Anatomical Feasibility of Endobentall Strategies for Management of Acute type A Aortic Dissection.

IF 7.5 1区 医学 Q1 SURGERY
Aurelien Vallée, Guillaume Guimbretière, Julien Guihaire, Antoine Guery, Maira Gaillard, Le Houerou Thomas, Antoine Gaudin, Ramzi Ramadan, Deleuze Phillippe, Blandine Maurel, Jean Christian Roussel, Said Ghostine, André Vincentelli, Francis Juthier, Dominique Fabre, Jonathan Sobocinski, Stephan Haulon
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引用次数: 0

Abstract

Objectives: This study assesses the feasibility of acute type A dissections treatment with a dedicated aortic root endograft concept and introduces a new aortic classification.

Summary background data: Acute type A aortic dissection (ATAAD) remains a catastrophic aortic condition with perioperative mortality ranging from 12% and 20%. Total Aortic root endovascular repair, "Endobentall concept", has been explored as an alternative but only documented on case report.

Methods: Imaging study of all consecutive patients treated in three French centers were achieved. The study introduces an adapted aortic classification to report entry tear locations. Measurements included aortic annulus mensuration, coronary height, and several aortic lengths. Two treatment concepts were described "fenestrated Endobentall" and "branched Endobentall". Patients were eligible to the "fenestrated endobentall" design if their aortic root dimensions fitted the Edwards Sapien® and Corevalve Medtronic® instruction for use. Eligibility for the "branched Endobentall" required meeting the criteria for a "fenestrated Endobentall" and having a left coronary main stem length exceeding 5 mm. "Branched Endobentall" was mandatory when the entry was located in the aortic root.

Results: A total of 250 CT scans for acute type A aortic dissection were reviewed, 116 were finally included for analysis. The primary entry tear was found in the aortic root in 9% of patients, and in 31% of cases, it was located within the first centimeter distal to the sinotubular junction (STJ). 63.7% of the patients were eligible for an Endobentall procedure, even 73.3% when considering extended criterion. Fenestrated Endobentall accounted for 2/3 of cases.

Conclusion: In our study, 63.7% of patients with aortic type A dissections are deemed eligible to an "Endobentall repair", increasing to 73.3% when considering extended anatomical criteria.

治疗急性 A 型主动脉夹层的内支架策略在解剖学上的可行性。
目的:本研究评估了使用专用主动脉根部内移植概念治疗急性 A 型夹层的可行性,并介绍了新的主动脉分类:本研究评估了使用专用主动脉根部内移植概念治疗急性 A 型夹层的可行性,并介绍了一种新的主动脉分类方法:急性 A 型主动脉夹层(ATAAD)仍然是一种灾难性主动脉疾病,围手术期死亡率在 12% 到 20% 之间。全主动脉根部血管内修复术,即 "Endobentall 概念",已被视为一种替代方案,但只有病例报告:方法:对在法国三个中心接受治疗的所有连续患者进行影像学研究。方法:对法国三个中心接受治疗的所有连续患者进行了成像研究。研究采用了一种经过改良的主动脉分类法来报告入口撕裂位置。测量包括主动脉瓣环测量、冠状动脉高度和几个主动脉长度。研究介绍了 "栅栏式 Endobentall "和 "分枝式 Endobentall "两种治疗理念。如果患者的主动脉根部尺寸符合 Edwards Sapien® 和 Corevalve Medtronic® 的使用说明,则有资格使用 "栅栏式 Endobentall "设计。使用 "分枝式 Endobentall "的患者必须符合 "有孔 Endobentall "的标准,且左冠状动脉主干长度超过 5 毫米。如果入口位于主动脉根部,则必须使用 "分支 Endobentall":共审查了 250 例急性 A 型主动脉夹层的 CT 扫描,最终有 116 例被纳入分析范围。9%的患者在主动脉根部发现原发撕裂,31%的病例的原发撕裂位于窦管交界处(STJ)远端第一厘米处。63.7%的患者符合 Endobentall 手术的条件,如果考虑到扩展标准,这一比例甚至达到了 73.3%。结论:在我们的研究中,63.7%的主动脉A型夹层患者被认为符合 "Endobentall修复术 "的条件,如果考虑到扩展的解剖学标准,这一比例将增至73.3%。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Annals of surgery
Annals of surgery 医学-外科
CiteScore
14.40
自引率
4.40%
发文量
687
审稿时长
4 months
期刊介绍: The Annals of Surgery is a renowned surgery journal, recognized globally for its extensive scholarly references. It serves as a valuable resource for the international medical community by disseminating knowledge regarding important developments in surgical science and practice. Surgeons regularly turn to the Annals of Surgery to stay updated on innovative practices and techniques. The journal also offers special editorial features such as "Advances in Surgical Technique," offering timely coverage of ongoing clinical issues. Additionally, the journal publishes monthly review articles that address the latest concerns in surgical practice.
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