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Publications

Journal Article Ahead of print

PubMed: 41363661 DOI: 10.1177/15266028251396292

Technical Notes: Open Ascending Aorta and Valve Repair Following Total Arch Endovascular Repair.

J Endovasc Ther

Authors: Florent Porez, Robert Pruna-Guillen, Julien Guihaire, Konstantinos Zannis, Antoine Gaudin, Alessandro Costanzo, Dominique Fabre, Thomas Le Houerou, Alexandros Mallios, Stéphan Haulon

Affiliations

  • Aortic Center, Department of Vascular Surgery, Hôpital Marie Lannelongue, Groupe Hospitalier Paris Saint Joseph, INSERM UMR_S 999, Université Paris Saclay, Le Plessis-Robinson, France.
  • Department of Cardiac Surgery, Institut Mutualiste Montsouris, Paris, France.
  • Department of Vascular Surgery, Hôpital Saint Joseph, Groupe Hospitalier Paris Saint Joseph, Paris, France.

Abstract

INTRODUCTION

Arch-branched endovascular repair (B-TEVAR) is an emerging alternative to open arch repair in high-risk patients. As its use grows, complex reoperations involving the ascending aorta (AA) and heart valves will become more frequent. No prior technique for open AA repair after B-TEVAR has been described.

TECHNIQUE

Two patients with prior B-TEVAR underwent open AA and valve surgery. The first patient had AA replacement under circulatory arrest and selective bicarotid perfusion. The second underwent Bentall and mitral valve replacement using femoral-femoral bypass, with a compliant balloon for distal aortic control and selective brachiocephalic trunk (BCT) perfusion.

RESULTS AND DISCUSSION

Both surgeries were successful. The first patient recovered uneventfully. The second had a prolonged ICU stay but recovered fully. Surgical planning must account for endograft position, branch orientation, and clamping strategy. Preoperative CT with 3D reconstruction is essential.

CONCLUSION

AA and valve repair after B-TEVAR is feasible. These cases offer technical insights for managing such complex reoperations as B-TEVAR becomes more common.Clinical ImpactArch-branched endovascular repair (B-TEVAR) is a less invasive alternative to standard open arch repair (OAR). We describe 2 surgical techniques to successfully perform cardiac surgery, including AA and aortic and mitral valve repairs, in patients with a history of B-TEVAR. Tailored approaches to address these challenging cases are mandatory, with a special focus on the endograft branches position and direction.

MeSH

Mitral Valve, Aorta, Aortic Valve, Vascular Surgical Procedures, Endovascular Aneurysm Repair