Chun-Che Shih
Nationality
Taiwan
Current Position
1.Deputy Superintendent of Wanfang Hospital
2. Professor & Director of Taipei Heart Institute Taipei Medical University
Organization
1. Taipei Municipal Wanfang Hospital (Managed by Taipei Medical University)
2. Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University
Thoracic Aorta Session

Topic: The Design Secret of Proximal Conformability of Type B Aortic Dissection

Abstract

Many parameters influence technical and clinical outcomes in TEVAR related to the arch. pathology, device-related parameters such as stent graft design, conformability, radial force, and placement accuracy significantly contribute to the early technical success of the procedure.

Over the last decades of widespread use, improvements in materials, reduction in delivery sheath size, improved conformability, tapered grafts, and a wider range of sizes have been improved TEVAR applicability and outcomes.

In our early observational study, structural changes and incomplete endograft apposition to the aortic arch (bird-beak configuration) after thoracic endovascular aortic repair are demonstrated (J Vasc Surg 2014;59:80-8.). Aortic remodeling after TEVAR is a continuous process. Significant arch angle transformation was discovered over the zone 2 and left subclavian artery levels. TX2 Pro-Form stent grafts improved arch conformation comparing to the Zenith Z-Trak stent grafts . Furthermore, in the patients with dissection, a preoperative distal arch angle of zone 2 was predictive of postoperative bird-beak configuration, regardless of whether they were treated with a Pro-Form stent graft.

The aim of a upcoming new design of TEVAR delivery system should be allowed staged, predictable endograft deployment and in situ angulation control, while avoiding windsocking and bird-beaking. To avoid bird beak configuration after TEVAR, the staged deployment and optional angulation of the new control GORE TAG Conformable Thoracic Stent Graft try to optimizes device placement and accuacy. Early experience is convincing and preliminary results are promising. The device is designed and tried to overcome the described existing limitations in TEVAR. Larger studies and longer follow-up are still needed to prove these early observations. The SURPASS registry has already begun in Europe to address these endpoints.

The other new endovascular devices and insights with advancing endovascular options is kept going to extend the envolope of TEVAR. Stay concerned the future trend of technology development.

Thoracic Aorta Session

Topic: Value of ascending aortic banding for aortic arch lesions

Abstract

Banding of the ascending aorta has been introduced as a less complex procedure to optimize the proximal landing zone of the stent graft in hybrid aortic arch surgery. However, data about the long-term results and effects of this technique are still limited. We aimed to study the efficacy of banding of the ascending aorta in hybrid aortic arch repair. The study included 11 high-risk patients with dilated ascending aorta (wider than 38 mm in diameter) undergoing ascending aortic banding for hybrid arch repair. Clinical outcomes, including technical success, endoleaks, perioperative mortality and morbidity, and sequential remodeling of the ascending aorta were investigated. The average diameter of the ascending aorta had been reduced (p = 0.02) from 42.1 mm (range = 39.0-46.4) to 37.2 mm (range = 35.6-38.6) after banding procedure. The technical success rate was 100.0%. No type I endoleak occurred, but 2 cases of distal stent graft-induced new entry required re-interventions. The 5-year survival and freedom from aortic events rates both were 81.8%. The ascending aortic diameter remained stable and no proximal migration of the stent graft was observed during the study period. The 5-year results validated the durability of this therapeutic modality, especially in high-risk patients.

Keywords Banding technique · Aortic wrapping · Thoracic endovascular aortic repair · Hybrid arch repair

Published in  Heart and Vessels (2019) 34:1524–1532