Status Of Aortic Wrapping For Ascending Aortic Aneurysms ...
Transcript of Status Of Aortic Wrapping For Ascending Aortic Aneurysms ...
Ralf R. Kolvenbach Duesseldorf FRG
Ron Karmeli Jerusalem Israel
Status Of Aortic Wrapping For Ascending Aortic Aneurysms: A Less Invasive Approach: Indications And Results
Conflict of Interest: None
Contraindications Ascending Hybrid Repair
Aortic Valve incompetence
Coronary artery disease requiring CABG
Congestive Heart failure NYHA III - IV
Indications:
True AneurysmsExtension of Landing ZoneHybrid Procedure
Pseudo Aneurysm after CABG
Options
• Banding of the Aneurysm
• Creation of a proximal landing zone only
Technique
5,7 - 4,2 cm
Beware ofthe PA
Mini Sternotomy
Lachat et al.
Wrapping and Downsizing of Ascending Aorta
•
• Supraaortic Debranching
• Ascending Aortic Bypass
Arch Aneurysm-Extension of Landing Zone
• Diameter Reduction Ascending aorta: 5,2 cm 3,5 cm
• Sandwich Grafts + Chimneys
Reduction in Shear Stress
Maximum Diameter - Proximal Landing Zone
Banding - Before and After
Proximal Landing Zone Max Diameter
GORE TAG Chimney Innominate Artery
Proximal Landing Zone ( 45 – 29 mm )
Max. Diameter (6,2 -> 36 mm)
Chimney Graft Innominate Artery
Pre – and post Stent
Diameter Reduction Landing ZoneRemodelling: Conical -> Tubular
Risk Factors
Patient Gender Age COPD Home Oxygen Renal Insufficiency
(creatinine>1.8
Atrial or
Ventricular
Arrythmia
Coronary Artery
Disease
Hypertension Smoking (during
the last 2 years )
Congestive Heart
Failure NYHA III,
IV
Aortic Valve
Stenosis II °
Aortic Valve
Incompetence II°
1 female 79 x x x x x
2 female 69 x x x
3 male 87 x x x x x x
4 female 79 x x x x
5 female 67 x x x
6 male 67 x x x x
7 male 82 x x x
8 female 80 x x x
9 female 68 x x x
10 female 80 x x x x
11 male 77 x x x
12 female 79 x x x x x x
13 male 73 x x x x
Perioperative Details
Results
Conclusion : Endo Bentall ?
Ralf R. Kolvenbach Duesseldorf FRG
Ron Karmeli Jerusalem Israel
Status Of Aortic Wrapping For Ascending Aortic Aneurysms: A Less Invasive Approach: Indications And Results