Associate Professor Università degli Studi di Padova Padova, Veneto, Italy
Disclosure(s):
Augusto D'Onofrio: No relevant disclosure to display
Please explain the educational or technical point that this video addresses.: Open surgery for aortic arch pathologies is associated with significant morbidity and mortality in high-risk patients and it's associated with frequent need for blood transfusions. An endovascular "microinvasive" (beating heart, off-pump, percutaneous, normothermic, no circulatory arrest) procedure might help reduce surgical trauma and optimize postoperative outcomes. Nearly all Jehovah's Witnesses refuse blood transfusions and some also refuse coagulation factors. Aim of this case video is to present two cases of microinvasive total endovascular aortic arch repair in Jehovah's witnesses with aortic arch disease.
Please provide a 250 word summary of the surgical video being submitted.: The study device is a single-branch, bi-modular, off-the-shelf endovascular aortic arch stent-graft that allows proximal landing in zone 0 and distal landing in zone 3. The first module is advanced on a through-and-through axillary-femoral guidewire; it has a branch for the brachio-cephalic trunk and covers the aortic arch and the descending aorta. The second module is implanted in the ascending aorta and connects to the first module through an interlocking system. Patients undergo supra-aortic debranching procedures before stent-graft implantation. The endovascular procedure is erformed in a hybrid room under general anesthesia and it's completely percutaneous. The first patient was a 58-year-old man with residual aortic arch disease after surgery for type A acute aortic dissection. The procedure was successfully performed and the patient was discharged on 15th postoperative day after a minor stroke occurred with no consequences. The second patient was a 74-year-old man with a saccular aneurysm, of the anterior portion of the aortic arch. The endovascular procedure was uneventful and the patient was discharged on 15th postoperative day. At 6-year follow-up this patient is alive and in good clinical conditions. Angio-CT scan at follow-up shows stability of the device, no endoleaks and patency of supra-aortic bypass. In both cases there was no need for blood transfusions.
Learning Objectives:
Understand microinvasive total endovascular aortic arch repair.
Describe minimization of surgical impact on the treatment of aortic arch pathologies.
Conduct an alternative procedure to open surgery in patients who refuse blood and blood products and who are otherwise at a very high transfusion risk with a traditional approach.
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