iTalian RegIstry of doUble inner branch stent graft for arch PatHology (the TRIUmPH Registry)

• Published in: Journal of vascular surgery 2019-09, Vol.70 (3), p.672-682.e1
• Main Authors: Ferrer, Ciro, MD, Cao, Piergiorgio, MD, FRCS, Coscarella, Carlo, MD, Ferri, Michelangelo, MD, Lovato, Luigi, MD, Camparini, Stefano, MD, di Marzo, Luca, MD
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Aorta, Thoracic - surgery; Aortic arch; Aortic Diseases - diagnostic imaging; Aortic Diseases - mortality; Aortic Diseases - surgery; Blood Vessel Prosthesis; Blood Vessel Prosthesis Implantation - adverse effects; Blood Vessel Prosthesis Implantation - instrumentation; Blood Vessel Prosthesis Implantation - mortality; Clinical Competence; Endovascular aortic arch repair; Endovascular Procedures - adverse effects; Endovascular Procedures - instrumentation; Endovascular Procedures - mortality; Female; Hospital Mortality; Humans; Inner branch stent graft; Italy; Learning Curve; Male; Middle Aged; Postoperative Complications - mortality; Postoperative Complications - therapy; Prosthesis Design; Registries; Retrospective Studies; Risk Factors; Stents; Surgery; Thoracic endovascular aortic repair; Thoracic stent graft; Time Factors; Treatment Outcome
• ISSN: 0741-5214; 1097-6809
• DOI: 10.1016/j.jvs.2018.11.046

AbstractObjectiveThe objective of this study was to assess early and midterm results after endovascular aortic arch repair using a double inner branch stent graft (DIBSG) in patients with aortic arch aneurysm or dissection unfit for open surgery. MethodsBetween 2012 and 2018, there were 24 patients with aortic arch disease who were treated with a single model of a DIBSG (Terumo Aortic, Glasgow, United Kingdom) in nine Italian cardiovascular centers. We investigated technical success, mortality, occurrence of major complications, and need for reintervention in a multicenter, nonrandomized, retrospective fashion. ResultsThe in-hospital mortality rate was 16.7%. Cerebrovascular events occurred in 25% of patients and major strokes in 12.5%. Two patients experienced a retrograde dissection (8.3%), whereas none reported any type I or type III endoleak. During a mean follow-up of 18 months (range, 1-60 months), one patient died of a nonaortic cause and one reported a nonarch-related major stroke. No late secondary intervention was needed during the follow-up. Excluding from the analysis the first six patients treated until 2014 as part of the learning curve, in-hospital mortality, major stroke, and retrograde dissection rates were 11.1%, 11.1%, and 5.6%, respectively. ConclusionsEndovascular aortic arch repair using this model of DIBSG is feasible, and results are acceptable for a new technique in a high-risk subset of patients. Operative mortality suffers the effect of a learning curve, whereas midterm aorta-related survival is promising. Endovascular repair of aortic arch disease with a DIBSG should always be considered to give high-risk patients a chance of repair. Large-scale studies are needed to assess the long-term durability of this technique.