Transcatheter electrosurgical aortic septostomy optimizes distal landing zone in chronic dissectionCentral MessagePerspective
Objective: Efficacy of thoracic endovascular aortic repair (TEVAR) for chronic type B aortic dissection (CTBAD) is dependent on eliminating retrograde false lumen perfusion and remodeling the aorta. We describe the efficacy of a novel transcatheter electrosurgical technique to fenestrate the dissect...
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Elsevier
2024-10-01
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| Series: | JTCVS Techniques |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666250724002803 |
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| author | Alexander P. Nissen, MD Yazan M. Duwayri, MD William D. Jordan, MD Vasilis C. Babaliaros, MD Robert J. Lederman, MD Bradley G. Leshnower, MD |
| author_facet | Alexander P. Nissen, MD Yazan M. Duwayri, MD William D. Jordan, MD Vasilis C. Babaliaros, MD Robert J. Lederman, MD Bradley G. Leshnower, MD |
| author_sort | Alexander P. Nissen, MD |
| collection | DOAJ |
| description | Objective: Efficacy of thoracic endovascular aortic repair (TEVAR) for chronic type B aortic dissection (CTBAD) is dependent on eliminating retrograde false lumen perfusion and remodeling the aorta. We describe the efficacy of a novel transcatheter electrosurgical technique to fenestrate the dissection flap and create a distal seal zone for TEVAR in CTBAD. Methods: A retrospective review of the Emory Aortic Database from 2016 to 2023 identified 33 patients who underwent TEVAR with intentional endovascular rupture of the dissection flap (Knickerbocker; KNICK) for CTBAD. In 11 patients, we performed transcatheter electrosurgical aortic septostomy (TECSAS) before KNICK. The technical aspects of TECSAS + KNICK are described and results compared with TEVAR + KNICK alone. Results: Dissection chronicity, aortic size, and preoperative demographics were similar between groups. Technical success was 100%, with zero stroke or paraplegia in both groups. Thirty-day mortality for TECSAS versus KNICK was 0% versus 13.6% (P = .199). Median follow-up was shorter after TECSAS versus KNICK, although not statistically significant (14.6 months vs 21.9 months; P = .065). Elimination of retrograde false lumen perfusion (TECSAS 100% vs KNICK 68.2%; P = .035) and complete false lumen thrombosis or obliteration (TECSAS 91.9% vs KNICK 54.6%; P = .037) were more frequent after the TECSAS procedure. Aortic reinterventions were less frequent after TECSAS versus KNICK (0% vs 13.6%, P = .199), although not statistically significant. Conclusions: The addition of TECSAS to intentional endovascular rupture of the dissection flap in CTBAD improves distal seal, eliminating retrograde false lumen perfusion. This technique is a safe and precise method to fenestrate a dissection flap and optimize TEVAR in CTBAD. |
| format | Article |
| id | doaj-art-2013526e88a04598b6ed7c3b8165d889 |
| institution | Kabale University |
| issn | 2666-2507 |
| language | English |
| publishDate | 2024-10-01 |
| publisher | Elsevier |
| record_format | Article |
| series | JTCVS Techniques |
| spelling | doaj-art-2013526e88a04598b6ed7c3b8165d8892025-08-20T03:36:38ZengElsevierJTCVS Techniques2666-25072024-10-0127192810.1016/j.xjtc.2024.07.007Transcatheter electrosurgical aortic septostomy optimizes distal landing zone in chronic dissectionCentral MessagePerspectiveAlexander P. Nissen, MD0Yazan M. Duwayri, MD1William D. Jordan, MD2Vasilis C. Babaliaros, MD3Robert J. Lederman, MD4Bradley G. Leshnower, MD5Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, GaDivision of Vascular Surgery, Emory University School of Medicine, Atlanta, GaDivision of Vascular Surgery, Emory University School of Medicine, Atlanta, GaDivision of Cardiology, Emory University School of Medicine, Atlanta, GaDivision of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MdDivision of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Ga; Address for reprints: Bradley G. Leshnower, MD, Division of Cardiothoracic Surgery, Department of Surgery, Emory University School of Medicine, 1365 Clifton Rd NE, Ste A2213, Atlanta, GA 30322.Objective: Efficacy of thoracic endovascular aortic repair (TEVAR) for chronic type B aortic dissection (CTBAD) is dependent on eliminating retrograde false lumen perfusion and remodeling the aorta. We describe the efficacy of a novel transcatheter electrosurgical technique to fenestrate the dissection flap and create a distal seal zone for TEVAR in CTBAD. Methods: A retrospective review of the Emory Aortic Database from 2016 to 2023 identified 33 patients who underwent TEVAR with intentional endovascular rupture of the dissection flap (Knickerbocker; KNICK) for CTBAD. In 11 patients, we performed transcatheter electrosurgical aortic septostomy (TECSAS) before KNICK. The technical aspects of TECSAS + KNICK are described and results compared with TEVAR + KNICK alone. Results: Dissection chronicity, aortic size, and preoperative demographics were similar between groups. Technical success was 100%, with zero stroke or paraplegia in both groups. Thirty-day mortality for TECSAS versus KNICK was 0% versus 13.6% (P = .199). Median follow-up was shorter after TECSAS versus KNICK, although not statistically significant (14.6 months vs 21.9 months; P = .065). Elimination of retrograde false lumen perfusion (TECSAS 100% vs KNICK 68.2%; P = .035) and complete false lumen thrombosis or obliteration (TECSAS 91.9% vs KNICK 54.6%; P = .037) were more frequent after the TECSAS procedure. Aortic reinterventions were less frequent after TECSAS versus KNICK (0% vs 13.6%, P = .199), although not statistically significant. Conclusions: The addition of TECSAS to intentional endovascular rupture of the dissection flap in CTBAD improves distal seal, eliminating retrograde false lumen perfusion. This technique is a safe and precise method to fenestrate a dissection flap and optimize TEVAR in CTBAD.http://www.sciencedirect.com/science/article/pii/S2666250724002803aortic dissectionchronic type B aortic dissection (CTBAD)thoracic endovascular aortic repair (TEVAR)electrosurgicalaortic septostomy |
| spellingShingle | Alexander P. Nissen, MD Yazan M. Duwayri, MD William D. Jordan, MD Vasilis C. Babaliaros, MD Robert J. Lederman, MD Bradley G. Leshnower, MD Transcatheter electrosurgical aortic septostomy optimizes distal landing zone in chronic dissectionCentral MessagePerspective JTCVS Techniques aortic dissection chronic type B aortic dissection (CTBAD) thoracic endovascular aortic repair (TEVAR) electrosurgical aortic septostomy |
| title | Transcatheter electrosurgical aortic septostomy optimizes distal landing zone in chronic dissectionCentral MessagePerspective |
| title_full | Transcatheter electrosurgical aortic septostomy optimizes distal landing zone in chronic dissectionCentral MessagePerspective |
| title_fullStr | Transcatheter electrosurgical aortic septostomy optimizes distal landing zone in chronic dissectionCentral MessagePerspective |
| title_full_unstemmed | Transcatheter electrosurgical aortic septostomy optimizes distal landing zone in chronic dissectionCentral MessagePerspective |
| title_short | Transcatheter electrosurgical aortic septostomy optimizes distal landing zone in chronic dissectionCentral MessagePerspective |
| title_sort | transcatheter electrosurgical aortic septostomy optimizes distal landing zone in chronic dissectioncentral messageperspective |
| topic | aortic dissection chronic type B aortic dissection (CTBAD) thoracic endovascular aortic repair (TEVAR) electrosurgical aortic septostomy |
| url | http://www.sciencedirect.com/science/article/pii/S2666250724002803 |
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