Transapical wire-assisted endovascular repair of thoracic aortic dissection

Fabio Ramponi*, Michael P. Vallely, Michael S. Stephen, Paul G. Bannon, Matthew S. Bayfield, Geoffrey H. White

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

17 Citations (Scopus)

Abstract

Purpose: To describe a technique for transapical wire-assisted endograft deployment under rapid ventricular pacing for a type B dissection involving the proximal left subclavian artery and extending to the aortic bifurcation. Case Report: A 58-year-old man presented with a symptomatic thoracic aneurysm as a complication of a chronic type B dissection, with a short proximal neck in zone 1. After arch vessel debranching, the patient underwent endoluminal repair with deployment of a closed web, tapered Valiant thoracic endograft over a through-and-through wire from the left groin to the apex of the left ventricle, using rapid ventricular pacing to reduce cardiac output. The remaining dissected aorta was covered with a second Valiant endograft down to the distal third of the descending thoracic aorta and bare Z stents down to the aortic bifurcation to re-expand the true lumen. A freeflow Valiant endograft was deployed as a proximal extension to treat a proximal type I endoleak. The recovery was complicated by retrograde type A aortic dissection, considered secondary to the bare stent. The complication was repaired surgically; postoperative computed tomography after recovery was unremarkable. Conclusion: Transapical wire-assisted deployment with rapid ventricular pacing is feasible and may provide improved stability for stenting within the aortic arch. The use of a stentgraft with a proximal bare stent is associated with a higher risk of retrograde extension of the dissection and warrants lifelong imaging follow-up.

Original languageEnglish
Pages (from-to)350-354
Number of pages5
JournalJournal of Endovascular Therapy
Volume18
Issue number3
DOIs
Publication statusPublished - Jun 2011
Externally publishedYes

Keywords

  • Aortic dissection
  • Rapid ventricular pacing
  • Stent-graft
  • Thoracic endovascular aortic repair
  • Through-and-through wire
  • Transapical wire

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