P361. Two-Year Outcomes of Endovascular Repair of Isolated Thoracic Aortic Lesions Using a Single-Branch Thoracic Endograft with Left Subclavian Artery Preservation
Duke University
Durham, NC
United States - Contact Me
Dr. Hughes is Professor of Surgery (with tenure) and Chief of the Section of Aortic Disease in the Divisions of Thoracic and Cardiovascular Surgery and Vascular and Endovascular Surgery at Duke University Medical Center. He is Director of the Duke Center for Aortic Disease and Surgical Director of the Duke Center for Structural Heart Disease. He earned his undergraduate degree from Wake Forest University, where he was a Phi Beta Kappa graduate and varsity letterman in baseball, and his medical degree from Duke University School of Medicine, where he was elected to Alpha Omega Alpha, followed by general and thoracic surgery training at Duke.
Dr. Hughes is an internationally recognized leader in aortic surgery, with expertise spanning complex aortic valve repair and valve-sparing procedures, open and endovascular aortic reconstruction, branched thoracic endovascular repair, and transcatheter aortic valve therapies.
His research focuses on clinical outcomes, device innovation, and neurocognitive protection in aortic surgery. He has served as principal investigator for more than 30 multicenter clinical trials and was the co-principal investigator of an NIH R01-funded randomized trial examining the cognitive effects of body temperature during hypothermic circulatory arrest. He currently serves as National Co–Principal Investigator for the Gore TBE Zone 0/1 Post-Approval Study and is a member of the Steering Committee for the Gore ARISE II and III trials.
Dr. Hughes has authored more than 300 peer-reviewed publications and book chapters and serves as Senior Editor for Adult Cardiac Surgery for The Annals of Thoracic Surgery. He has contributed to major national and international guideline and reporting documents, including EACTS/STS aortic disease guidelines, and served as Co-Chair of the SVS/STS Type B Aortic Dissection Reporting Standards Writing Group (2017–2019). He serves on the Executive Council of the Southern Thoracic Surgical Association.
Description
Hughes GC, Dake MD, Patel HJ, Matsumura JS, Panneton JM, Azizzadeh A, Lee JT, Brinkman WT, Lumsden AB, Long CA.
Objective. Thoracic endovascular aortic repair (TEVAR) has become the preferred management strategy for most pathologies (aneurysm, dissection, trauma, other) involving the descending thoracic aorta. When coverage of the left subclavian artery (LSA) is required during TEVAR to achieve adequate proximal landing zone (PLZ), revascularization of the LSA is recommended. Branched aortic endografts represent an alternative to surgical LSA revascularization.
Methods. Across 34 investigative sites, 13 adult patients with isolated lesions (non-aneurysm, non-dissection, non-trauma) of the descending thoracic aorta requiring zone 2 PLZ were enrolled in a nonrandomized, prospective study of a single-branched aortic endograft (Gore TAG Thoracic Branch Endoprosthesis (TBE), W.L. Gore and Associates, Flagstaff, AZ). The TBE device allows for zone 2 coverage and incorporates a single side branch for maintenance of LSA perfusion.
Results. Mean patient age was 65±13 years and 54% of patients were female. Pathologies treated included intramural hematoma (IMH) in 23% (n=3/13), penetrating aortic ulcer in 39% (n=5/13), and other isolated aortic lesion in 39% (n=5/13). Procedural technical success rate was 100%; 31% (n=4/13) of patients required distal thoracic endografting, in addition to the TBE device, for complete exclusion of their aortic pathology. Median procedure time was 142 [66,357] minutes. 30-day/in-hospital mortality, stroke, paraparesis/paraplegia, and new dialysis rates were all 0%. Through 24-month complete core laboratory adjudicated imaging follow-up, there have been no type I or III endoleaks, loss of LSA branch patency, or re-interventions. One (8%) patient, who underwent index intervention for an IMH, suffered a new acute type B dissection due to distal stent graft-induced new entry at 533 days postoperatively which resulted in aortic rupture and late death. An additional 3 (23%) patients suffered late deaths due to non-aorta related causes including cerebral hemorrhage (n=1; POD 129) and respiratory failure (n=2; POD 167 & 875). Through 24 months, no patients had aortic enlargement (>5mm) and there were no cases of wire fracture, migration, or compression.
Conclusions. Two-year results from a multi-center, prospective, non-randomized cohort study utilizing an investigational single-branched thoracic endograft for maintaining LSA perfusion in patients with isolated lesions of the descending thoracic aorta demonstrates excellent perioperative and early mid-term outcomes and avoids the need for concomitant surgical LSA revascularization in patients with appropriate anatomy. Longer-term follow up is needed to ensure continued branch graft patency and sustained protection from aortic events.
Authors
G. Chad Hughes (1), Michael Dake (2), Himanshu Patel (3), Jon Matsumura (4), Jean Panneton (5), Ali Azizzadeh (6), Jason Lee (7), William Brinkman (8), Alan Lumsden (9), Chandler Long (1)
Institutions
(1) Duke University Medical Center, Durham, NC, (2) University of Arizona Health Sciences, Tuscon, AZ, (3) University of Michigan Hospital, Ann Arbor, MI, (4) University of Colorado Health, Aurora, CO, (5) Sentara Vascular Specialists, Norfolk, VA, (6) Cedars-Sinai Medical Center, Los Angeles, CA, (7) Stanford University, STANFORD, CA, (8) Baylor Scott & White Health, TX, (9) Houston Methodist, Houston, TX