International experience with endovascular therapy of the ascending aorta with a dedicated endograft

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• 作者：Nikolaos Tsilimparis ; MD ; PhD^a ; ^{n.tsilimparis@uke.de" class="auth_mail" title="E-mail the corresponding author} ; E. Sebastian Debus ; MD ; PhD^a ; Gustavo S. Oderich ; MD^b ; Stephan Haulon ; MD^c ; Kim Allan Terp ; MD^d ; Blayne Roeder^e ; Christian Detter ; MD ; PhD^a ; Tilo Kö ; lbel ; MD ; PhD^a
• 刊名：Journal of Vascular Surgery
• 出版年：2016
• 出版时间：June 2016
• 年：2016
• 卷：63
• 期：6
• 页码：1476-1482
• 全文大小：776 K

文摘

The objective of this study was to evaluate the safety and feasibility of a novel stent graft specifically designed for treatment of the ascending aorta.

Methods

This was a multicenter, retrospective analysis of all consecutive patients treated with the dedicated Zenith Ascend TAA Endovascular Graft (William Cook Europe, Bjaeverskov, Denmark) for pathologic processes requiring stent grafting of the ascending aorta. The graft is short (6.5 cm), with a delivery system designed for transfemoral placement in the ascending aorta.

Results

In 10 patients (five men; age, 67 years; range, 26-90 years), the Zenith Ascend graft was implanted for the following indications: dissection (n = 5) and aneurysm (n = 4) of the ascending aorta and fixation of an intraprocedural dislocated aortic valve (n = 1). All patients were judged to be at high risk for open surgery (nine patients were classified as American Society of Anesthesiologists class 3 or class 4). A transfemoral approach was selected in eight cases and a transapical approach in two. All endografts were successfully deployed without intraoperative adverse events at the targeted landing zone. Clinical success in coverage of the lesions was achieved in all cases with the exception of an attempted treatment of an intraprocedural aortic valve implantation dissection that resulted in early mortality. The 30-day survival was 90%. Early neurologic events included one patient with stroke and paraplegia and one patient with a transient ischemic attack. One patient underwent early evacuation of a hemopericardium. There were two late reinterventions for persisting endoleaks. At a mean follow-up of 10 months (range, 1-36 months), three late deaths occurred, with one treatment related, as a result of graft infection.

Conclusions

Despite the fact that in this first published series the graft was frequently used as a “rescue tool” outside its intended indication, treatment with the Zenith Ascend graft in this early experience appears to be safe and feasible for repair of ascending aorta pathologic processes in high-risk patients unsuitable for open repair.