Aldag Mustafa, Nana Petroula, Panuccio Giuseppe, Torrealba José I, Schofer Niklas, Spanos Konstantinos, von Kodolitsch Yskert, Brickwedel Jens, Demal Till Joscha, Detter Christian, Kölbel Tilo
German Aortic Center, Department of Vascular Medicine, University Medical Center Eppendorf, Hamburg, Germany.
German Aortic Center, Department of Vascular Medicine, University Medical Center Eppendorf, Hamburg, Germany.
J Vasc Surg. 2025 Apr;81(4):797-803. doi: 10.1016/j.jvs.2024.10.084. Epub 2024 Nov 23.
This study aimed to evaluate the suitability of a coronary-branched ascending aortic endograft, paired with aortic valve (AV) prosthesis (Endo-Bentall), for the endovascular repair of ascending aortic aneurysms.
Preoperative ≤1 mm computed tomography angiographies of consecutive patients managed with Bentall procedure or ascending aortic replacement and AV reconstruction/replacement, in a single institution (from January 1, 2008, to December 31, 2023), were retrospectively analyzed. Dedicate software was used to assess (1) vascular access, (2) proximal landing zone, (3) coronary artery anatomy, and (4) distal landing. Eligibility criteria for Endo-Bentall were ≥8 mm iliac arteries, without severe calcification/tortuosity, proximal landing with an 18- to 29-mm aortic annulus diameter, ≥10 mm annulus-coronary ostium distance, no mechanical AV, absence of coronary grafts in the ascending aorta, no left ventricle thrombus, coronary arteries ≥3 mm wide and ≥10 mm long, with no anatomical abnormalities, ostial stent or stenosis, and ≥20 mm long and ≤38 mm wide distal landing zone within the ascending aorta or applicability of branched endovascular arch repair.
Twenty-nine patients (55.2% females) were included. All patients had adequate proximal landing zone in terms of annulus diameter (median, 25 mm; interquartile range [IQR], 5 mm). Two (6.8%) had inadequate iliac access (external iliac artery <8 mm). Two patients (6.8%) had a mechanical AV. Twenty-six patients (89.6%) had adequate landing zone for stenting of the left main coronary artery (median diameter, 5.2 mm; IQR, 1.8 mm) and 28 (96.6%) had adequate right coronary artery landing (median diameter, 4.1 mm; IQR, 1 mm). The left main coronary artery and right coronary artery were located at 5:00 minute and 10:50 minute clock positions, respectively. Three patients (20.7%) had an adequate distal landing zone within the ascending aorta. The remaining were suitable for extension with a branched arch device. According to the predefined criteria, 75.9% of patients were anatomically suitable for Endo-Bentall.
Three out of four patients with ascending aortic aneurysms may be considered as anatomically eligible for endovascular treatment with an Endo-Bentall prosthesis.
本研究旨在评估一种冠状动脉分支型升主动脉腔内移植物与主动脉瓣（AV）假体（Endo-Bentall）配对用于升主动脉瘤腔内修复的适用性。
回顾性分析了在单一机构（从2008年1月1日至2023年12月31日）接受Bentall手术或升主动脉置换及AV重建/置换的连续患者术前≤1mm的计算机断层扫描血管造影。使用专用软件评估（1）血管入路，（2）近端锚定区，（3）冠状动脉解剖结构，以及（4）远端锚定。Endo-Bentall的入选标准为髂动脉≥8mm，无严重钙化/迂曲，近端锚定处主动脉瓣环直径为18至29mm，瓣环-冠状动脉开口距离≥10mm，无机械性AV，升主动脉无冠状动脉移植，无左心室血栓，冠状动脉≥3mm宽且≥10mm长，无解剖异常、开口处支架或狭窄，升主动脉内远端锚定区≥20mm长且≤38mm宽，或适用于分支型腔内主动脉弓修复。
纳入29例患者（女性占55.2%）。就瓣环直径而言，所有患者的近端锚定区均足够（中位数为25mm；四分位间距[IQR]为5mm）。2例（6.8%）患者的髂动脉入路不足（髂外动脉<8mm）。2例患者（6.8%）有机械性AV。26例患者（89.6%）有足够的左主冠状动脉锚定区用于支架置入（中位数直径为5.2mm；IQR为1.8mm），28例（96.6%）有足够的右冠状动脉锚定区（中位数直径为4.1mm；IQR为1mm）。左主冠状动脉和右冠状动脉分别位于时钟5:00和10:50的位置。3例患者（20.7%）在升主动脉内有足够的远端锚定区。其余患者适合使用分支型主动脉弓装置进行扩展。根据预定义标准，75.9%的患者在解剖学上适合Endo-Bentall。
四分之三的升主动脉瘤患者在解剖学上可能适合使用Endo-Bentall假体进行腔内治疗。
