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Thoracic Endovascular Aortic Repair (TEVAR) in Proximal (Type A) Aortic Dissection: Ready for a Broader Application?

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Thoracic Endovascular Aortic Repair (TEVAR) in Proximal (Type A) Aortic Dissection: Ready for a Broader Application? / Nienaber, Christoph A.; Sakalihasan, Natzi; Clough, Rachel E.; Aboukoura, Mohamed; Mancuso, Enrico; Yeh, James S.M.; Defraigne, Jean-Olivier; Cheshire, Nick; Rosendahl, Ulrich Peter; Quarto, Cesare; Pepper, John.

In: Journal of Thoracic and Cardiovascular Surgery, 29.08.2016.

Research output: Contribution to journalArticle

Harvard

Nienaber, CA, Sakalihasan, N, Clough, RE, Aboukoura, M, Mancuso, E, Yeh, JSM, Defraigne, J-O, Cheshire, N, Rosendahl, UP, Quarto, C & Pepper, J 2016, 'Thoracic Endovascular Aortic Repair (TEVAR) in Proximal (Type A) Aortic Dissection: Ready for a Broader Application?', Journal of Thoracic and Cardiovascular Surgery. https://doi.org/10.1016/j.jtcvs.2016.07.078

APA

Nienaber, C. A., Sakalihasan, N., Clough, R. E., Aboukoura, M., Mancuso, E., Yeh, J. S. M., ... Pepper, J. (2016). Thoracic Endovascular Aortic Repair (TEVAR) in Proximal (Type A) Aortic Dissection: Ready for a Broader Application? Journal of Thoracic and Cardiovascular Surgery. https://doi.org/10.1016/j.jtcvs.2016.07.078

Vancouver

Nienaber CA, Sakalihasan N, Clough RE, Aboukoura M, Mancuso E, Yeh JSM et al. Thoracic Endovascular Aortic Repair (TEVAR) in Proximal (Type A) Aortic Dissection: Ready for a Broader Application? Journal of Thoracic and Cardiovascular Surgery. 2016 Aug 29. https://doi.org/10.1016/j.jtcvs.2016.07.078

Author

Nienaber, Christoph A. ; Sakalihasan, Natzi ; Clough, Rachel E. ; Aboukoura, Mohamed ; Mancuso, Enrico ; Yeh, James S.M. ; Defraigne, Jean-Olivier ; Cheshire, Nick ; Rosendahl, Ulrich Peter ; Quarto, Cesare ; Pepper, John. / Thoracic Endovascular Aortic Repair (TEVAR) in Proximal (Type A) Aortic Dissection: Ready for a Broader Application?. In: Journal of Thoracic and Cardiovascular Surgery. 2016.

Bibtex Download

@article{49ac32973060497b8dc2025fd6588c0b,
title = "Thoracic Endovascular Aortic Repair (TEVAR) in Proximal (Type A) Aortic Dissection: Ready for a Broader Application?",
abstract = "ObjectiveThoracic endovascular aortic repair (TEVAR) has demonstrated encouraging results and is gaining increasing acceptance as a treatment option for aortic aneurysms and dissections. Yet, its role in managing proximal aortic pathologies is unknown - this is important because in proximal (Stanford type A) aortic dissections, 10-30{\%} are not accepted for surgery, and 30-50{\%} are technically amenable for TEVAR. We describe our case series of type A aortic dissections treated using TEVAR.MethodsBetween year 2009 and 2016, 12 patients with acute, subacute or chronic type A aortic dissection with the proximal entry tear located between the coronaries and brachiocephalic artery were treated with TEVAR at 3 centers. Various stent-graft configurations were used to seal the proximal entry tear in the ascending aorta under rapid pacing.Results12 patients (9 male, 3 female), mean age 81±7 years, EuroSCORE II 9.1±4.5, underwent TEVAR for the treatment of type A aortic dissection. Procedural success was achieved in 11/12 patients (91.7{\%}). There was one intra-procedural death and one minor stroke. No additional deaths at 30 days. At 36 months, there were 4 further deaths (all from non-aortic causes). The mean survival of these 4 deceased was 23 months (range 15-36 months). Follow-up computed tomography demonstrated favorable aortic remodeling.ConclusionTEVAR is feasible and reveals promising early results in selected patients with type A aortic dissection who are poor candidates for surgical repair. The current iteration of stent-graft technology however needs to be adapted to the specific features of the ascending aorta.",
author = "Nienaber, {Christoph A.} and Natzi Sakalihasan and Clough, {Rachel E.} and Mohamed Aboukoura and Enrico Mancuso and Yeh, {James S.M.} and Jean-Olivier Defraigne and Nick Cheshire and Rosendahl, {Ulrich Peter} and Cesare Quarto and John Pepper",
year = "2016",
month = "8",
day = "29",
doi = "10.1016/j.jtcvs.2016.07.078",
language = "English",
journal = "Journal of Thoracic and Cardiovascular Surgery",
issn = "0022-5223",

}

RIS (suitable for import to EndNote) Download

TY - JOUR

T1 - Thoracic Endovascular Aortic Repair (TEVAR) in Proximal (Type A) Aortic Dissection: Ready for a Broader Application?

AU - Nienaber, Christoph A.

AU - Sakalihasan, Natzi

AU - Clough, Rachel E.

AU - Aboukoura, Mohamed

AU - Mancuso, Enrico

AU - Yeh, James S.M.

AU - Defraigne, Jean-Olivier

AU - Cheshire, Nick

AU - Rosendahl, Ulrich Peter

AU - Quarto, Cesare

AU - Pepper, John

PY - 2016/8/29

Y1 - 2016/8/29

N2 - ObjectiveThoracic endovascular aortic repair (TEVAR) has demonstrated encouraging results and is gaining increasing acceptance as a treatment option for aortic aneurysms and dissections. Yet, its role in managing proximal aortic pathologies is unknown - this is important because in proximal (Stanford type A) aortic dissections, 10-30% are not accepted for surgery, and 30-50% are technically amenable for TEVAR. We describe our case series of type A aortic dissections treated using TEVAR.MethodsBetween year 2009 and 2016, 12 patients with acute, subacute or chronic type A aortic dissection with the proximal entry tear located between the coronaries and brachiocephalic artery were treated with TEVAR at 3 centers. Various stent-graft configurations were used to seal the proximal entry tear in the ascending aorta under rapid pacing.Results12 patients (9 male, 3 female), mean age 81±7 years, EuroSCORE II 9.1±4.5, underwent TEVAR for the treatment of type A aortic dissection. Procedural success was achieved in 11/12 patients (91.7%). There was one intra-procedural death and one minor stroke. No additional deaths at 30 days. At 36 months, there were 4 further deaths (all from non-aortic causes). The mean survival of these 4 deceased was 23 months (range 15-36 months). Follow-up computed tomography demonstrated favorable aortic remodeling.ConclusionTEVAR is feasible and reveals promising early results in selected patients with type A aortic dissection who are poor candidates for surgical repair. The current iteration of stent-graft technology however needs to be adapted to the specific features of the ascending aorta.

AB - ObjectiveThoracic endovascular aortic repair (TEVAR) has demonstrated encouraging results and is gaining increasing acceptance as a treatment option for aortic aneurysms and dissections. Yet, its role in managing proximal aortic pathologies is unknown - this is important because in proximal (Stanford type A) aortic dissections, 10-30% are not accepted for surgery, and 30-50% are technically amenable for TEVAR. We describe our case series of type A aortic dissections treated using TEVAR.MethodsBetween year 2009 and 2016, 12 patients with acute, subacute or chronic type A aortic dissection with the proximal entry tear located between the coronaries and brachiocephalic artery were treated with TEVAR at 3 centers. Various stent-graft configurations were used to seal the proximal entry tear in the ascending aorta under rapid pacing.Results12 patients (9 male, 3 female), mean age 81±7 years, EuroSCORE II 9.1±4.5, underwent TEVAR for the treatment of type A aortic dissection. Procedural success was achieved in 11/12 patients (91.7%). There was one intra-procedural death and one minor stroke. No additional deaths at 30 days. At 36 months, there were 4 further deaths (all from non-aortic causes). The mean survival of these 4 deceased was 23 months (range 15-36 months). Follow-up computed tomography demonstrated favorable aortic remodeling.ConclusionTEVAR is feasible and reveals promising early results in selected patients with type A aortic dissection who are poor candidates for surgical repair. The current iteration of stent-graft technology however needs to be adapted to the specific features of the ascending aorta.

U2 - 10.1016/j.jtcvs.2016.07.078

DO - 10.1016/j.jtcvs.2016.07.078

M3 - Article

JO - Journal of Thoracic and Cardiovascular Surgery

JF - Journal of Thoracic and Cardiovascular Surgery

SN - 0022-5223

ER -

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