Key result
An optimized endovascular technique based on TEVAR and TAVI procedures provides a detailed, safe, and reproducible approach for treating ascending aorta diseases.
Why the study?
Acute ascending aorta pathology carries high open-surgery mortality linked to cardiopulmonary bypass and circulatory arrest, making an optimized endovascular alternative desirable.
This paper details an optimized endovascular technique combining TEVAR and TAVI principles for the treatment of acute ascending aorta pathology, offering a potential alternative for patients unsuitable for open surgery.
May warrant consideration in select high-risk cases; leaves open need for prospective validation before wider use.
PURPOSE: Ascending aorta (AAo) acute pathology still has an open-surgery indication with a high mortality rate associated to cardiopulmonary bypass and circulatory arrest. In these cases, the endovascular aortic approach could be an excellent option. The aim of the present study is to detail an optimized technique for the endovascular treatment of AAo diseases, based on thoracic endovascular aortic repair (TEVAR) and transcatheter aortic valve implantation (TAVI) procedures. TECHNIQUE: The procedure implies the usual preparation for TEVAR and TAVI implants. A transient pacemaker lead is necessary to deliver the prosthesis under "rapid pacing." As in the TAVI technique, a final high-support guidewire is placed at the left ventricle. The proximal landing zone is the sinotubular junction (zone 0B). Transesophageal echocardiography is essential to ensure aortic valve function and patency in coronary arteries during the delivery. To assess a potential occlusion of the brachiocephalic artery, a guidewire is positioned in the descending aorta from the axillary artery. Finally, a noncovered stent is implanted to stabilize the AAo prosthesis. CONCLUSION: The technique presented here can standardize a safe and reproducible procedure to endovascular repair of AAo diseases. However, new devices specifically designed for the AAo could facilitate the transcatheter approach. CLINICAL IMPACT: Ascending aorta acute pathology still has an open-surgery indication with high mortality rate associated to cardiopulmonary bypass and circulatory arrest. Moreover, near 30% of patients are not considered suitable for surgery because of age, critical situation or the presence of severe comorbidities. The present study provides a detailed and optimized technique for the endovascular treatment of ascending aorta disease, based on TEVAR and TAVI procedures.
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Garrido et al. (2023) studied Ascending aorta acute pathology. Endovascular technique based on TEVAR and TAVI procedures was evaluated. An optimized endovascular technique based on TEVAR and TAVI procedures provides a detailed, safe, and reproducible approach for treating ascending aorta diseases.
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