Percutaneous thoracic endovascular aortic repair for ascending aortic pseudoaneurysm after prosthetic aortic valve repair

Abstract OBJECTIVES Aortic insufficiency (AI) is common in patients with proximal aortic disease, but limited options exist to facilitate aortic valve repair (AVr) in this population. This study reports ‘real-world’ early results of AVr using newly FDA-approved trileaflet and bicuspid geometric annuloplasty rings for patients with AI undergoing proximal aortic repair (PAR) in a single referral centre. METHODS All patients undergoing AVr with a rigid internal geometric annuloplasty ring (n = 47) in conjunction with PAR (ascending +/− root +/− arch) were included. Thirty-six patients underwent AVr with a trileaflet ring, and 11 patients underwent AVr with a bicuspid ring. The rings were implanted in the subannular position, and concomitant leaflet repair was performed if required for cusp prolapse identified after ring placement. RESULTS The median age was 58 years [interquartile range (IQR) 46–70]. PAR included supracoronary ascending replacement in 26 (55%) patients and remodelling valve-sparing root replacement with selective sinus replacement in 20 (42%) patients. Arch replacement was performed in 38 (81%) patients, including hemi-arch in 34 patients and total arch in 4 patients. There was no 30-day/in-hospital mortality. Preoperative AI was 3–4+ in 37 (79%) patients. Forty-one (87%) patients had zero–trace AI on post-repair transoesophageal echocardiography, and 6 patients had 1+ AI. The median early post-repair mean gradient was 13 mmHg (IQR 5–20). Follow-up imaging was available in 32 (68%) patients at a median of 11 months (IQR 10–13) postsurgery. AI was ≤1+ in 97% of patients with 2+ AI in 1 patient. All patients were alive and free from aortic valve reintervention at last follow-up. CONCLUSIONS Early results with geometric rigid internal ring annuloplasty for AVr in patients undergoing PAR appear promising and allow a standardized approach to repair with annular diameter reduction and cusp plication when needed. Longer-term follow-up will be required to ensure the durability of the procedure.

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Combined Transcatheter Aortic Valve Replacement and Thoracic Endovascular Aortic Repair Using Transapical Access

The Annals of Thoracic Surgery ◽

10.1016/j.athoracsur.2014.10.024 ◽

2015 ◽

Vol 100 (2) ◽

pp. 723-727 ◽

Cited By ~ 4

Author(s):

Keith B. Allen ◽

Lesley M. Johnson ◽

A. Michael Borkon ◽

Sanjeev Aggarwal ◽

J. Russell Davis ◽

...

Keyword(s):

Aortic Valve ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Transcatheter Aortic Valve Replacement ◽

Thoracic Endovascular Aortic Repair ◽

Endovascular Aortic Repair ◽

Transcatheter Aortic Valve ◽

Aortic Repair ◽

Transapical Access

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Transapical thoracic endovascular aortic repair in aortic arch aneurysm through a pre-existent bioprosthetic aortic valve

Journal of Vascular Surgery Cases and Innovative Techniques ◽

10.1016/j.jvscit.2018.07.003 ◽

2018 ◽

Vol 4 (4) ◽

pp. 265-267

Author(s):

Eijiro Nogami ◽

Junji Yunoki ◽

Takahiro Kitsuka ◽

Manabu Itoh ◽

Atsuhisa Tanaka ◽

...

Keyword(s):

Aortic Valve ◽

Aortic Arch ◽

Thoracic Endovascular Aortic Repair ◽

Aortic Arch Aneurysm ◽

Endovascular Aortic Repair ◽

Aortic Repair ◽

Arch Aneurysm

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Successful Two-Stage Treatment for Coarctation of the Aorta-postductal Type and Aortic Regurgitation with Thoracic Endovascular Aortic Repair and Aortic Valve Replacement

Annals of Vascular Diseases ◽

10.3400/avd.cr.20-00040 ◽

2020 ◽

Vol 13 (4) ◽

pp. 414-417

Author(s):

Ryuta Seguchi ◽

Takafumi Horikawa ◽

Ryuta Kiuchi ◽

Junichiro Sanada ◽

Hiroshi Ohtake ◽

...

Keyword(s):

Aortic Valve ◽

Aortic Valve Replacement ◽

Aortic Regurgitation ◽

Valve Replacement ◽

Coarctation Of The Aorta ◽

Thoracic Endovascular Aortic Repair ◽

Endovascular Aortic Repair ◽

Two Stage ◽

Aortic Repair

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Evidence for Cerebral Embolic Prevention in Transcatheter Aortic Valve Implantation and Thoracic Endovascular Aortic Repair

Annals of Vascular Surgery ◽

10.1016/j.avsg.2018.06.035 ◽

2019 ◽

Vol 55 ◽

pp. 292-306 ◽

Cited By ~ 1

Author(s):

Hoi Tung Lam ◽

Joy Melody Kwong ◽

Pak Lun Lam ◽

Wai Lok Yeung ◽

Yiu Che Chan

Keyword(s):

Aortic Valve ◽

Transcatheter Aortic Valve Implantation ◽

Thoracic Endovascular Aortic Repair ◽

Endovascular Aortic Repair ◽

Transcatheter Aortic Valve ◽

Aortic Repair ◽

Aortic Valve Implantation ◽

Valve Implantation

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Thoracic Endovascular Aortic Repair for a Ruptured Mycotic Aortic Pseudoaneurysm Secondary to Esophageal Carcinoma

Case Reports in Vascular Medicine ◽

10.1155/2022/5489653 ◽

2022 ◽

Vol 2022 ◽

pp. 1-4

Author(s):

Sean-Tee J. M. Lim ◽

Stephen Murphy ◽

Said Atyani ◽

Michael Anthony Moloney

Keyword(s):

Esophageal Carcinoma ◽

Thoracic Endovascular Aortic Repair ◽

Endovascular Aortic Repair ◽

Vascular Control ◽

Cross Sectional ◽

Aortic Pseudoaneurysm ◽

Aortic Repair ◽

Cross Sectional Imaging ◽

Contrast Ct ◽

Esophageal Carcinomas

A 47-year-old female presented to the emergency department with new episodes of hematemesis. She had a background of unresectable T4b + N1 + M0 esophageal squamous cell carcinoma. Contrast CT thoracic aorta diagnosed a ruptured mycotic aortic pseudoaneurysm of the descending aorta, forming a life threating aorto-esophageal fistula secondary to neoplasm. Due to the high risk of fatal haemorrhage, she underwent successful emergency thoracic endovascular aortic repair (TEVAR). Mycotic aortic pseudoaneurysms are a rare and often fatal complication of esophageal carcinomas. They represent a small subsection of aorto-esophageal fistulas. Early diagnosis with cross sectional imaging and vascular control of the sentinel bleed is essential for survival. TEVAR may be used as a bridge to palliative treatment in the case of unresectable esophageal carcinoma.

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