A New Device For Aortic Arch Replacement : Work In Progress
Rosa Alba Mozzillo, Antonio Mariniello, Ettorino Di Tommaso, Fabio Scigliano, Valentina Raglianti, Luigi Di Tommaso, Gabriele Iannelli.
Departement of Cardiac Surgery A.O.U. Federico II, Napoli, Italy.
Objective:Conventional surgery procedures for aortic arch aneurysms are still hampered by substantial mortality and neurological complications. Alternative endovascular options are not suitable attempts. The hybrid approach, consisting of a primary revascularization of epiaortic vessels followed by endovascular stent-grafting, is just a promising option; nevertheless this hybrid approach leaves the aneurysmatic sac with an increase risk of endoleaks, sealing and infection, as well as a time-consuming and expensive procedure.
The aim of this new project is to treat aortic arch aneurysms in one step by an open approachwithout aortic cross-clamping, cardio-pulmonary bypass and selective cerebral perfusion and to resect the aneurysmatic sac.
Methods: The prosthesis showed a main body with proximal and distal stent tips and three side stent branches.Previous purse strings packaging on the aorta and the epiaortic vessels, the deployment of the prosthesis opening of the three side-branch grafts, and the Proximal and Distal stent zones, should be quick, either in rapid succession or preferably simultaneously.
Results: The prosthesis has obtained an international patent and the approval of the Ministry of Health for the testing of animals. Ten pigs were treated, eight of these with aortic arch replacement and two with abdominal aortic replacement.
Conclusions: This concept appears feasible given the relatively successful bench deployment of this first prototype.The requirement for stability and orthogonal deployment of the proximal stent in the ascending aorta must be considered.The Peel-away sheath concept appears the most promising option and should be considered further, in conjunction with a deployment method that can be used by a single person
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