P352. Total endovascular arch repair: Initial Experience in Bologna
Bologna, Bologna
Italy - Contact Me
Luca Di Marco is an assistant professor of cardiac surgery and consultant cardiac surgeon at the Cardiac Surgery Unit of the S. Orsola University Hospital, Bologna, Italy. He received his MD graduation and his PhD from the University of Bologna, and during his training in Cardiac Surgery he focused his interest and research on diseases of the thoracic aorta and on cerebral protection in aortic arch surgery with Antegrade Selective Cerebral Perfusion. During and after his training in cardiac surgery, he carried out several fellowships, stages and observership periods at qualified and important international centers ( St. Luc Hospital UCL, Brussels, Belgium; Cardiothoracic Department London Chest Hospital, London, UK; Department of Cardiothoracic Surgery, St. Antonious Ziekenhuis, Nieuwegein, Netherlands; Department of Cardiovascular and Thoracic Surgery, University of Pennsylvania, Philadelphia, USA; Department of Cardiovascular Surgery Herzzentrum, Freiburg, Germany; Deutsches Herzzentrum Berlin, Germany). He is currently co-chairman and member of the Italian Group of Study on Outcome in Cardiac Surgery (GIROC) - Italian Society for Cardiac Surgery (SICCH), and co-responsible of the TEVAR outpatient clinic at Cardiac Surgery Unit of the University Hospital of Bologna. His main practice and scientific areas include aortic and mitral valve repair, minimally invasive surgery, open and endovascular surgery of the thoracic aorta, cerebral protection, heart trasplantation. He is author and co-author of more than 150 publications.
Description
Total endovascular repair of the aortic arch is an evolving field. In the last few years, several options, including fenestrated, branched or scalloped custom grafts have become available to adapt to the complex anatomy of the aortic arch. While open surgery is still the gold standard, endovascular arch replacement allows treatment in a wide cohort of patients with increased surgical risk and appropriate anatomy. Much of the literature available on the matter includes hybrid procedures with previous debranching of the supra-aortic trunks (SATs) or procedures with a zone 2 landing zone. Our aim is to focus on total endovascular aortic arch replacement with a zone 0 or zone 1 landing zone to describe its short- and long-term outcomes.
Methods
This is a single-center, retrospective study. From May 2017 to November 2023, 15 patients underwent total endovascular aortic arch repair with a zone 0 or zone 1 landing zone. We retrospectively collected patients' data. We performed a Kaplan-Meier analysis to evaluate survival and freedom from reintervention at follow-up.
Results
The study population was 15 patients. Mean age was 74.7 ± 7.8 years. All were elective cases. Indications were aortic aneurysms (6; 40%), followed by penetrating ulcers (5; 33.3%), dissections (2; 13.3%) and pseudoaneurysms (2; 13.3%). All patients were evaluated to have a prohibitive risk for open surgery. The main risk factors were hypertension (11; 73.3%), COPD (5,33.3%), renal failure (2; 13.3%) and coronary artery disease (1; 6.7%).
The most frequently performed procedure was aortic arch fenestrated EVAR (FEVAR) associated 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%). In two cases a scalloped graft was used on the left carotid artery, associated with LCSB (2; 13.3%).
There was 1 in-hospital death, caused by an ischemic stroke with hemorrhagic transformation. Perioperative stroke occurred in 2 cases (both in the Double branched group, both showed patent SAT stents at the CT- scan). There was no occurrence of spinal cord injury or retrograde dissection.
Mean follow-up (FU) time was 16.4±15.1 months. There were 3 deaths at FU, all for non-cardiovascular causes, and 1 stroke at FU. One patient also required reintervention, which was performed by further stenting of the brachio-cephalic trunk for a type III endoleak. In our analysis, 12-month survival was 87.5% and freedom from reintervention was 85.7% (Figure 1).
Conclusions
Total endovascular aortic arch repair with custom-made prosthesis is a safe and effective procedure in the cohort of patients with prohibitive surgical risk, even though stroke remains the main complication with still significant rates. Our initial experience showed promising results.
Authors
Luca Di Marco (1), Chiara Nocera (1), Francesco Buia (2), Francesco Campanini (1), Domenico Attinà (2), Vincenzo Russo (2), Luigi Lovato (2), Davide Pacini (3)
Institutions
(1) IRCCS Azienda Ospedaliero-Universitaria di Bologna, Alma Mater Studiorum Università di Bologna, Bologna, Italy, (2) Division of Radiology. IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy., Bologna, Italy, (3) IRCCS Azienda Ospedaliero-Universitaria di Bologna, Alma Mater Studiorum Università di Bologna, Depa, Bologna, Italy