Charles P E Milne1, Mau Amako2, Rafaelle Spear3, Rachel E Clough3, Adrien Hertault3, Jonathan Sobocinski3, Wendy Brown4, Stéphan Haulon5. 1. Aortic Center, Hôpital Cardiologique, Centre Hospitalier Régional Universitaire de Lille, Lille, France; Department of Surgery, The Alfred Hospital, Monash University, Melbourne, Victoria, Australia. 2. Aortic Center, Hôpital Cardiologique, Centre Hospitalier Régional Universitaire de Lille, Lille, France; Department of Cardiovascular Surgery, Fukuoka University, Fukuoka, Japan. 3. Aortic Center, Hôpital Cardiologique, Centre Hospitalier Régional Universitaire de Lille, Lille, France. 4. Department of Surgery, The Alfred Hospital, Monash University, Melbourne, Victoria, Australia. 5. Aortic Center, Hôpital Cardiologique, Centre Hospitalier Régional Universitaire de Lille, Lille, France. Electronic address: stephan.haulon@chru-lille.fr.
Abstract
BACKGROUND: The development of a postdissection aortic arch aneurysm after open ascending aortic replacement for type A dissection places the patient at increased risk for an open operation due to the need for redo sternotomy and total arch replacement. We conducted a computed tomography-based feasibility study to assess what proportion of these patients would be anatomically suitable for branched endograft repair of an arch aneurysm. We also aimed to identify ways to tailor the index operation to increase suitability for future endovascular repair. METHODS: Our study was conducted at the Aortic Centre, Lille University Hospital, Lille, France. Postoperative images were assessed for patients after open replacement of the ascending aorta for acute type A dissection in this center between 2009 and 2015 to determine suitability for use of an aortic arch inner-branched device. RESULTS: The assessment found 52 of 73 patients (71.2%) were anatomically suitable for treatment with the aortic arch inner-branched device. The only cause for absolute exclusion from suitability was the absence of a proximal landing zone in the ascending aorta. Reasons for this were the ascending aortic graft being too short (71.4%), the presence of a major kink in the graft (23.8%), and the graft diameter being too large (4.8%). CONCLUSIONS: Approximately 70% of patients with arch aneurysm formation after open ascending aortic replacement for type A dissection are anatomically suitable for treatment with the aortic arch inner-branched device. In the future, surgeons will be able to fashion the prosthetic graft at the time of the index operation to ensure it fulfills criteria for an adequate proximal landing zone.
BACKGROUND: The development of a postdissection aortic arch aneurysm after open ascending aortic replacement for type A dissection places the patient at increased risk for an open operation due to the need for redo sternotomy and total arch replacement. We conducted a computed tomography-based feasibility study to assess what proportion of these patients would be anatomically suitable for branched endograft repair of an arch aneurysm. We also aimed to identify ways to tailor the index operation to increase suitability for future endovascular repair. METHODS: Our study was conducted at the Aortic Centre, Lille University Hospital, Lille, France. Postoperative images were assessed for patients after open replacement of the ascending aorta for acute type A dissection in this center between 2009 and 2015 to determine suitability for use of an aortic arch inner-branched device. RESULTS: The assessment found 52 of 73 patients (71.2%) were anatomically suitable for treatment with the aortic arch inner-branched device. The only cause for absolute exclusion from suitability was the absence of a proximal landing zone in the ascending aorta. Reasons for this were the ascending aortic graft being too short (71.4%), the presence of a major kink in the graft (23.8%), and the graft diameter being too large (4.8%). CONCLUSIONS: Approximately 70% of patients with arch aneurysm formation after open ascending aortic replacement for type A dissection are anatomically suitable for treatment with the aortic arch inner-branched device. In the future, surgeons will be able to fashion the prosthetic graft at the time of the index operation to ensure it fulfills criteria for an adequate proximal landing zone.
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