Stéphan Haulon1, Roy K Greenberg2, Rafaëlle Spear3, Matt Eagleton2, Cherrie Abraham4, Christos Lioupis4, Eric Verhoeven5, Krassi Ivancev6, Tilo Kölbel7, Brendan Stanley8, Timothy Resch9, Pascal Desgranges10, Blandine Maurel3, Blayne Roeder11, Timothy Chuter12, Tara Mastracci2. 1. Aortic Centre, Hôpital Cardiologique, Centre Hospitalier Régional Universitaire de Lille, Lille, France. Electronic address: stephan.haulon@chru-lille.fr. 2. Vascular Surgery, Cleveland Clinic Foundation, Cleveland, Ohio. 3. Aortic Centre, Hôpital Cardiologique, Centre Hospitalier Régional Universitaire de Lille, Lille, France. 4. Vascular Surgery, Jewish General Hospital, McGill University, Montreal, Quebec, Canada. 5. Vascular and Endovascular Surgery, Klinikum Nürnberg Süd, Nürnberg, Germany. 6. Vascular Surgery, Royal Free Hospital, London, England. 7. Vascular Medecine, University Hospital Eppendorf, Hamburg, Germany. 8. Vascular Surgery, Fremantle Hospital, Perth, Australia. 9. Vascular Center, Skane University Hospital, Malmö, Sweden. 10. Vascular Center, Centre Hospitalier Universitaire Mondor, Créteil, France. 11. Cook Medical, Bloomington, Ind. 12. Vascular Surgery, Univeristy of California, San Francisco, San Francisco, Calif.
Abstract
BACKGROUND: Branched endografts are a new option to treat arch aneurysm in high-risk patients. METHODS AND RESULTS: We performed a retrospective multicenter analysis of all patients with arch aneurysms treated with a new branched endograft designed with 2 inner branches to perfuse the supra aortic trunks. Thirty-eight patients were included. The median age was 71 years (range, 64-74 years). An American Society of Anesthesiologists score of 3 or 4 was reported in 89.5% (95% confidence interval [CI], 79.7-99.3) of patients. The 30-day mortality rate was 13.2% (95% CI, 2.2-24.2). Technical success was obtained in 32 patients (84.2% [95% CI, 72.4-95.9]). Early secondary procedures were performed in 4 patients (10.5% [95% CI, 0.7-20.3]). Early cerebrovascular complications were diagnosed in 6 patients (15.8% [95% CI, 4.0-27.6]), including 4 transient ischemic attacks, 1 stroke, and 1 subarachnoid hemorrhage. The median follow-up was 12 months (range, 6-12 months). During follow-up, no aneurysm-related death was detected. Secondary procedures during follow-up were performed in 3 patients (9.1% [95% CI, 0.0-19.1]), including 1 conversion to open surgery. We compared the first 10 patients (early experience group) with the subsequent 28 patients. Intraoperative complications and secondary procedures were significantly higher in the early experience group. Although not statistically significant, the early mortality was higher in the early experience group (30% [95% CI, 0.0-60.0]) versus the remainder (7.1% [95% CI, 0.0-16.9]; P=.066). Being part of the early experience group and ascending aortic diameter≥38 mm were found to be associated to higher rates of combined early mortality and neurologic complications. CONCLUSIONS: Our preliminary study confirms the feasibility and safety of the endovascular repair of arch aneurysms in selected patients who may not have other conventional options. CLINICAL TRIAL REGISTRATION INFORMATION: Thoracic IDE NCT00583817, FDA IDE# 000101.
BACKGROUND: Branched endografts are a new option to treat arch aneurysm in high-risk patients. METHODS AND RESULTS: We performed a retrospective multicenter analysis of all patients with arch aneurysms treated with a new branched endograft designed with 2 inner branches to perfuse the supra aortic trunks. Thirty-eight patients were included. The median age was 71 years (range, 64-74 years). An American Society of Anesthesiologists score of 3 or 4 was reported in 89.5% (95% confidence interval [CI], 79.7-99.3) of patients. The 30-day mortality rate was 13.2% (95% CI, 2.2-24.2). Technical success was obtained in 32 patients (84.2% [95% CI, 72.4-95.9]). Early secondary procedures were performed in 4 patients (10.5% [95% CI, 0.7-20.3]). Early cerebrovascular complications were diagnosed in 6 patients (15.8% [95% CI, 4.0-27.6]), including 4 transient ischemic attacks, 1 stroke, and 1 subarachnoid hemorrhage. The median follow-up was 12 months (range, 6-12 months). During follow-up, no aneurysm-related death was detected. Secondary procedures during follow-up were performed in 3 patients (9.1% [95% CI, 0.0-19.1]), including 1 conversion to open surgery. We compared the first 10 patients (early experience group) with the subsequent 28 patients. Intraoperative complications and secondary procedures were significantly higher in the early experience group. Although not statistically significant, the early mortality was higher in the early experience group (30% [95% CI, 0.0-60.0]) versus the remainder (7.1% [95% CI, 0.0-16.9]; P=.066). Being part of the early experience group and ascending aortic diameter≥38 mm were found to be associated to higher rates of combined early mortality and neurologic complications. CONCLUSIONS: Our preliminary study confirms the feasibility and safety of the endovascular repair of arch aneurysms in selected patients who may not have other conventional options. CLINICAL TRIAL REGISTRATION INFORMATION: Thoracic IDE NCT00583817, FDA IDE# 000101.
Authors: Theodorus M van Bakel; Hector W de Beaufort; Santi Trimarchi; Massimiliano M Marrocco-Trischitta; Jean Bismuth; Frans L Moll; Himanshu J Patel; Joost A van Herwaarden Journal: Ann Cardiothorac Surg Date: 2018-05
Authors: Alexander A Brescia; Himanshu J Patel; Donald S Likosky; Tessa M F Watt; Xiaoting Wu; Raymond J Strobel; Karen M Kim; Shinichi Fukuhara; Bo Yang; G Michael Deeb; Michael P Thompson Journal: Ann Thorac Surg Date: 2019-08-07 Impact factor: 4.330