External Wrapping of the Ascending Aorta as an Adjunct to ...

External Wrapping of the Ascending Aorta as an Adjunct

to Endografting

Ralf R. Kolvenbach Duesseldorf FRG

Ron Karmeli Jerusalem Israel

Conflict of Interest: None

Contraindications

Aortic Valve incompetence

Coronary artery disease requiring CABG

Congestive Heart failure NYHA III - IV

Indications:

True AneurysmsExtension of Landing ZoneHybrid Procedure

Transvalvular Manipulation is

essential

Illustrated techniques for transapical aortic valve implantationAnson Cheung1, Kevin M. Lichtenstein21Division of Cardiothoracic Surgery, St. Paul’s Hospital, University of British Columbia, Vancouver, Canada; 2Brighton and Sussex Medical School, Brighton, East Sussex, United Kingdom

• Previous Ascendingrepair = ideal case

Ascending Aortic Pseudo Aneurysms

Tubular landing zone

Technical Issues: Graft Kinking Consider Transapical Approach

Illustrated techniques for transapical aortic valve implantation

Anson Cheung1, Kevin M. Lichtenstein2

1Division of Cardiothoracic Surgery, St. Paul’s Hospital, University of British Columbia, Vancouver,

Canada; 2Brighton and Sussex Medical School, Brighton, East Sussex, United Kingdom

R.Kolvenbach et al. The JVS 2012

Optimal Length of the graft

Thrombus

Pseudo Aneurysm

Pseudo Aneurysm after CABG

True AneurysmsThe role ofwrappingprocedures

Creation of a proximal landing Zone

Options

• Banding of the Aneurysm

• Creation of a proximal landing zone only

Options

• Banding of the Aneurysm

• Creation of a proximal landing zone only

5,7 - 4,2 cm

Beware ofthe PA

Mini Sternotomy

5.9 cm

4.4 cm

Lachat et al.

Downsizing Ascending Aorta

• Ascending Wrappping

• Supraaortic Debranching

• Aortic Arch Stent

Arch Aneurysm-Extension of Landing Zone

• Diameter Reduction Ascending aorta: 5,2 cm 3,5 cm

• Sandwich Grafts + Chimneys

Ascending Aneurysm -Wrapping

• Wrapping as an adjunct to debranching

• Ascending Bypass –Reinforcement

Published in: Feng Gao; Qian Zeng; Fangming Lin; Xiaohu Ge; J Endovasc Ther 24, 647-653.

DOI: 10.1177/1526602817721674

Feng Gao et al. 2017

Ascending BandingSandwich Graft Periscope Technique

Biomechanics

Stress Reduction

Dacron Sleeve

Ascending aortic aneurysm

71 years old COPD

Diabetes

Maximum Diameter - Proximal Landing Zone

Banding - Before and After

Proximal Landing Zone Max Diameter

GORE TAG Chimney Innominate Artery

Proximal Landing Zone

Max. Diameter

Chimney Graft Innominate Artery

True Aneurysms

Patients 18

Follow up 21 months

Wrapping only 9

Wrapping + Stent Graft 9

Mortality 0

Stroke 0

Conclusion : Endo Bentall ?

External Wrapping of the Ascending Aorta as an Adjunct

to Endografting

Ralf R. Kolvenbach Duesseldorf FRG

Ron Karmeli Jerusalem Israel

External Wrapping of the Ascending Aorta as an Adjunct to ...

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