(P204) TOTAL ENDOVASCULAR AORTIC ARCH REPAIR

Background: Although surgery is the gold standard to treat aortic arch aneurysms, previous aortic surgery and cumulative co-morbidities may portend to a prohibitive operative risk in select patients. Total endovascular aortic arch repair (TEAAR) represents a novel, less-invasive alternative for such patients, with increasing reports to its utilization within the literature. We performed a systematic review of TEAAR, with the aim to delineate early outcomes with this new evolving technology.

METHODS AND RESULTS: A systematic review for endovascular aortic arch therapies with a proximal seal at Zone 0 was carried forth. Inclusion criteria were all studies describing outcomes with CE certified ‘custom made’ or ‘off-the-shelf’ Zone 0 stent graft deployments. Physician modified devices and in-situ fenestrated grafts were excluded. The primary search of MEDLINE, EMBASE, CINAHL, and the Cochrane CENTRAL register was supplemented with searches of Web of Science, ClinicalTrials.gov, conference abstracts (within last 3 years) and a hand search of citations within relevant articles. Articles underwent two stage screening by two independent reviewers prior to inclusion. 15 investigations were identified (8 observational studies and 7 case report/series). A combined total of 273 TEAAR patients (76% male) were included in the pooled data set. Previous aortic surgery was frequent within the cohort (74%; 148/200). Hypertension was the most common preoperative characteristic (94%; 198/211), followed by chronic kidney disease (39%; 87/225), coronary artery disease (29%; 62/213), prior stroke (18%; 37/210), type 2 diabetes (15%; 30/196), and peripheral vascular disease (13%; 18/142). The most common indication for TEAAR was chronic arch dissection with degenerative aneurysmal disease (54%; 148/273). Pure arch aneurysm (41%; 112/273), penetrating atherosclerotic ulcer (2%; 5/273) and type IA endoleak from a Zone 2 thoracic endograft (1%; 3/273) were other indications. Double branch (70%; 192/273), Triple branch (19%; 53/273) and single branch [into innominate artery] (10%; 28/273) devices were utilized. Adjunct left carotid-subclavian bypass occurred in 90% of double and single branched procedures. Procedural success with TEAAR was 96% (242/256). Aggregate data for the cumulative studies showed an all-cause mortality of 10% (26/269), stroke 9% (23/268), peripheral vascular events 7% (11/157) and myocardial infarction 2% (5/219). Endoleaks were identified at a collective rate of 12% (31/268). Type I endoleaks were reported at 9% (23/248), Type II 9% (8/92) and type III 6% (6/98).

Conclusion: TEAAR represents an emerging option for the management of aortic arch disease. TEAAR associates with high procedural success rates and acceptable early outcomes in a high-risk patient population.