ABSTRACT
OBJECTIVE: Acute type A aortic syndromes and its chronic complications are fatal diseases traditionally treated by open surgery, with high mortality rates. An endovascular approach to the ascending aorta could reduce the morbidity and mortality associated with open surgery. Our aim was to report our initial experience in treating ascending aortic pathology using commercially available descending thoracic endografts. METHODS: From 2007 to 2012, 69 patients presented to our center in Belo Horizonte, Brazil, with acute type A aortic syndrome or its chronic complications. Of the 69 patients, 8 high-risk patients had suitable anatomy, and 7 agreed to participate in the present study. RESULTS: Of the 7 patients, 4 had penetrating ulcers, 2 had acute dissections, and 1 had chronic dissection with an aneurysm. The technical success rate was 87%, with 1 intraoperative death from acute aortic valve insufficiency. The proximal landing zone was, on average, 21 mm above the aortic valve in all patients. Three patients required intraoperative cervical debranching due to a lesion in the distal third of the ascending aorta, compromising the supra-aortic branches. The distal landing zone was at zone 0 in 4 patients, zone 2 in 1 patient, and in zone 4 in 2 patients. The mean follow-up was 26.3 months. Two repeat dissections developed an average of 2 months after treatment. Both presented with acute dissection that was treated with additional open surgery and both patients survived. Thereafter, no patient had presented again with an acute aortic syndrome or other referable symptoms. CONCLUSIONS: Endovascular treatment of the ascending aorta is feasible. We had 4 good mid-term results in 7 patients who had presented with penetrating ulcers or aneurysm formation. Acute dissections seem to be more unstable, and additional research is mandatory.
Subject(s)
Aorta, Thoracic/surgery , Aortic Aneurysm, Thoracic/surgery , Blood Vessel Prosthesis Implantation/instrumentation , Blood Vessel Prosthesis , Endovascular Procedures/instrumentation , Stents , Ulcer/surgery , Aged , Aorta, Thoracic/diagnostic imaging , Aortic Aneurysm, Thoracic/diagnosis , Aortic Aneurysm, Thoracic/mortality , Aortography/methods , Blood Vessel Prosthesis Implantation/adverse effects , Blood Vessel Prosthesis Implantation/mortality , Brazil , Endovascular Procedures/adverse effects , Endovascular Procedures/mortality , Feasibility Studies , Female , Hospital Mortality , Humans , Male , Middle Aged , Postoperative Complications/mortality , Postoperative Complications/surgery , Prosthesis Design , Reoperation , Time Factors , Tomography, X-Ray Computed , Treatment Outcome , Ulcer/diagnosis , Ulcer/mortalityABSTRACT
Em 8 cäes anestesiados, foram estabelecidas preparaçöes coraçäo-pulmäo isoladas, mantendo-se a resistência periférica para assegurar pressäo arterial média constante (PA) de 80 mmHg. A artéria coronária descendente anterior (DA) foi ligada e um cateter introduzido distalmente. Foram controlados fluxo sistêmico (FS), EGG e fluxo colateral (FCCo), medido pelo cateter na DA. Estas variáveis foram estudadas antes e 5, 15 e 30 min depois da injeçäo de 10mg de dipiridamol. Os resultados obtidos demonstram que, mantendo-se a PA em 80 mmHg, o fluxo coronário permanece constante (p < 0,01) mesmo na vigência de variaçöes do fluxo sistêmico de 30 a 50% do controle. Na presente investigaçäo, näo foi possível constatar o fenômeno "steal effect" descrito para o dipiridamol
