Tan Sven Z C P, Surkhi Abedalaziz O, Jubouri Matti, Bailey Damian M, Williams Ian M, Bashir Mohamad
Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom.
Faculty of Medicine, Al-Quds University, Jerusalem, Palestine.
Front Cardiovasc Med. 2022 Jul 18;9:969858. doi: 10.3389/fcvm.2022.969858. eCollection 2022.
The high mortality and morbidity rates in surgical aortic arch repair are a barrier to therapy for a considerable proportion of patients with aortic arch aneurysm or dissection. There is hence a demand for the development and adoption of a minimally invasive alternative to aortic arch repair, such as thoracic endovascular aortic repair (TEVAR). Procedural duration is a key factor in the pathogenesis of complications in surgical aortic arch repair. Herein, we evaluate whether endovascular duration impacts neurological outcomes, target vessel patency, and reintervention rates in aortic arch TEVAR with RELAY™ Branched (Terumo Aortic, Inchinnan, UK), which is specifically developed for on-label use within the aortic arch.
Prospective data was collected between January 2019 and January 2022 on the clinical outcomes of TEVAR for aortic arch dissection and aneurysm with RELAY™ single-, double-, and triple branched endoprostheses from centers across Europe. They were then retrospectively analyzed with descriptive and distributive analysis. Follow-up data on the incidence of disabling stroke (DS), target vessel patency, and reintervention from 30 days and 6-, 12-, and 24 months postoperative was included in the analysis.
147 (99.3%) of all 148 cases were successful. Over the 24 month follow-up period, in total 6 (4.1%) patients suffered DS, 24 (16.3%) required reintervention, and target vessel patency was exhibited in 118 (80.2%) patients. The modal endovascular duration was 100-150 min (in 64.6%, = 95 cases). Analysis revealed that endovascular duration was associated with a lower likelihood of reintervention at 30 days, 6-, and 12 months ( = 0.011, = 0.019, = 0.037), a greater likelihood of target vessel patency at 6- and 24 months ( = 0.032, = 0.035). No relationship between endovascular duration and DS was revealed.
The data demonstrates that RELAY™ Branched is associated with promising clinical outcomes for on-label aortic arch TEVAR. The underlying mechanism linking endovascular duration and reintervention rates, or target vessel patency is likely multifactorial and complex. Given that TEVAR is carried out under general anesthetic only, it is unlikely that prolonged procedural duration has any major effect over neurological outcomes for arch TEVAR.
外科主动脉弓修复术的高死亡率和发病率是相当一部分主动脉弓瘤或夹层患者治疗的障碍。因此，需要开发并采用一种微创的主动脉弓修复替代方法，如胸主动脉腔内修复术（TEVAR）。手术持续时间是外科主动脉弓修复术中并发症发病机制的关键因素。在此，我们评估血管内手术持续时间是否会影响使用专门为主动脉弓内标签使用而开发的RELAY™分支（泰尔茂主动脉，英国因钦南）进行主动脉弓TEVAR时的神经学结果、靶血管通畅率和再次干预率。
收集了2019年1月至2022年1月期间欧洲各中心使用RELAY™单分支、双分支和三分支血管内支架进行主动脉弓夹层和动脉瘤TEVAR的临床结果的前瞻性数据。然后对其进行回顾性分析，包括描述性和分布性分析。分析纳入了术后30天以及6个月、12个月和24个月时致残性卒中（DS）发生率、靶血管通畅率和再次干预的随访数据。
148例病例中的147例（99.3%）手术成功。在24个月的随访期内，共有6例（4.1%）患者发生DS，24例（16.3%）需要再次干预，118例（80.2%）患者的靶血管保持通畅。血管内手术持续时间的众数为100 - 150分钟（占64.6%，n = 95例）。分析显示，血管内手术持续时间与术后30天、6个月和12个月时再次干预的可能性较低相关（P = 0.011、P = 0.019、P = 0.037），与术后6个月和24个月时靶血管通畅的可能性较高相关（P = 0.032、P = 0.035）。未发现血管内手术持续时间与DS之间存在关联。
数据表明，RELAY™分支在主动脉弓TEVAR标签内使用时具有良好的临床结果。血管内手术持续时间与再次干预率或靶血管通畅率之间的潜在机制可能是多因素且复杂的。鉴于TEVAR仅在全身麻醉下进行，手术持续时间延长不太可能对主动脉弓TEVAR的神经学结果产生任何重大影响。
