International Society For Minimally Invasive Cardiothoracic Surgery

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Multi-layer Flow-modulating Stents For The Treatment Of Thoracoabdominal Aortic Dissections
Victor Costache1, Ovidiu Stiru2, Kak Yeung3, Andreea Costache1, Crina Solomon1, Tatiana Melnic1, Mihai Sandu1, Rodney White4, Grayson Wheatley, III5.
1NextCARDIO Research Institute, Sibiu, Romania, 2Emergency Institute for Cardiovascular Diseases, Bucharest, Romania, 3Amsterdam University Medical Center, Amsterdam, Netherlands, 4MemorialCare Heart & Vascular Institute, Long Beach, CA, USA, 5Siragusa Vascular, Nashville, TN, USA.

BACKGROUND-Treatment of thoracoabdominal aortic dissections (TAAD) frequently requires open repair with increased procedural risk. Conventional endovascular prostheses have had limited repairing TAAD due to inadequate fenestration coverage and inability to maintain branch vessel flow. We evaluated the outcomes of patients with TAAD treated with multi-layer flow-modulating (MFM) stents. METHODS-A retrospective analysis of a prospectively maintained institutional database was undertaken for all patients with TAAD treated with MFM stents (n=21) between April 2014 and July 2018. Outcome data were collected including stroke, paraplegia, branch vessel patency, endoleaks, degree of aortic remodeling and death. Patients were followed with annual computed tomography angiography (CTA) scans and regular telephone interviews. Morphologic computational fluid dynamics (CFD) analysis of CTA scans was performed using Momics and Ansys software to assess aortic remodeling as defined as a reduction in total aortic length along with changes to the volume and diameters of the true and false lumens.RESULTS-M:F ratio was 16:5. Mean age was 49 years (27-73). Indications for treatment included chronic Type B aortic dissection (n=15), prior Type A dissection repair with false lumen expansion (n=5), and distal malperfusion post-acute Type A dissection repair (n=1). Proximal landing zones were: Zone 0 (n=17), Zone 2 (n=3) and Zone 3 (n=1). Seventy-two stents were used (mean 3.42 devices/patient) and 136 branch vessels were covered. Procedural success was 100% wit no strokes, paraplegia, acute kidney injuries, endoleaks or deaths. There was 1 reintervention for an access sheath-related iliac artery dissection. Follow-up was available for all patients (average 18 months; range 1-51 months). At 3-years, branch vessel patency was 100% and there were no aortic-related deaths (Figure 1). Two patients died from non-aortic related causes subsequent to their 2-year follow-up imaging. Positive aortic remodeling (reduction in volume and diameter of the false lumen) was observed in all patients.CONCLUSIONS-MFM stents appear to provide a safe treatment option for TAAD patients, with low-risk of complications. Patency is preserved to covered aortic arch and visceral side-branches and positive aortic remodeling is observed in the short-term. Additional study is needed to better understand the role of MFM stents in the management of TAAD.

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