Aortic remodeling following hybrid arch repair with zone 0 to 5 thoracic endovascular aortic repairs for complex arch and descending thoracic aortic pathologiesCentral MessagePerspective
Objective: For high-risk patients with aortic arch pathology, hybrid aortic arch repair with simultaneous or staged thoracic endovascular repair of the descending aorta may be a viable alternative to open repair. However, data on postintervention aortic remodeling remain limited. We report the short...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2024-02-01
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| Series: | JTCVS Open |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666273623004205 |
| _version_ | 1797303930676314112 |
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| author | Irbaz Hameed, MD Adham Ahmed, BS Stevan Pupovac, MD Naiem Nassiri, MD Roland Assi, MD, MMS Prashanth Vallabhajosyula, MD, MS |
| author_facet | Irbaz Hameed, MD Adham Ahmed, BS Stevan Pupovac, MD Naiem Nassiri, MD Roland Assi, MD, MMS Prashanth Vallabhajosyula, MD, MS |
| author_sort | Irbaz Hameed, MD |
| collection | DOAJ |
| description | Objective: For high-risk patients with aortic arch pathology, hybrid aortic arch repair with simultaneous or staged thoracic endovascular repair of the descending aorta may be a viable alternative to open repair. However, data on postintervention aortic remodeling remain limited. We report the short-term outcomes of remodeling of the thoracoabdominal aorta after hybrid arch repair + thoracic endovascular repair. Methods: All patients undergoing hybrid arch repair with planned zones 0 to 5 thoracic endovascular repair from January 2020 to March 2022 were retrospectively reviewed. Computed tomography angiography scans preoperatively, after hybrid aortic arch repair, and on long-term follow-up were analyzed for thoracoabdominal aorta remodeling. Mean change in aortic true luminal diameter and full luminal diameter was calculated at every level, and paired-samples t test was used to compare means. Results: Of 39 patients, 38 had follow-up data at a mean duration of 14.9 months. There were a total of 3 (7.7%) deaths, 0 (0.0%) strokes, and 0 (0.0%) paralysis. For the 35 patients undergoing thoracic endovascular repair for aortic dissection, at follow-up, there was a significant increase in the mean true luminal diameter at each level (P < .05), except at the aortic bifurcation and common iliac arteries. The largest increase in mean true luminal diameter (P < .01) was observed at the level of the left inferior pulmonary vein (mean difference +13.22 mm, 95% CI, 10.38-16.07), tracheal carina (mean difference +13.06 mm, 95% CI, 10.05-16.07), and inferior left atrium (mean difference +11.19 mm, 95% CI, 7.84-14.53). Conclusions: Hybrid arch repair with zones 0 to 5 leads to improved true lumen augmentation in zones 0 to 8 with complete false lumen thrombosis down to zone 5 at short-term follow-up. Zones 9 to 11, if involved, may require adjunctive treatment strategies for total aortic remodeling and complete false lumen obliteration. |
| first_indexed | 2024-03-07T23:59:45Z |
| format | Article |
| id | doaj.art-662158d94fe642e39589d5ca8196728c |
| institution | Directory Open Access Journal |
| issn | 2666-2736 |
| language | English |
| last_indexed | 2024-03-07T23:59:45Z |
| publishDate | 2024-02-01 |
| publisher | Elsevier |
| record_format | Article |
| series | JTCVS Open |
| spelling | doaj.art-662158d94fe642e39589d5ca8196728c2024-02-18T04:44:16ZengElsevierJTCVS Open2666-27362024-02-01172336Aortic remodeling following hybrid arch repair with zone 0 to 5 thoracic endovascular aortic repairs for complex arch and descending thoracic aortic pathologiesCentral MessagePerspectiveIrbaz Hameed, MD0Adham Ahmed, BS1Stevan Pupovac, MD2Naiem Nassiri, MD3Roland Assi, MD, MMS4Prashanth Vallabhajosyula, MD, MS5Division of Cardiac Surgery, Department of Surgery, Yale University School of Medicine, New Haven, ConnDivision of Cardiac Surgery, Department of Surgery, Yale University School of Medicine, New Haven, ConnDivision of Cardiac Surgery, Department of Surgery, Yale University School of Medicine, New Haven, ConnDivision of Vascular Surgery, Department of Surgery, Yale University School of Medicine, New Haven, ConnDivision of Cardiac Surgery, Department of Surgery, Yale University School of Medicine, New Haven, ConnDivision of Cardiac Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Conn; Address for reprints: Prashanth Vallabhajosyula, MD, MS, Division of Cardiac Surgery, Department of Surgery, Yale School of Medicine, Yale Aortic Institute, 330 Cedar St, New Haven, CT 06510.Objective: For high-risk patients with aortic arch pathology, hybrid aortic arch repair with simultaneous or staged thoracic endovascular repair of the descending aorta may be a viable alternative to open repair. However, data on postintervention aortic remodeling remain limited. We report the short-term outcomes of remodeling of the thoracoabdominal aorta after hybrid arch repair + thoracic endovascular repair. Methods: All patients undergoing hybrid arch repair with planned zones 0 to 5 thoracic endovascular repair from January 2020 to March 2022 were retrospectively reviewed. Computed tomography angiography scans preoperatively, after hybrid aortic arch repair, and on long-term follow-up were analyzed for thoracoabdominal aorta remodeling. Mean change in aortic true luminal diameter and full luminal diameter was calculated at every level, and paired-samples t test was used to compare means. Results: Of 39 patients, 38 had follow-up data at a mean duration of 14.9 months. There were a total of 3 (7.7%) deaths, 0 (0.0%) strokes, and 0 (0.0%) paralysis. For the 35 patients undergoing thoracic endovascular repair for aortic dissection, at follow-up, there was a significant increase in the mean true luminal diameter at each level (P < .05), except at the aortic bifurcation and common iliac arteries. The largest increase in mean true luminal diameter (P < .01) was observed at the level of the left inferior pulmonary vein (mean difference +13.22 mm, 95% CI, 10.38-16.07), tracheal carina (mean difference +13.06 mm, 95% CI, 10.05-16.07), and inferior left atrium (mean difference +11.19 mm, 95% CI, 7.84-14.53). Conclusions: Hybrid arch repair with zones 0 to 5 leads to improved true lumen augmentation in zones 0 to 8 with complete false lumen thrombosis down to zone 5 at short-term follow-up. Zones 9 to 11, if involved, may require adjunctive treatment strategies for total aortic remodeling and complete false lumen obliteration.http://www.sciencedirect.com/science/article/pii/S2666273623004205aneurysmaortic archdissectionhybrid arch repairthoracic endovascular repair |
| spellingShingle | Irbaz Hameed, MD Adham Ahmed, BS Stevan Pupovac, MD Naiem Nassiri, MD Roland Assi, MD, MMS Prashanth Vallabhajosyula, MD, MS Aortic remodeling following hybrid arch repair with zone 0 to 5 thoracic endovascular aortic repairs for complex arch and descending thoracic aortic pathologiesCentral MessagePerspective JTCVS Open aneurysm aortic arch dissection hybrid arch repair thoracic endovascular repair |
| title | Aortic remodeling following hybrid arch repair with zone 0 to 5 thoracic endovascular aortic repairs for complex arch and descending thoracic aortic pathologiesCentral MessagePerspective |
| title_full | Aortic remodeling following hybrid arch repair with zone 0 to 5 thoracic endovascular aortic repairs for complex arch and descending thoracic aortic pathologiesCentral MessagePerspective |
| title_fullStr | Aortic remodeling following hybrid arch repair with zone 0 to 5 thoracic endovascular aortic repairs for complex arch and descending thoracic aortic pathologiesCentral MessagePerspective |
| title_full_unstemmed | Aortic remodeling following hybrid arch repair with zone 0 to 5 thoracic endovascular aortic repairs for complex arch and descending thoracic aortic pathologiesCentral MessagePerspective |
| title_short | Aortic remodeling following hybrid arch repair with zone 0 to 5 thoracic endovascular aortic repairs for complex arch and descending thoracic aortic pathologiesCentral MessagePerspective |
| title_sort | aortic remodeling following hybrid arch repair with zone 0 to 5 thoracic endovascular aortic repairs for complex arch and descending thoracic aortic pathologiescentral messageperspective |
| topic | aneurysm aortic arch dissection hybrid arch repair thoracic endovascular repair |
| url | http://www.sciencedirect.com/science/article/pii/S2666273623004205 |
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