Presentation Duration
PODS will be on display in the exhibit hall for the duration of the meeting during exhibit hall hours. PODS will also be available for viewing on the meeting website. There is no formal presentation associated with your POD, but we encourage you to visit the PODS area during breaks to connect with those viewing.