International experience with endovascular therapy of the ascending aorta with a dedicated endograft

Nikolaos Tsilimparis, E. Sebastian Debus, Gustavo S. Oderich, Stephan Haulon, Kim Allan Terp, Blayne Roeder, Christian Detter, Tilo Kölbel

Research output: Contribution to journalArticle

41 Scopus citations

Abstract

Objective The objective of this study was to evaluate the safety and feasibility of a novel stent graft specifically designed for treatment of the ascending aorta. Methods This was a multicenter, retrospective analysis of all consecutive patients treated with the dedicated Zenith Ascend TAA Endovascular Graft (William Cook Europe, Bjaeverskov, Denmark) for pathologic processes requiring stent grafting of the ascending aorta. The graft is short (6.5 cm), with a delivery system designed for transfemoral placement in the ascending aorta. Results In 10 patients (five men; age, 67 years; range, 26-90 years), the Zenith Ascend graft was implanted for the following indications: dissection (n = 5) and aneurysm (n = 4) of the ascending aorta and fixation of an intraprocedural dislocated aortic valve (n = 1). All patients were judged to be at high risk for open surgery (nine patients were classified as American Society of Anesthesiologists class 3 or class 4). A transfemoral approach was selected in eight cases and a transapical approach in two. All endografts were successfully deployed without intraoperative adverse events at the targeted landing zone. Clinical success in coverage of the lesions was achieved in all cases with the exception of an attempted treatment of an intraprocedural aortic valve implantation dissection that resulted in early mortality. The 30-day survival was 90%. Early neurologic events included one patient with stroke and paraplegia and one patient with a transient ischemic attack. One patient underwent early evacuation of a hemopericardium. There were two late reinterventions for persisting endoleaks. At a mean follow-up of 10 months (range, 1-36 months), three late deaths occurred, with one treatment related, as a result of graft infection. Conclusions Despite the fact that in this first published series the graft was frequently used as a "rescue tool" outside its intended indication, treatment with the Zenith Ascend graft in this early experience appears to be safe and feasible for repair of ascending aorta pathologic processes in high-risk patients unsuitable for open repair.

Original languageEnglish (US)
Pages (from-to)1476-1482
Number of pages7
JournalJournal of vascular surgery
Volume63
Issue number6
DOIs
StatePublished - Jun 1 2016

ASJC Scopus subject areas

  • Surgery
  • Cardiology and Cardiovascular Medicine

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    Tsilimparis, N., Debus, E. S., Oderich, G. S., Haulon, S., Terp, K. A., Roeder, B., Detter, C., & Kölbel, T. (2016). International experience with endovascular therapy of the ascending aorta with a dedicated endograft. Journal of vascular surgery, 63(6), 1476-1482. https://doi.org/10.1016/j.jvs.2015.12.027