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Catheter-based treatment of the dissected ascending aorta: a systematic review
- Source :
- European Journal of Cardio-Thoracic Surgery. 59:80-91
- Publication Year :
- 2020
- Publisher :
- Oxford University Press (OUP), 2020.
-
Abstract
- Summary OBJECTIVES Type A aortic dissection requires immediate surgical repair. Despite improvements in surgery and anaesthesia, there is still a considerable risk when high-risk patients are concerned. Less invasive endovascular treatments are under evaluation. We investigated the current status of catheter-based treatment for type A aortic dissection with the entry tear located in the ascending aorta. METHODS A PubMed search was supplemented by searching through bibliographies and key articles. Demographics, risk score, stent graft detail, access route, mortality, cause of death, complications, reinterventions and follow-up data were extracted and analysed. RESULTS Thirty-one articles (7 retrospective reports; 24 case reports/series) were included in the study. In total, 104 patients (mean age 71 ± 14 years) received endovascular treatment for acute (63) or chronic (41) type A dissection. A history of a major cardiac or aortic operation was present in 29 patients. The mean EuroSCORE II was 30 ± 20 in 4 reports. A total of 114 stent grafts were implanted: ‘off-the-shelf’, 65/114; custom made, 12/114; and modified, 7/114. Hospital complications included intraprocedural conversion to open surgery (2/104), stroke (2/104), coronary stenting (2/104), early endoleak (9/104) and repeat aortic endovascular treatment for endoleak (5/104). Hospital mortality was 10% (intraoperative death 2/104). Mean duration of follow-up time was 21 ± 21 months (range 1–81 months); follow-up data were available for 86 patients: 10 patients died of non-aortic-related causes; reintervention for aortic disease (endovascular repair or open surgery) was performed in 8 patients. CONCLUSIONS Catheter-based ascending aorta repair for type A aortic dissection with the entry tear in the ascending aorta can be considered in carefully selected high-risk patients. Further analysis and specifically designed devices are required.
- Subjects :
- Pulmonary and Respiratory Medicine
medicine.medical_specialty
Catheters
medicine.medical_treatment
610 Medicine & health
Aorta, Thoracic
030204 cardiovascular system & hematology
11171 Cardiocentro Ticino
Blood Vessel Prosthesis Implantation
03 medical and health sciences
0302 clinical medicine
medicine.artery
Ascending aorta
medicine
Humans
Stroke
Aorta
Aged
Retrospective Studies
Cause of death
Aged, 80 and over
Aortic dissection
Framingham Risk Score
Aortic Aneurysm, Thoracic
business.industry
Endovascular Procedures
Stent
General Medicine
Middle Aged
medicine.disease
10020 Clinic for Cardiac Surgery
Surgery
Catheter
Treatment Outcome
030228 respiratory system
Stents
Cardiology and Cardiovascular Medicine
business
Subjects
Details
- ISSN :
- 1873734X and 10107940
- Volume :
- 59
- Database :
- OpenAIRE
- Journal :
- European Journal of Cardio-Thoracic Surgery
- Accession number :
- edsair.doi.dedup.....dc3763481c1bb17dcd425ebe754be6ce