P346. Thoracic Branched Endoprosthesis: Single-Institution Experience
Presented During: POD Abstracts (Available for viewing in the exhibit hall for the duration of the meeting)
University of Colorado Anschutz Medical Center
Aurora, CO
United States - Contact Me
I am a fourth year general surgery resident at the University of Colorado. I have a background in clinical reseach and hold a Masters in Clinical Research from the University of Michigan School of Public Health. I'm interested in clinical outcomes in aortic surgery and heart failure.
Thursday, April 25, 2024: 5:38 PM - 7:00 PM
Sheraton Times Square
Room: Central Park
Description
Objective: Thoracic branched endoprosthesis (TBE) gained FDA approval in May 2022, offering an alternative to surgical revascularization of left subclavian artery (LSCA) territory for patients undergoing thoracic endovascular aortic repair (TEVAR) for aortic pathology abutting or proximal to the take-off of the LSCA. Prior reports have described reduced total length of stay (LOS) without difference in outcomes. We sought to describe our institution's experience with TBEs during the first year of our institutional practice.
Methods: We performed a retrospective review of prospectively collected clinical data from all patients undergoing TBE at a single tertiary care center from September 2022 through October 2023. Data were retrieved from the electronic medical record. Patients whose primary indication for hospital admission was not related to aortic pathology were excluded.
Results: Twenty-seven patients met the inclusion criteria and underwent TBE during the study period. Twenty (74.1%) were male with a median age of 63.3 (IQR 53.3–73.9) years. Median BMI was 28.3 (IQR 26.0–30.5). Comorbidities and cardiac surgical history are shown in Table 1. Fifteen (55.6%) patients had an aortic aneurysm, 13 (48.1%) had an aortic dissection, and 6 (22.2%) had a penetrating aortic ulcer.
Twenty-three (85.2%) cases were performed electively and 4 (14.8%) were performed urgently. Two (7.4%) patients underwent Ishimaru zone 0 repair, 3 (11.1%) underwent zone 1 repair, and 22 (81.5%) underwent zone 2 repair. Twenty (74.1%) patients had native flow through their innominate artery and 16 (59.3%) through their left carotid artery (LCA). Six (22.2%) patients had extra-anatomic bypasses of their innominate, 11 (40.7%) of their LCA, and 1 (3.7%) of their LSCA.
Mean LOS was 3.6 ± 2.6 days and mean ICU LOS was 1.8 ± 1.5 days. No operations were converted to open operations. Two (7.4%) patients experienced postoperative access site hemorrhage and 1 (3.7%) experienced intraoperative lower extremity ischemia. No upper extremity access complications occurred. Two (7.4%) patients experienced an intraoperative Type II endoleak. One (3.7%) patient experienced an intraoperative cerebrovascular accident. One (3.7%) patient experienced postoperative acute kidney injury according to STS criteria but did not need renal replacement therapy. One (3.7%) patient has undergone reoperation with open arch replacement. There were no deaths during postoperative hospitalization.
Conclusions: The implementation of TBE at our institution aligns with initial proof-of-concept reports. TBE is a well-tolerated procedure with minimal operative and postoperative morbidity and shortened total LOS compared with traditional surgical revascularization and TEVAR.
Authors
Michael Kirsch (1), Adam Carroll (1), Donald Jacobs (1), Rafael Malgor (1), Muhammad Aftab (1), T. Brett Reece (1)
Institutions
(1) University of Colorado Anschutz, Denver, CO
Methods: We performed a retrospective review of prospectively collected clinical data from all patients undergoing TBE at a single tertiary care center from September 2022 through October 2023. Data were retrieved from the electronic medical record. Patients whose primary indication for hospital admission was not related to aortic pathology were excluded.
Results: Twenty-seven patients met the inclusion criteria and underwent TBE during the study period. Twenty (74.1%) were male with a median age of 63.3 (IQR 53.3–73.9) years. Median BMI was 28.3 (IQR 26.0–30.5). Comorbidities and cardiac surgical history are shown in Table 1. Fifteen (55.6%) patients had an aortic aneurysm, 13 (48.1%) had an aortic dissection, and 6 (22.2%) had a penetrating aortic ulcer.
Twenty-three (85.2%) cases were performed electively and 4 (14.8%) were performed urgently. Two (7.4%) patients underwent Ishimaru zone 0 repair, 3 (11.1%) underwent zone 1 repair, and 22 (81.5%) underwent zone 2 repair. Twenty (74.1%) patients had native flow through their innominate artery and 16 (59.3%) through their left carotid artery (LCA). Six (22.2%) patients had extra-anatomic bypasses of their innominate, 11 (40.7%) of their LCA, and 1 (3.7%) of their LSCA.
Mean LOS was 3.6 ± 2.6 days and mean ICU LOS was 1.8 ± 1.5 days. No operations were converted to open operations. Two (7.4%) patients experienced postoperative access site hemorrhage and 1 (3.7%) experienced intraoperative lower extremity ischemia. No upper extremity access complications occurred. Two (7.4%) patients experienced an intraoperative Type II endoleak. One (3.7%) patient experienced an intraoperative cerebrovascular accident. One (3.7%) patient experienced postoperative acute kidney injury according to STS criteria but did not need renal replacement therapy. One (3.7%) patient has undergone reoperation with open arch replacement. There were no deaths during postoperative hospitalization.
Conclusions: The implementation of TBE at our institution aligns with initial proof-of-concept reports. TBE is a well-tolerated procedure with minimal operative and postoperative morbidity and shortened total LOS compared with traditional surgical revascularization and TEVAR.
Authors
Michael Kirsch (1), Adam Carroll (1), Donald Jacobs (1), Rafael Malgor (1), Muhammad Aftab (1), T. Brett Reece (1)
Institutions
(1) University of Colorado Anschutz, Denver, CO
Presentation Duration
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