| Antegrade delivery of stent grafts to treat complex thoracic aortic disease. | |
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MedLine Citation:
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PMID: 20667347 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Thoracic aortic disease involving the aortic arch presents a challenge to cardiovascular surgeons. The purpose of this study was to establish the safety and efficacy of antegrade delivery techniques of aortic stent grafting for the treatment of high-risk, complex thoracic aortic disease. METHODS: From April 2007 to December 2009, 38 patients underwent stent graft repair of complex thoracic aortic diseases not otherwise amenable to standard retrograde delivery. Chart review, query of the Social Security Death Index, and three-dimensional analysis of computed tomography was performed. Indications were elective (n = 17), urgent (n = 11), or emergent (n = 10). Causes included coarctation (n = 1), acute aortic dissection (n = 4), traumatic transection (n = 2), and aneurysm or pseudoaneurysm (n = 31), of which 6 were ruptured. Sites of delivery included axillary (n = 4), ascending aorta (n = 18), and direct aortic placement (frozen elephant trunk, n = 16). Eleven were performed off-pump, 4 were performed on pump with a beating heart, 3 with cardiac arrest, and 20 under deep hypothermic circulatory arrest. Delivery was facilitated by transesophageal echocardiography alone (n = 14), or with fluoroscopy (n = 24). All devices used were commercially available (TAG, 18; Talent, 1; TX2, 19). Concomitant procedures were performed in 26 patients including 17 ascending repairs, 16 coronary artery bypass graftings, and 4 aortic valve replacements. RESULTS: Technical success was achieved in 97% (37 of 38 patients). Hospital mortality was 10% (n = 4), and serious complications included stroke (n = 4), paraparesis (transient n = 3, persistent n = 1), renal failure (n = 4), and respiratory failure (n = 12). Mean length of hospital stay was 14.7 days (range, 4 to 36 days), and 6.7 days (range, 1 to 20 days) in the intensive care unit. Overall survival was 74% at median follow-up of 1.2 + or - 0.8 years. Ten endoleaks in 9 patients (8 type II, 2 type I) required 3 late reinterventions. CONCLUSIONS: Antegrade delivery of commercially available stent grafts to treat high-risk, complex thoracic aortic diseases is feasible with a high rate of technical success and good intermediate-term outcomes. Further evaluation of these alternative stent graft delivery techniques is warranted. |
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Authors:
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Eric E Roselli; Edward G Soltesz; Tara Mastracci; Lars G Svensson; Bruce W Lytle |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: The Annals of thoracic surgery Volume: 90 ISSN: 1552-6259 ISO Abbreviation: Ann. Thorac. Surg. Publication Date: 2010 Aug |
Date Detail:
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Created Date: 2010-07-29 Completed Date: 2010-08-24 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 15030100R Medline TA: Ann Thorac Surg Country: Netherlands |
Other Details:
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Languages: eng Pagination: 539-46 Citation Subset: AIM; IM |
Copyright Information:
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Copyright 2010 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved. |
Affiliation:
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Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH 44195, USA. rosellle@ccf.org |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Aorta, Thoracic
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surgery* Aortic Diseases / surgery* Female Humans Male Middle Aged Prospective Studies Prosthesis Implantation / adverse effects, methods Risk Factors Stents* Time Factors Treatment Outcome |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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