Targeting landing zone 0 by total arch rerouting and TEVAR: midterm results of a transcontinental registry.
Publication/Presentation Date
7-1-2012
Abstract
BACKGROUND: Landing zone 0, defined as a proximal landing zone in the ascending aorta, remains the last frontier to be taken. Midterm results of total arch rerouting and thoracic endovascular aortic repair (TEVAR) extending into landing zone 0 remain to be determined.
METHODS: From 2003 to 2011, 66 patients (mean age, 70 years; 68% men) presenting with pathologic conditions affecting the aortic arch (atherosclerotic aneurysms [n = 48], penetrating ulcers [n = 6], type B dissections [n = 6], type B after type A dissections [n = 5], and anastomotic aneurysm [n = 1]) were treated in 5 participating centers. Of these 66 patients, only 12% would have been deemed suitable for any kind of conventional surgical repair because of multisegmental aortic disease or comorbidities.
RESULTS: In-hospital mortality was 9%. Retrograde type A dissection was observed in 3% of patients. The assisted type I and type III endoleak rate was 0%. Stroke was seen in 5% of patients. Permanent paraplegia was observed in 3% of those studied. Median follow-up was 25 months (8-41 months). There was 1 late type Ib endoleak, which was followed by watchful waiting. Five-year survival was 72%. Five-year aorta-related survival was 96%. No aorta-related reintervention had to be performed in the segments treated.
CONCLUSIONS: Midterm results of total arch rerouting and TEVAR extending into landing zone 0 are excellent in regard to aorta-related survival and freedom from aorta-related reintervention. Retrograde type A dissection, potentially related to compliance mismatch between the ascending aorta and the stent-graft, warrants further attention. Extended application of this strategy augments therapeutic options in a group of patients who are not suitable candidates for conventional therapy.
Volume
94
Issue
1
First Page
84
Last Page
89
ISSN
1552-6259
Published In/Presented At
Czerny, M., Weigang, E., Sodeck, G., Schmidli, J., Antona, C., Gelpi, G., Friess, T., Klocker, J., Szeto, W. Y., Moeller, P., Pochettino, A., & Bavaria, J. E. (2012). Targeting landing zone 0 by total arch rerouting and TEVAR: midterm results of a transcontinental registry. The Annals of thoracic surgery, 94(1), 84–89. https://doi.org/10.1016/j.athoracsur.2012.03.024
Disciplines
Medicine and Health Sciences
PubMedID
22595468
Department(s)
Department of Surgery
Document Type
Article