Is it time to stent the ascending aorta? Martin Czerny
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1 Is it time to stent the ascending aorta? Martin Czerny
2 Content Basic insights into pathological process Dissection induced geometry changes Initial attempts Dedicated programme Future developments Summary
3 The aorta displays heterogenity regarding developmental origin 2 Neural crest Secondary heart field SMCs Secondary heart field MMCs Dijke, Arthur, Nat Rev 2007
4 CT Angiography From the first frame, segment aorta lumen segmentation Schwartz, Czerny, Biomed Imag 2012
5 CT Angiography From segmentation and deformation fields, extract motion Schwartz, Czerny, Biomed Imag 2012
6 Results Schwartz, Czerny, Biomed Imag 2012
7 Intraoperative view
8 Morphological correlate Sobocinski EJVES 2011
9 Functional imaging
10 Functional imaging
11 Functional imaging
12 Functional imaging
13 Functional imaging
14 Content Basic insights into pathological process Dissection induced geometry changes Initial attempts Dedicated programme Future developments Summary
15 Objective To assess the extent of changes in aortic geometry induced by the dissection process by means of computed tomography angiography (CTA) obtained prior and after acute type A aortic dissection
16 Methods L c
17 Methods
18 Results Overall 63 patients Median age 68 years 46% females Similar risk profile Pre-dissection ascending diameter was <50 mm in all AADA N=63 Spontaneous N=27 Retrograde N=36
19 Results Pre-Dissection Post-Dissection Pre-Dissection Post-Dissection
20 Mid-Ascending Aortic Diameter (mm) Results Spontaneous AADA Retrograde AADA mm +12.8mm (+32%) p< mm Pre-Dissection Post-Dissection /
21 Content Basic insights into pathological process Dissection induced geometry changes Initial attempts Dedicated programme Future developments Summary
22 Ideal clinical scenario
23 Alternative approaches- still experimental
24 Completion CT scan Zimpfer, Czerny ATS 2006
25 Content Basic insights into pathological process Dissection induced geometry changes Initial attempts Dedicated programme Future developments Summary
26
27 day 0 day 5
28 /
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30 /
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33 Content Basic insights into pathological process Dissection induced geometry changes Initial attempts Dedicated programme Future developments Summary
34 Morphological correlate Sobocinski EJVES 2011
35 Concept Prototype Distal extension to cover to the level of the brachiocephalic trunk Aortic valve Perfusion Covered to exclude entry
36 Describe any practical results achieved to date ie., sales, profits, users, citations etc 1. The CT-feasibility study was conducted according to the population of 1196 patients with severe aortic stenosis screened for TAVI (J Card Surg 2014;29: ) 2. Novel device prototype was made using Symetis TAVI Valve and Cook thoracic stentgraft and was implanted into transparent 3D printed proximal aorta
37 Conclusions Developing a single-unit endovascular device for simultaneous ascending and aortic valve is a question of time. A novel composite endovascular valved graft will extend the application of transcatheter techniques to patients denied TAVI due to a concomitant ascending aneurysm and those with acute type A dissection with high risk of mortality.
38 Summary Thorough understanding of pathophysiology is key Complexity is amplified as compared to distal aortic segments A tube alone is not sufficient to treat the majority of patients Efforts for a valved conduit are ongoing Combining knowledge and technology will pave the way
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