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Endovascular therapy in patients with genetically triggered thoracic aortic disease: applications and short- and mid-term outcomes

Selected in European Journal of Cardio-Thoracic Surgery by Rylski

References

Authors

O. Preventza, S. Mohammed, BY Cheong, L Gonzalez, M Ouzounian, JJ Livesay, DA Cooley, JS Coselli

Reference

Eur J Cardiothorac Surg. 2014;46:248-53

Published

August 2014

Link

Access the Abstract

My Comment

What is known

Endovascular aortic repair in patients with genetically triggered thoracic aortic disease is controversial. These patients are usually very young, their aortic wall is vulnerable and any endovascular manipulation may lead to serious complications. Dr. Coselli’s group has an outstanding experience in aortic surgery. They evaluated the results of endovascular aortic treatment in patients with genetically triggered thoracic aortic disease operated on in Houston.

Results

  • Between 2003 and 2013, 60 patients received endovascular treatment for thoracic aortic disease (n=30 patients aged <50 years, n=15 with bicuspid aortic valve, n=10 with Marfan syndrome, n=3 with Loeys-Dietz syndrome, n=3 with familial thoracic aneurysm and n=2 with genetic mutations)
  • The technical success rate was 100%
  • In-hospital mortality was 3% (n=2), neurological events occurred in 2 patients
  • Fifteen reinterventions were required in 10 patients
  • Overall survival during median 2.3 years follow-up was 95%

My comments

The authors concluded that endovascular technology could be helpful in treating selected young patients with genetically triggered thoracic aortic disease. However, we should be caution evaluating results of this mid-term follow-up study. Most aortic surgeons support the idea of endovascular therapy of genetically triggered aortic disease, but only in case of already prosthetic replaced aortic segments corresponding to proximal and distal landing zones. Endovascular treatment of the native aorta in Marfan and Loeys-Dietz syndrome patients is not recommended due to high-risk of later endoleaks type I. Further research and long-term follow-up studies are necessary to identify patients with genetically triggered thoracic aortic disease who benefit from endovascular aortic repair and delineate contraindication for endovascular approach.

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