Quo Vadis Cardiovascular Surgery: The Role of Open and Endovascular Techniques in the future (21st Century)
|
|
|
- Sherman Mills
- 5 years ago
- Views:
Transcription
1 Quo Vadis Cardiovascular Surgery: The Role of Open and Endovascular Techniques in the future (21st Century) Joseph E. Bavaria, MD Roberts-Measey Professor of Surgery Vice Chair, Division of Cardiovascular Surgery University of Pennsylvania Immediate Past-President; Society of Thoracic Surgeons (STS) Aorta Live; Hamburg, Germany 2017
2 Proximal Aortic Surgery in 21 st Century I m here to Set Up this excellent Session!!
3 Proximal Aortic Surgery in 21 st Century I m ALSO here to tell you that we are at the beginning of a Revolution
4 Aortic Arch Surgery in 21 st Century Recently, We (The Aorta Community) spent much energy and time trying to Optimize and answer the Question: What is the best Circulation Management Technique during Aortic Arch Reconstruction? Temperature HCA, RCP, ACP, Unilateral, Bilateral, etc.
5 The Optimization revolved around: What is the KEY CONCEPT Regarding Circulation Management of the Open Aortic Arch??? The mortality and morbidity of SHORT arch reconstructive times (<30-35min) is EMBOLIC (lateralized CVA). The mortality and morbidity of LONGER arch reconstructive times (>35-40min) is GLOBAL neurological deficit.
6 Aortic Arch Surgery in 21 st Century General Consensus on Circulation Management Tepid Temperatures are reasonable with good ACP technique ACP thought to be best, RCP reasonable especially for Short Arch reconstructive times, HCA Alone should be abandoned.
7 On Circulation Management: Cerebral Oximetry
8 Aortic Arch Surgery in 21 st Century Recently, We spent much energy and time trying to Optimize and answer the Question: What is the best Circulation Management Technique during Aortic Arch Reconstruction? But Now: We are Changing Practices and Developing Reconstructive Operations. Based on the Availability of New Devices. New Technology!!
9 Proximal Aortic Surgery in 21 st Century Aneurysm
10 Proximal Aortic/Arch Aneurysm: Future Ascending Aorta and Arch Asc Ao IA LCA Des Ao CT Chest, Ascending Ao SAX
11 Aortic Arch Surgery in 21 st Century: Aneurysm All open (proximal) operations will be performed with an Attitude looking towards Distal TEVAR Solutions. The Classic elephant trunk will be rare FET will be victorious All Conduct of Operation will be geared towards Proximalization into Zones 2,1,and 0 The (New) Debranching concept Zone 2 Zone 0
12 The Arch in Acute Type A Dissection? What is State of the Art. Now/Future?? Original Video Courtesy of J. Bavaria
13 Cause of death Acute CHF due to AI resuspension Coronary malperfusion Cerebral malperfusion Free Ascending rupture Treatment Aortic valve Aortic root repair Arch replacement Asc aortic replacement Fate of Distal Descending Aorta!
14 Do we have a problem with the downstream aorta?? R. Fattori et al. : Evolution of Aortic Dissection after Surgical Repair; Am J Cardiol Follow-up 12 to 90 month (58 pat.): 77,5% patent false lumen Year aortic growth rate: 0,56 cm PDFL vs. 0,11 cm TFL During 7 year period: 27,5 % re-op due to increasing diameter Barron DJ et al.: Twenty year follow-up of acute type A dissection: the incidence and extend of distal aortic disease using MRI. J Card Surg Follow-up 60 month (87 pat.): 72 % patent false lumen Most common cause for late death: related to distal aortic disease
15 Senior Surgeon Series Bavaria et al, 2007 (USA), 26% Reoperation at 12 years Included Debakey II Ishihara et al, 2009 (Japan), 27% Aortic Events at 5 years DeBartolomeo et al, 2001 (Italy), 27% Reoperation at 7 years Griepp et al, (USA), 16% reoperation at 8 years Included Debakey II Glauber and Murzi, 2010, 39% reoperation at 10 years (proximal and distal)
16 39% reoperation rate at 10 years Glauber, Murzi, et al; 2010: J Thorac Cardiovasc Surg 2002;123:
17
18 y.o male
19 Rapidly Expanding False lumen Larger Tear site = More Time Averaged Wall Shear Stress E.Shang, B.Jackson, J.Bavaria, et al (JVS 2015) Rapid Expa nsion
20
21
22
23 Do we have a problem with the distal aorta after repair of acute type A dissection?. YES Especially if we use a COMPOSITE function of Index Operation Failure: 1. Aortic Death; 2. Reoperation; 3. Aneurysm > 6.0 cm. 23
24 What can we do?? What Options are available??
25 STS San Diego, Jan 2015
26 Not worry about it: The Hemi-Arch (+/- Root) Aggressive Hemi-Arch with felt Neo- Media Reconstruction
27 Total Arch +/- Elephant Trunk with 4-branch graft Selective ACP Siena Graft
28 More Proximal Aortic Arch Surgery ENABLING later TEVAR if anatomy Suitable
29 77% of Stented Descending Aorta cases with Obliterated False Lumen vs only 25% for Standard hemi-arch Repair
30 Let s look at these
31 Aortic Arch Surgery in 21 st Century The Future Arch Treatment Civil War.
32
33 TBE Mona LSA Desai, Bavaria (First presented) STS 2015; AATS 2016 JTCVS 2017 (in press)
34 Zone 2 TBE (12 mm Portal) in Residual Type A Dissection (Downstream Aorta) 10 days Side branch sheath positioned in LSA Note nice horizontal access 3 cm Dacron LZ previously constructed with Zone 2 Arch (10 days earlier) 34
35
36 The Classic Type A Operation is under Siege!! There are reasonable arguments to extend the operation BOTH distally and proximally. However, The Arch and Distal imperative is MORE IMPORTANT!!
37 There are Multiple Ways to manage the ARCH in an Acute Type A Dissection My Prediction on the future based on our data, our increased sophistication, and the available technology: In Patients with < years life expectancy (>65).. Use Classic Hemi- Arch In Patients with an arch tear or distal Malperfusion. FET In patients < 65 and stable.. Zone 2 Arch with possible (60%) SEQUENTIAL Arch branch TEVAR Coming to you SOON!
38 Rapid Supra-Aortic Arch Vessel Anastomosis Using the Gore Hybrid Prostheses (90 seconds and better!!) Courtesy of Jim Williams, Peoria IL MM. Levack, JE. Bavaria, RC. Gorman, JH. Gorman III, LP. Ryan. The Annals of Thoracic Surgery Volume 95, Issue e163 - e165.
39 Gore Zone 0 TBE
40 Endovascular Arch Repair? Gore Zone 0 TBE
41 Isolated Arch Pathology? Arch Pathology WITH Ascending Pathology? Arch Pathology WITH Root/Valve Pathology? Arch Pathology as a Proximal extension of Descending pathology?
42 Aortic Arch Surgery in 21 st Century This anatomy only represents 1-3% of ALL ARCH cases There is already a TOTAL TEVAR (Endo) Solution for this anatomy
43 Courtesy of Bolton Medical
44 Cook Branched Arch Graft Courtesy of Cherrie Abraham, MD, Montreal, Canada
45 Isolated Arch Pathology? Arch Pathology WITH Ascending Pathology? Arch Pathology WITH Root/Valve Pathology? Arch Pathology as a Proximal extension of Descending pathology?
46 Zone 0 Landing: Achilles Heal?? Most Arch TEVAR will be Secondary or Sequential to PROXIMAL OPERATION DACRON
47 Aortic Arch Surgery in 21 st Century There are Significant Proximal Landing Zone Issues
48 Giant Fusiform Thoracic Aortic Aneurysm: Isolated Arch Endograft?? Where s the LZ?? Ascending Aorta and Arch Asc Ao IA LCA Des Ao CT Chest, Ascending Ao SAX
49 Distal LZ?? May Want to Replace Ascending Aorta?! Innominate
50 Bicuspid Valve Phenotype Aorta: Isolated Arch TEVAR??.. Where s the LZ??
51 Water Hammer Pulse AI Aneurysm: Major LZ Issue!! +3 AI BAV Aneurysm
52 Long Term TEVAR stability will possibly have issues
53 Aortic Arch Surgery in 21 st Century Despite all of That!!
54 The Future of Ascending TEVAR?: Repair of Ascending Aneurysm Trans-Apically with Stent Graft Szeto, Bavaria, et al; AnnThorSurg 2010 Pre Post
55 Medtronic Ascending Endograft FDA Physician IDE (Type A Dissection) Valiant Captiva 46x46x80 mm Courtesy of Khoynezhad/White; Cedars-Sinai /UCLA
56 Proximal Aortic Surgery in 21 st Century The Audit Function Data and Outcomes
57 Open and TEVAR Surgery Presentation of a Newly Designed Thoracic Aortic Surgery Database: A Report from the STS Adult Cardiac Surgery Database Nimesh D. Desai MD. PhD., E. Chen, M.D., J. Bavaria, MD on Behalf of the STS Aortic Surgery Task Force (First reported at the Jan STS Annual Mtg, Houston, TX)
58 Proximal Aortic Surgery in 21 st Century Conclusions
59 Proximal Aortic Surgery in 21 st Century: Index Proximal operations will be driven and concieved by the NEW Availability of New Technology Endografts Zones 0,1, and 2 TEVAR Branched Arch grafts Proximalization of the Conduct of Operation will continue (reduced Nerve injury and Collateral Network friendly) Supra-Aortic Vessel anastomosis will also improve with Technology Much faster and easier Zone 0
60 Proximal Aortic Surgery in 21 st Century: Index Operation Tactics will be driven to REDUCE Total CPB TIME (more important than Circ Arrest time) It s too early to have Guidelines on Aortic ARCH Surgery!! Very (Too) Dynamic at this Stage The only thing we should do is Outlaw HCA alone Better Outcomes Data (Global) Zone 0
61 Questions?
62 Thomas Eakins: Gross Clinic and Agnew Clinic Great Progress in 10 years! Thank You
STS/EACTS LatAm CV Conference 2017
STS/EACTS LatAm CV Conference 2017 Joseph E. Bavaria, MD Director, Thoracic Aortic Surgery Program Roberts-Measey Professor and Vice Chair of CV Surgery University of Pennsylvania Immediate-Past President
Antegrade Thoracic Stent Grafting during Repair of Acute Debakey I Dissection: Promotes Distal Aortic Remodeling and Reduces Late Open Re-operation
Antegrade Thoracic Stent Grafting during Repair of Acute Debakey I Dissection: Promotes Distal Aortic Remodeling and Reduces Late Open Re-operation Vallabhajosyula, P: Szeto, W; Desai, N; Pulsipher, A;
Joseph E. Bavaria, MD
EACTS Master Class on Aortic Valve Repair Joseph E. Bavaria, MD Director, Thoracic Aortic Surgery Program Roberts Measey Professor and Vice Chair of CV Surgery University of Pennsylvania Immediate-Past
Management of Acute Aortic Syndromes. M. Grabenwoger, MD Dept. of Cardiovascular Surgery Hospital Hietzing, Vienna, Austria
Management of Acute Aortic Syndromes M. Grabenwoger, MD Dept. of Cardiovascular Surgery Hospital Hietzing, Vienna, Austria I have nothing to disclose. Acute Aortic Syndromes Acute Aortic Dissection Type
Aggressive Resection/Reconstruction of the Aortic Arch in Type A Dissection
Aggressive Resection/Reconstruction of the Aortic Arch in Type A Dissection M. Grabenwoger Dept. of Cardiovascular Surgery Hospital Hietzing Vienna, Austria Disclosure Statement Consultant of Jotec, Hechingen,
Endovascular Branched Aortic Arch Repair
Houston Aortic Symposium 2018 Endovascular Branched Aortic Arch Repair Nimesh D. Desai MD PhD Associate Professor of Surgery, University of Pennsylvania Co-Director, Penn Thoracic Aortic Surgery Program
Emerging Roles for Distal Aortic Interventions in Type A Dissection Surgery
Emerging Roles for Distal Aortic Interventions in Type A Dissection Surgery Type A Dissection Workshop 2014 CCC Vancouver Oct 26 th, 2014 Jehangir Appoo Libin Cardiovascular Institute University of Calgary
Jean M Panneton, MD Professor of Surgery Program Director Vascular Surgery Chief EVMS. Arch Pathology: The Endovascular Era is here
Jean M Panneton, MD Professor of Surgery Program Director Vascular Surgery Chief EVMS Arch Pathology: The Endovascular Era is here Disclosures Consultant: Cook Medical, Bolton Medical, Medtronic Inc, Volcano,
TEVAR for the Ascending Aorta
TEVAR for the Ascending Aorta Himanshu J. Patel MD Joe D. Morris Collegiate Professor Section Head, Adult Cardiac Surgery University of Michigan Frankel Cardiovascular Center Disclosures Himanshu J. Patel
Aggressive Resection/Reconstruction of the Aortic Arch in Type A Dissection: Con
Aggressive Resection/Reconstruction of the Aortic Arch in Type A Dissection: Con Thomas G. Gleason, M.D. Ronald V. Pellegrini Professor and Chief Division of Cardiac Surgery University of Pittsburgh Presenter
Distal Arch and Descending Aorta: What Is the Optimal Therapy in 2017?
Distal Arch and Descending Aorta: What Is the Optimal Therapy in 2017? Eric E. Roselli, MD Chief, Adult Cardiac Surgery Director, Aorta Center Heart and Vascular Institute, Cleveland Clinic Disclosures
Minimally Invasive Aortic Arch Surgery:
Minimally Invasive Aortic Arch Surgery: Where are we? Where are we headed? Jehangir J. Appoo Libin Cardiovascular Institute University of Calgary www.aorta.ca June 15, 2016 Cardiac Masters Day: Minimally
Title. Different arch branched devices are available, is morphology the. main criteria of choice? Ciro Ferrer, MD
Different arch branched devices are available, is morphology the Title main criteria of choice? Ciro Ferrer, MD Vascular Surgery Unit Sapienza University of Rome Disclosure Speaker name: Ciro Ferrer Proctoring/speaking
Endo-Bentall: Fact or Fiction?
Endo-Bentall: Fact or Fiction? Eric E. Roselli, MD Chief, Adult Cardiac Surgery Surgical Director, Aorta Center Heart and Vascular Institute, Cleveland Clinic Disclosures Bolton Cook Cryolife Edwards Gore
Frozen Elephant Trunk in Acute Aortic Dissection
Frozen Elephant Trunk in Acute Aortic Dissection Derek R. Brinster, M.D. Professor of Cardiovascular and Thoracic Surgery Hofstra North Shore-LIJ School of Medicine Director of Aortic Surgery for the North
Acute Aortic Dissection: Decision and Outcome
Acute Aortic Dissection: Decision and Outcome Marc R. Moon, M.D. John M. Shoenberg Chair in CV Disease Chief, Cardiac Surgery Director, Center for Diseases of the Thoracic Aorta Washington University School
Type II arch hybrid debranching procedure
Safeguards and Pitfalls Type II arch hybrid debranching procedure Prashanth Vallabhajosyula, Wilson Y. Szeto, Nimesh Desai, Caroline Komlo, Joseph E. Bavaria Division of Cardiovascular Surgery, University
Combined Endovascular and Surgical Repair of Thoracoabdominal Aortic Pathology: Hybrid TEVAR
Combined Endovascular and Surgical Repair of Thoracoabdominal Aortic Pathology: Hybrid TEVAR William J. Quinones-Baldrich MD Professor of Surgery Director UCLA Aortic Center UCLA Medical Center Los Angeles,
Development of Stent Graft. Kato et al. Development of an expandable intra-aortic prothesis for experimental aortic dissection.
Development of Stent Graft Kato et al. Development of an expandable intra-aortic prothesis for experimental aortic dissection. ASAIO J 1993 The New England Journal of Medicine Downloaded from nejm.org
Current State of Thoracic Branch Devices and Ongoing Clinical Trials
Current State of Thoracic Branch Devices and Ongoing Clinical Trials Hiroo Takayama, MD, PhD Associate Professor of Surgery Director of Cardiovascular Institute Co-Director of Aortic Center NY Presbyterian/Columbia
Aortic Arch/ Thoracoabdominal Aortic Replacement
Aortic Arch/ Thoracoabdominal Aortic Replacement Joseph S. Coselli, M.D. Vice Chair, Department of Surgery Professor, Chief, and Cullen Foundation Endowed Chair Division of Cardiothoracic Surgery Baylor
Evolution of Thoracic Aortic Surgery A Rapidly Advancing Paradigm. October 15 th, 2014 Family Practice Evening Course University of Calgary
Evolution of Thoracic Aortic Surgery A Rapidly Advancing Paradigm October 15 th, 2014 Family Practice Evening Course University of Calgary Jehangir Appoo Division of Cardiac Surgery Libin Cardiovascular
Development of a Branched LSA Endograft & Ascending Aorta Endograft
Development of a Branched LSA Endograft & Ascending Aorta Endograft Frank R. Arko III, MD Sanger Heart & Vascular Institute Carolinas Medical Center Charlotte, North Carolina, USA Disclosures Proximal
DISCLOSURES ISOLATED DTA LESION? TYPE B DISSECTIONS TREATMENT OPTIONS
Endovascular Repair of Aortic Arch Pathologies; What is available/possible in the U.S. in 2018? Kaiser Permanente Endovascular Symposium 6/2/18 Sukgu M Han, MD, MS Assistant Professor of Clinical Surgery
Optimal Treatment of Chronic Dissection
Optimal Treatment of Chronic Dissection Chun-Che Shih 施俊哲 MD, Ph.D. Chief, Professor Institute of Clinical Medicine National Yang Ming University Division of Cardiovascular Surgery Taipei Veterans General
OPEN AND ENDOVASCULAR TECHNIQUES IN THE CARDIOTHORACIC SURGEON S HANDS
4 th Aortic Live Symposium OPEN AND ENDOVASCULAR TECHNIQUES IN THE CARDIOTHORACIC SURGEON S HANDS A/Prof George Matalanis Director Cardiac Surgery Austin Hospital Disclosure I do not have any potential
Introducing the GORE TAG Conformable Thoracic Stent Graft with ACTIVE CONTROL System
Introducing the GORE TAG Conformable Thoracic Stent Graft with ACTIVE CONTROL System K. Oikonomou Department of Vascular Surgery Regensburg University Disclosures W.L. Gore & Associates Sponsored Presentation
AORTIC DISSECTIONS Current Management. TOMAS D. MARTIN, MD, LAT Professor, TCV Surgery Director UF Health Aortic Disease Center University of Florida
AORTIC DISSECTIONS Current Management TOMAS D. MARTIN, MD, LAT Professor, TCV Surgery Director UF Health Aortic Disease Center University of Florida DISCLOSURES Terumo Medtronic Cook Edwards Cryolife AORTIC
UC SF. Disclosures. Thoracic Endovascular Aortic Repair 4/24/2009. Management of Acute Dissections: Is There Still a Role for Open Surgery?
UC SF Management of Acute Dissections: Is There Still a Role for Open Surgery? Darren B. Schneider, M.D. Assistant Professor of Surgery and Radiology Division of Vascular Surgery University of California
Technique and Outcome of Laser Fenestration For Arch Vessels
Technique and Outcome of Laser Fenestration For Arch Vessels Jean M. Panneton MD, FRCSC, FACS Professor of Surgery Chief & Program Director Division of Vascular Surgery Eastern Virginia Medical School
The Petticoat Technique Managing Type B Dissection with both Early and Long Term Considerations
The Petticoat Technique Managing Type B Dissection with both Early and Long Term Considerations Joseph V. Lombardi, MD Professor & Chief, Division of Vascular & Endovascular Surgery Department of Surgery,
Therapeutic Pathway In Acute Aortic Dissection. Speaker: Cesare Quarto Consultant Cardiac Surgeon Royal Brompton Hospital, London UK
Therapeutic Pathway In Acute Aortic Dissection Speaker: Cesare Quarto Consultant Cardiac Surgeon Royal Brompton Hospital, London UK Disclosure of Interest Speaker name: Cesare Quarto I do not have any
Ascending Aorta: Is The Endovascular Approach Realistic?
University Heart Center Hamburg GERMAN AORTIC CENTER UHC Ascending Aorta: Is The Endovascular Approach Realistic? Tilo Kölbel, Christian Detter, Yskert v. Kodolitsch, Sebastian Debus University Heart Center
Redo treatment and open conversion after TEVAR
Redo treatment and open conversion after TEVAR Roberto Chiesa Vascular Surgery, Vita-Salute University Scientific Institute San Raffaele Milan, Italy Number of procedures Off-Label indications for TEVAR
Aortic Arch pathology options: Open,Hybrid, fenestration, Chimney or branched stent-graft?
Aortic Arch pathology options: Open,Hybrid, fenestration, Chimney or branched stent-graft? Chang Shu, M.D., Ph.D Vascular Surgery Center National Center for Cardiovascular Diseases. Fuwai Hospital, CAMS
I-Hui Wu, M.D. Ph.D. Clinical Assistant Professor Cardiovascular Surgical Department National Taiwan University Hospital
Comparisons of Aortic Remodeling and Outcomes after Endovascular Repair of Acute and Chronic Complicated Type B Aortic Dissections I-Hui Wu, M.D. Ph.D. Clinical Assistant Professor Cardiovascular Surgical
Gelweave TM. Thoracic and Thoracoabdominal Graft Geometries. Ante-Flo TM 4 Branch Plexus. Siena Valsalva TM Trifurcate Arch Graft. Coselli.
Gelweave TM Thoracic and Thoracoabdominal Graft Geometries Ante-Flo TM 4 Branch Plexus Siena Valsalva TM Trifurcate Arch Graft Coselli Lupiae Product availability subject to local regulatory approval.
Santi Trimarchi, MD, PhD Vascular Surgeon Thoracic Aortic Research Center, Director IRCCS Policlinico San Donato University of Milan
The Gore GREAT Registry: Update about a real life data collection Santi Trimarchi, MD, PhD Vascular Surgeon Thoracic Aortic Research Center, Director IRCCS Policlinico San Donato University of Milan Disclosures
Early outcomes of acute retrograde dissection in the aortic arch and the ascending aorta data from IRAD
Early outcomes of acute retrograde dissection in the aortic arch and the ascending aorta data from IRAD Foeke JH Nauta, MD, PhD Resident Cardiothoracic Surgery, Academic Medical Center, Amsterdam Disclosure
THE EVOLUTION OF FET-TECHNIQUE
4 th Aortic Live Symposium THE EVOLUTION OF FET-TECHNIQUE Heinz Jakob, MD PhD West German Heart andvascular Center, University Duisburg-Essen, Germany Disclosure Speaker name: Heinz Jakob JOTEC GmbH, Hechingen,
Acute dissections of the descending thoracic aorta (Debakey
Endovascular Treatment of Acute Descending Thoracic Aortic Dissections Nimesh D. Desai, MD, PhD, and Joseph E. Bavaria, MD Acute dissections of the descending thoracic aorta (Debakey type III or Stanford
Modification in aortic arch replacement surgery
Gao et al. Journal of Cardiothoracic Surgery (2018) 13:21 DOI 10.1186/s13019-017-0689-y LETTER TO THE EDITOR Modification in aortic arch replacement surgery Feng Gao 1,2*, Yongjie Ye 2, Yongheng Zhang
Hybrid Repair of a Complex Thoracoabdominal Aortic Aneurysm
Hybrid Repair of a Complex Thoracoabdominal Aortic Aneurysm Virendra I. Patel MD MPH Assistant Professor of Surgery Massachusetts General Hospital Division of Vascular and Endovascular Surgery Disclosure
Surgical Considerations of TEVAR
Surgical Considerations of TEVAR University of Alberta, June 14 th, 2013 Jehangir Appoo Libin Cardiovascular Institute University of Calgary, Today: Lesions/Pathology amenable to TEVAR On label Off label
Ascending Aorta: Is The Endovascular Approach Realistic?
Ascending Aorta: Is The Endovascular Approach Realistic? Tilo Kölbel, MD, PhD University Heart Center Hamburg University Hospital Eppendorf Disclosures Research-grants, travelling, proctoring speaking-fees,
Follow-up of Aortic Dissection: How, How Often, Which Consequences Euro Echo 2011
Follow-up of Aortic Dissection: How, How Often, Which Consequences Euro Echo 2011 Susan E. Wiegers, MD, FASE Director of Clinical Echocardiography Hospital of the University of Pennsylvania Disclosure
The Current Status Of Endovascular Repair Of Ascending Aorta And Aortic Arch
The Current Status Of Endovascular Repair Of Ascending Aorta And Aortic Arch Tilo Kölbel German Aortic Center Dpt. of Vascular Medicine University Heart Center Hamburg Disclosures Research-grants, travelling,
Objective assessment of current stent grafts: which graft for which lesion. Ludovic Canaud, MD, PhD Pierre Alric, MD, PhD Montpellier, France
Objective assessment of current stent grafts: which graft for which lesion Ludovic Canaud, MD, PhD Pierre Alric, MD, PhD Montpellier, France Conflict of interest: none 1 Introduction Different diseases
Joseph E. Bavaria, M.D. Roberts Measy Professor and Vice Chief CardioVascular Surgery Director: Thoracic Aortic Surgery Program University of
Joseph E. Bavaria, M.D. Roberts Measy Professor and Vice Chief CardioVascular Surgery Director: Thoracic Aortic Surgery Program University of Pennsylvania, USA North American Valve Repair, Philadelphia
Toward Total Endovascular Therapy of the Aorta. Adam W. Beck, MD. Associate Professor of Surgery Division of Vascular Surgery and Endovascular Therapy
Toward Total Endovascular Therapy of the Aorta Adam W. Beck, MD Associate Professor of Surgery Division of Vascular Surgery and Endovascular Therapy University of Alabama at Birmingham Disclosures Grant
Re-interventions after TEVAR:
Re-interventions after TEVAR: How often does it occur and what are procedures most commonly utilized to treat these issues? Pacific Northwest Endovascular Conference Seattle, WA June 15, 2018 PENN Surgery
Extended Arch Techniques for Acute Aortic Dissection: a systematic review and classification
Extended Arch Techniques for Acute Aortic Dissection: a systematic review and classification Holly Smith PGY2 Thoracic Aortic Rounds, Foothills Hospital September 25, 2015 Libin Cardiovascular Institute
What is the best treatment for False Lumen growth after type B Dissection
What is the best treatment for False Lumen growth after type B Dissection Nikolaos Tsilimparis, Fiona Rohlffs, Yuk Law, Sebastian Debus, Tilo Kölbel N. Tsilimparis, MD, PhD, FEBVS Deputy Head of German
Total Endovascular Repair Type A Dissection. Eric Herget Interventional Radiology
Total Endovascular Repair Type A Dissection Eric Herget Interventional Radiology 65 year old male Acute Type A Dissection Severe Aortic Regurgitation No co-morbidities Management? Part II Evolving Global
State of Art Hybrid Approach
State of Art Hybrid Approach for Complex Aorta Diseases Won Ho Kim, MD Division of Cardiology, Eulji University Hospital Eulji University School of Medicine, Daejeon, Korea Introduction.Hybrid procedure
Performance of the conformable GORE TAG device in Type B aortic dissection from the GORE GREAT real world registry
University of Milan Thoracic Aortic Research Center Performance of the conformable GORE TAG device in Type B aortic dissection from the GORE GREAT real world registry Santi Trimarchi, MD, PhD Associate
THORACOABDOMINAL AORTIC ANEURYSMS HYBRID REPAIR
Update on Open and Endovascular Therapeutic Option for Aortic Repair CENTRE CARDIO-TORACIQUE DE MONACO Friday November 7 th, 2014 THORACOABDOMINAL AORTIC ANEURYSMS HYBRID REPAIR Roberto Chiesa Vascular
Advances in the Treatment of Acute Type A Dissection: An Integrated Approach
Advances in the Treatment of Acute Type A Dissection: An Integrated Approach Joseph E. Bavaria, MD, Derek R. Brinster, MD, Robert C. Gorman, MD, Y. Joseph Woo, MD, Thomas Gleason, MD, and Alberto Pochettino,
Challenges. 1. Sizing. 2. Proximal landing zone 3. Distal landing zone 4. Access vessels 5. Spinal cord ischemia 6. Endoleak
Disclosure I have the following potential conflicts of interest to report: Consulting: Medtronic, Gore Employment in industry Stockholder of a healthcare company Owner of a healthcare company Other(s)
Percutaneous Approaches to Aortic Disease in 2018
Percutaneous Approaches to Aortic Disease in 2018 Wendy Tsang, MD, SM Assistant Professor, University of Toronto Toronto General Hospital, University Health Network Case 78 year old F Lower CP and upper
Endovascular therapy for Ischemic versus Nonischemic complicated acute type B aortic dissection (catbad).
Endovascular therapy for Ischemic versus Nonischemic complicated acute type B aortic dissection (catbad). AS. Eleshra, MD 1, T. Kölbel, MD, PhD 1, F. Rohlffs, MD 1, N. Tsilimparis, MD, PhD 1,2 Ahmed Eleshra
Endovascular Ascending Repair: Is This the Next Frontier?
Endovascular Ascending Repair: Is This the Next Frontier? The 11 th Houston Aortic Symposium Session II: Ascending Aorta/Aortic Dissection (Proximal) February 15, 2018 Michael D. Dake, M.D. Thelma and
How to achieve a successful proximal sealing in TEVAR? Pr L Canaud
How to achieve a successful proximal sealing in TEVAR? Pr L Canaud CHU de Montpellier France Disclosure I have the following potential conflicts of interest to report: Consulting: Medtronic. Proximal neck
Animesh Rathore, MD 4/22/17. The Great Debate 45yo Man With Uncomplicated Acute TBAD: The Case For Medical Management
Animesh Rathore, MD 4/22/17 The Great Debate 45yo Man With Uncomplicated Acute TBAD: The Case For Medical Management Disclosures Just a young vascular surgeon who would like to keep his job My opponent
Changing Spectrum of Re-Interventions following TEVAR. 31 st Annual Florida Vascular Society. PENN Surgery
Changing Spectrum of Re-Interventions following TEVAR 31 st Annual Florida Vascular Society PENN Surgery No Disclosures Background: Challenges of analyzing TEVAR Outcomes in regard to re-interventions
Percutaneous Transapical Access for Thoracic Endovascular Repair
Percutaneous Transapical Access for Thoracic Endovascular Repair Atman P. Shah MD FACC FSCAI Co-Director, Hans Hecht Cardiac Catheterization Laboratory Clinical Director, Section of Cardiology Associate
Chairman and O. Wayne Isom Professor Department of Cardiothoracic Surgery Weill Cornell Medicine
Leonard N. Girardi, M.D. Chairman and O. Wayne Isom Professor Department of Cardiothoracic Surgery Weill Cornell Medicine New York, New York Houston Aortic Symposium Houston, Texas February 23, 2017 weill.cornell.edu
Dissection de type B: l étude Instead et corollaire stratégique
Dissection de type B: l étude Instead et corollaire stratégique Christoph A. Nienaber, MD, FACC University Rostock Heartcenter Med. Clinic I Cardiology christoph.nienaber@med.uni-rostock.de Type B aortic
OPTIONS IN AORTIC ARCH RECONSTRUCTION: CONVENTIONAL vs. FROZEN ELEPHANT TRUNK. Ricardo R Dias
OPTIONS IN AORTIC ARCH RECONSTRUCTION: CONVENTIONAL vs. FROZEN ELEPHANT TRUNK Ricardo R Dias ricardo.dias@incor.usp.br No disclosure 2 SURGERY should be considered maximal diameter 55mm symptons signs
UC SF Early Intervention in Type B Dissection: Results From the INSTEAD XL Trial. Acute Type B Dissection. Outline. Disclosures.
Early Intervention in Type B Dissection: Results From the INSTEAD XL Trial None Disclosures Jade S. Hiramoto, MD, MAS April 4, 2014 Outline Background Current treatment Results from INSTEAD trial Results
Aortic Center of Excellence at Sentara
Gordon K. Stokes, MD, FACS Eastern Virginia Medical School Sentara Vascular Specialists Norfolk, VA Aortic Center of Excellence at Sentara April 25, 2014 Disclosures I have no disclosures relevant to this
Tips and Tricks to Deliver a Stengraft to the Ascending Aorta
Tips and Tricks to Deliver a Stengraft to the Ascending Aorta Tilo Kölbel, MD, PhD University Heart Center University Hospital Eppendorf Hamburg, Germany Disclosures Research-grants, travelling, proctoring
UC SF An Algorithm to Choose Which Uncomplicated (Asymptomatic) Acute Type B Dissection Patients Should Undergo TEVAR. Disclosures.
An Algorithm to Choose Which Uncomplicated (Asymptomatic) Acute Type B Dissection Patients Should Undergo TEVAR Disclosures Royalties and research grant support from Cook Medical, Inc. Jade S. Hiramoto,
Intravascular Ultrasound in the Treatment of Complex Aortic Pathologies. Naixin Kang, M.D. Vascular Surgery Fellow April 26 th, 2018
Intravascular Ultrasound in the Treatment of Complex Aortic Pathologies Naixin Kang, M.D. Vascular Surgery Fellow April 26 th, 2018 DISCLOSURES Nothing To Disclose 2 ENDOVASCULAR AORTIC INTERVENTION Improved
Endovascular Management of Thoracic Aortic Pathology Stéphan Haulon, J Sobocinski, B Maurel, T Martin-Gonzalez, R Spear, A Hertault, R Azzaoui
Endovascular Management of Thoracic Aortic Pathology Stéphan Haulon, J Sobocinski, B Maurel, T Martin-Gonzalez, R Spear, A Hertault, R Azzaoui Aortic Center, Lille University Hospital, France Disclosures
Advances in Vascular and Cardiac Hybrid Procedures. Eric E. Roselli, MD
Advances in Vascular and Cardiac Hybrid Procedures Eric E. Roselli, MD Disclosures Medtronic Cook Investigator, consultant Terumo Apica Edwards % of Population Baby-Boomers now > 60 U.S. Population over
Joseph E. Bavaria, M.D. Roberts Measy Professor and Vice Chief CardioVascular Surgery Director: Thoracic Aortic Surgery Program University of
Joseph E. Bavaria, M.D. Roberts Measy Professor and Vice Chief CardioVascular Surgery Director: Thoracic Aortic Surgery Program University of Pennsylvania, USA AVRS Philadelphia Sept 2016 Pictures courtesy
Aortic Arch Treatment Open versus Endo Evidence versus Zeitgeist. M. Grabenwoger Dept. of Cardiovascular Surgery Hospital Hietzing Vienna, Austria
Aortic Arch Treatment Open versus Endo Evidence versus Zeitgeist M. Grabenwoger Dept. of Cardiovascular Surgery Hospital Hietzing Vienna, Austria Evidence Surgical aortic arch replacement with a Dacron
Treatment of acute type B aortic dissection: Current status
MEET Cannes, 18. - 21.06.2009 Treatment of acute type B aortic dissection: Current status Christoph A. Nienaber, MD, FACC University of Rostock Department of Internal Medicine, Cardiology christoph.nienaber@med.uni-rostock.de
Global Evidence for the Treatment of Type B Aortic Dissection
Global Evidence for the Treatment of Type B Aortic Dissection Ross Milner, MD Professor of Surgery Director, Center for Aortic Diseases September 17, 2016 Disclosures Consultant Cook, Endospan, Medtronic,
IMH/Penetrating Aortic Ulcers/ Saccular Aneurysms: How to manage and when to intervene
IMH/Penetrating Aortic Ulcers/ Saccular Aneurysms: How to manage and when to intervene UCSF Vascular Surgery Symposium 2018 Sukgu M Han, MD, MS Assistant Professor of Clinical Surgery Co-director, Comprehensive
Pioneering EVAR techniques in aortic dissection
Pioneering EVAR techniques in aortic dissection Jianing Yue, Weiguo Fu Department of Vascular Surgery Zhongshan Hospital Fudan University Shanghai, China LINC Asia-Pacific 2016 March 8-10, 2016 Hong Kong
ROLE OF VASCULAR SURGERY, CARDIAC SURGERY AND RADIOLOGY IN THE TREATMENT OF THORACIC AORTIC ANEURYSMS
ROLE OF VASCULAR SURGERY, CARDIAC SURGERY AND RADIOLOGY IN THE TREATMENT OF THORACIC AORTIC ANEURYSMS Armando Mansilha MD, PhD, FEBVS Joel Sousa MD 16 th National Congress of the Italian Society of Vascular
Acute Type B dissection. Closure of the infra diaphragmatic tear: how and when?
Acute Type B dissection. Closure of the infra diaphragmatic tear: how and when? Prof. Olgierd Rowiński II Department of Clinical Radiology Medical University of Warsaw Disclosure Speaker name: Olgierd
Presente e futuro negli aneurismi dell arco aortico
Sessione Congiunta SICVE, SEACV, SCVE, SPACV Presente e futuro negli aneurismi dell arco aortico Roberto Chiesa Vascular Surgery, Vita-Salute University Scientific Institute San Raffaele Milano, Italy
RETROGRADE BRANCH. Gustavo S. Oderich MD Professor of Surgery Director of Endovascular Therapy Division of Vascular and Endovascular Surgery
RETROGRADE BRANCH Gustavo S. Oderich MD Professor of Surgery Director of Endovascular Therapy Division of Vascular and Endovascular Surgery FACULTY DISCLOSURE Consulting* Cook Medical Inc., WL Gore Research
Low profile TEVAR: is it an added value? Michel Bosiers, G. Torsello Münster
Low profile TEVAR: is it an added value? Michel Bosiers, G. Torsello Münster Disclosure Speaker name:...michel Bosiers... I have the following potential conflicts of interest to report: Consulting Employment
Accepted Manuscript. Is A More Extensive Operation Justified for Acute Type A Dissection Repair? Dr. Leonard N. Girardi
Accepted Manuscript Is A More Extensive Operation Justified for Acute Type A Dissection Repair? Dr. Leonard N. Girardi PII: S0022-5223(18)32552-2 DOI: 10.1016/j.jtcvs.2018.09.048 Reference: YMTC 13502
Remodeling of the Remnant Aorta after Acute Type A Aortic Dissection Surgery
Remodeling of the Remnant Aorta after Acute Type A Aortic Dissection Surgery Are Young Patients More Likely to Develop Adverse Aortic Remodeling of the Remnant Aorta Over Time? Suk Jung Choo¹, Jihoon Kim¹,
Martin Czerny & Jürg Schmidli on behalf of the writing committee
Das Bildelement mit der Beziehungs-ID rid2 wurde in der Datei nicht gefunden. Expert Consensus Document on AORTIC ARCH Pathologies and its Treatment An expert consensus document of the European Association
The role of false lumen intervention to promote remodelling via induced thrombosis the FLIRT concept
The role of false lumen intervention to promote remodelling via induced thrombosis the FLIRT concept Professor Christoph A. Nienaber The Royal Brompton and Harefield NHS Trust Cardiology and Aortic Centre
Abdominal and thoracic aneurysm repair
Abdominal and thoracic aneurysm repair William A. Gray MD Director, Endovascular Intervention Cardiovascular Research Foundation Columbia University Medical Center Abdominal Aortic Aneurysm Endografts
Optimal repair of acute aortic dissection
Optimal repair of acute aortic dissection Dept. of Vascular Surgery, The 2nd Xiang-Yale Hospital, Central-South University, China Hunan Major Vessels Diseases Clinical Center Chang Shu Email:changshu01@yahoo.com
The Role of Stent-Grafts in Marfan Syndrome
The Role of Stent-Grafts in Marfan Syndrome James H. Black, III, MD, FACS The David Goldfarb, MD, Associate Professor of Surgery Chief, Division of Vascular Surgery and Endovascular Therapy The Johns Hopkins
Ascending Aorta: The Endovascular Approach
University Heart Center Hamburg GERMAN AORTIC CENTER Ascending Aorta: The Endovascular Approach Tilo Kölbel, MD, PhD University Heart Center Hamburg University Hospital Eppendorf Gold Standard for Ascending
Thoracic Aortic Research Center. University of Milan
University of Milan Thoracic Aortic Research Center Update on IRAD Santi Trimarchi, MD, PhD Associate Professor of Vascular Surgery, University of Milan Head, Unit of Vascular Surgery II Director, Thoracic
Asymptomatic Radiology / Clinical data Report / Cohort bias Referral bias. UCSF Vascular Symposium April 7-9, Acute Aortic Dissection
Aortic Dissection: Natural History What is the Natural History of Aortic Dissection? UCSF Vascular Symposium April 7-9, 2011 Asymptomatic Radiology / Clinical data Report / Cohort bias Referral bias Stephen
Disclosures: Acute Aortic Syndrome. A. Michael Borkon, M.D. Director of CV Surgery Mid America Heart Institute Saint Luke s Hospital Kansas City, MO
Acute Aortic Syndrome Disclosures: A. Michael Borkon, M.D. Director of CV Surgery Mid America Heart Institute Saint Luke s Hospital Kansas City, MO No financial relationships to disclose 1 Acute Aortic
COMPLICATIONS OF TEVAR
COMPLICATIONS OF TEVAR P. Bergeron, A.Petrosyan, F.Markatis, T.Abdulamit, J.-C. Trastour IMAD CONGRESS 2010 Liège Belgium BACKGROUND Stentgrafting is a recognized treatment for TAA & TAD and has been proposed