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Preliminary Outcomes Of Four Novel Endograft Systems For Total Endovascular Aortic Arch Repair
JIA HU, Yu Liu, Peng Yang.
West China Hospital， Sichuan University, Chengdu, China.
BACKGROUND: Minimally invasive endovascular procedures can offer a reliable alternative for patients at high risk for open surgery or those who refuse thoracotomy. In this study, we report the preliminary experience of a single-center series utilizing four novel endograft systems for total endovascular aortic arch repair.
METHODS: From August 2023 to December 2024, four innovative endograft systems were utilized for total endovascular aortic arch repair. The Zipper aortic arch stent-graft system (Endonom Medtech, Hangzhou, China) features a tapered, dumbbell-shaped unibody arch stent-graft with three branches, accompanied by branch stent-grafts and thoracic extension stent-grafts. The WeFlow-Tribranch aortic arch stent-graft system (Endonom Medtech, Hangzhou, China) includes a proximal main body with tunnels for supra-aortic and descending aorta connections, a distal main body with a retrograde inner branch, and bridging covered stents. The Concave Supra-arch Branched stent-graft system (Lifetech Scientific Co., Ltd., Shenzhen, China) comprises a grooved unibody thoracic stent-graft with two proximal inner branches, one distal inner branch, and a central groove covered by a mesh structure, along with supra-aortic branch and straight thoracic stent-grafts. Finally, The Stanford type A total endovascular reconstruction system (Chuangxin Medical Technology Co., Ltd., Shenzhen, China) consists of a covered main body stent-graft with a bare midsection and an additional thoracic stent-graft with a proximally covered section.
RESULTS: A total of 20 patients were enrolled, including 18 males, with a mean age of 59.5 ± 10.2 years (Table 1). Of these, 18 patients were diagnosed with aortic dissection, one with an aortic penetrating ulcer, and one with an anastomotic fistula at the aortic arch. The technical success rate was 100%, with a mean operative time of 181.5 minutes (interquartile range, 85.0-367.5 minutes). Within 30 days, one patient who received Zipper aortic arch stent-graft system deployment underwent re-intervention for branch-related endoleak. The mean follow-up duration was 9.5 ± 4.4 months, during which one patient experienced a non-aortic-related death.
CONCLUSIONS: These novel endograft systems offer a promising minimally invasive approach for total aortic arch repair, with high technical success and manageable complications. Further studies with longer follow-up are needed to assess long-term outcomes.
| Table 1. Patient demographics and clinical outcomes |
| Variable | N = 20 |
| Age (years) | 59.5 ± 10.2 |
| Male | 18 (90%) |
| Aortic pathology types | |
| Aortic dissection | 18 (90%) |
| Aortic penetrating ulcer | 1 (5%) |
| Aortic anastomotic fistula | 1 (5%) |
| Endograft system type | |
| Stanford type A total endovascular reconstruction system | 10 (50%) |
| Zipper aortic arch stent-graft system | 8 (40%) |
| WeFlow-Tribranch aortic arch stent-graft system | 1 (5%) |
| Concave Supra-arch Branched stent-graft system | 1 (5%) |
| Operative time (minutes) | 181.5 (IQR, 85.0-367.5) |
| 30-day mortality | 0 |
| Follow-up duration (months) | 9.5 ± 4.4 |
| Re-intervention | 1 (5%) |
| Overall mortality | 1 (5%) |
| IQR: interquartile range |
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