Intraoperative IVUS During Arch Repair for Type A Dissection Facilitates Accurate True Lumen Stent Deployment
Cenea Kemp, Christian Ghincea, Anna K Gergen, Zihan Feng, T. Brett Reece, Muhammad Aftab.
University of Colorado, Denver, CO, USA.
OBJECTIVE: Acute type A dissection (ATAD) with malperfusion is associated with significant morbidity and mortality. Operative approaches include hemiarch repair with antegrade thoracic endovascular stent (aTEVAR) or total aortic arch repair with frozen elephant trunk (FET) for false lumen exclusion and reinstitution of true lumen flow. Aortic stent grafts are often deployed under direct visualization. However, there remains a risk of false lumen stent deployment leading to persistent distal malperfusion which could be fatal. We hypothesize that utilizing intraoperative intravascular ultrasound (IVUS) results in accurate stent deployment and does not have negative effects on outcomes when compared to non-IVUS cases.
METHODS: Using our database, all ATADs repairs with total arch FET or hemiarch with aTEVAR were evaluated. The patents were categorized in IVUS and non-IVUS cohorts. Preoperative factors, including malperfusion, as well as intraoperative and postoperative outcomes were reviewed.
RESULTS: Between March of 2011 and March of 2021, 61 patients met the criteria. Of this, 63.3% of the IVUS and 54.8% of the non-IVUS group presented with malperfusion. Overall, intraoperative IVUS was utilized in 30 (49.2%) patients. Total arch with FET was frequently performed in all patients (p= 0.0195). There was no significant difference in the intraoperative characteristics and postoperative outcomes between both groups. Six deaths occurred in the IVUS group and 8 in the non-IVUS group (p= 0.865).
CONCLUSIONS:Utilizing IVUS during hybrid arch repair for ATAD facilitates stent deployment without any adverse effects on intraoperative or postoperative outcomes. This should be considered as an adjunct to hybrid arch repairs.
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