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New York Aortic Surgery Symposium 2010

The limited potential for hybridised thoracic endovascular aortic reconstruction in patients undergoing conventional aortic arch replacement. Mohamad Bashir, Aaron Ranasinghe, David Quin, Ben Holloway, Jorge Mascaro, Robert Bonser. New York Aortic Surgery Symposium 2010. Introduction.

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New York Aortic Surgery Symposium 2010

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  1. The limited potential for hybridised thoracic endovascular aortic reconstruction in patients undergoing conventional aortic arch replacement Mohamad Bashir, Aaron Ranasinghe, David Quin, Ben Holloway, Jorge Mascaro, Robert Bonser New York Aortic Surgery Symposium 2010

  2. Introduction • Thoracic endovascular aortic stent repair (TEVAR) is a rapidly developing technology in the treatment of aneurysms of the thoracic aorta • Use of TEVAR in patients with aneurysmal disease in the aortic arch has the ability to either • increase the number of potentially treatable patients or • Compete with traditional arch repair

  3. Objectives • Review of the pre-operative anatomy and operative data to assess the potential suitability of patients with aneurysmal aortic arch disease undergoing conventional surgical repair for hybrid TEVAR

  4. Methods • Consecutive patients undergoing conventional aortic arch surgery between January 2005 and October 2009 were identified from our prospectively maintained database • Pre-operative CT scans were sourced where available from our computerised hospital radiology database • Operation notes and follow-up data were obtained on all patients

  5. Methods • CT scans were analyzed to assess maximal distal ascending and proximal descending aortic short-axis diameter • Potential TEVAR landing zones were classified as a length of 20mm with a SAD < 40mm

  6. Results • 73 patients underwent conventional arch surgery during this time period • 62 (85%) underwent total arch • 11 (15%) underwent hemi-arch • 71 (97%) had conservation of a three vessel cranial circulation

  7. Pre-operative CT scans • Available in 42 (58%) • Median distal ascending SAD 5.4(4.2-6.5) cm • Median proximal descending SAD 3.8(3.0-4.8) cm • Of these only 17% and 19% had satisfactory zone 0 and zone 3 landing zones

  8. Operative details • 34 had documented atheroma of the supra-aortic vessels • 71 required replacement of the ascending aorta • 56 patients required additional proximal procedures • Aortic valve – 22 • Root – 33 • Mitral valve – 5 • CABG – 16 • 7 required descending aortic replacement • 39 had an elephant trunk procedure

  9. Conclusions • Only a minority of patients were suitable for TEVAR without zone 0 creation • In this series the majority of patients undergoing aortic arch replacement required additional procedures • The role of hybrid TEVAR in management of aortic arch pathology remains to be defined

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