Ralf R. Kolvenbach Duesseldorf FRG

Ron Karmeli Jerusalem Israel

Status Of Aortic Wrapping For Ascending Aortic Aneurysms: A Less Invasive Approach: Indications And Results

Conflict of Interest: None

Contraindications Ascending Hybrid Repair

Aortic Valve incompetence

Coronary artery disease requiring CABG

Congestive Heart failure NYHA III - IV

Indications:

True AneurysmsExtension of Landing ZoneHybrid Procedure

Pseudo Aneurysm after CABG

Options

• Banding of the Aneurysm

• Creation of a proximal landing zone only

Technique

5,7 - 4,2 cm

Beware ofthe PA

Mini Sternotomy

Lachat et al.

Wrapping and Downsizing of Ascending Aorta

•

• Supraaortic Debranching

• Ascending Aortic Bypass

Arch Aneurysm-Extension of Landing Zone

• Diameter Reduction Ascending aorta: 5,2 cm 3,5 cm

• Sandwich Grafts + Chimneys

Reduction in Shear Stress

Maximum Diameter - Proximal Landing Zone

Banding - Before and After

Proximal Landing Zone Max Diameter

GORE TAG Chimney Innominate Artery

Proximal Landing Zone ( 45 – 29 mm )

Max. Diameter (6,2 -> 36 mm)

Chimney Graft Innominate Artery

Pre – and post Stent

Diameter Reduction Landing ZoneRemodelling: Conical -> Tubular

Risk Factors

Patient Gender Age COPD Home Oxygen Renal Insufficiency

(creatinine>1.8

Atrial or

Ventricular

Arrythmia

Coronary Artery

Disease

Hypertension Smoking (during

the last 2 years )

Congestive Heart

Failure NYHA III,

IV

Aortic Valve

Stenosis II °

Aortic Valve

Incompetence II°

1 female 79 x x x x x

2 female 69 x x x

3 male 87 x x x x x x

4 female 79 x x x x

5 female 67 x x x

6 male 67 x x x x

7 male 82 x x x

8 female 80 x x x

9 female 68 x x x

10 female 80 x x x x

11 male 77 x x x

12 female 79 x x x x x x

13 male 73 x x x x

Perioperative Details

Results

Conclusion : Endo Bentall ?

Ralf R. Kolvenbach Duesseldorf FRG

Ron Karmeli Jerusalem Israel

Status Of Aortic Wrapping For Ascending Aortic Aneurysms: A Less Invasive Approach: Indications And Results