Titre :

Outcomes After Endovascular Aortic Intervention in Patients With Connective Tissue Disease.

Auteur(s) :

Olsson, Karl Wilhelm [Auteur]
Mani, Kevin [Auteur]
Uppsala University Hospital
Burdess, Anne [Auteur]
Scali, Salvatore T. [Auteur]
Kölbel, Tilo [Auteur]
University Heart Center [Hamburg]
Panuccio, Giuseppe [Auteur]
Eleshra, Ahmed [Auteur]
Bertoglio, Luca [Auteur]
Ardita, Vincenzo [Auteur]
Melissano, Germano [Auteur]
Universita Vita Salute San Raffaele = Vita-Salute San Raffaele University [Milan, Italie] [UniSR]
Acharya, Amish [Auteur]
Bicknell, Colin [Auteur]
Riga, Celia [Auteur]
Gibbs, Richard [Auteur]
Jenkins, Michael [Auteur]
Sweet, Matthew P. [Auteur]
University of Washington [Seattle]
Kasprzak, Piotr M. [Auteur]
Pfister, Karin [Auteur]
University of Regensburg
Oikonomou, Kyriakos [Auteur]
University Hospital Regensburg
Heloise, Tessely [Auteur]
Centre Hospitalier Régional Universitaire [CHU Lille] [CHRU Lille]
Sobocinski, Jonathan [Auteur]
Advanced Drug Delivery Systems (ADDS) - U1008
Butt, Talha [Auteur]
Dias, Nuno [Auteur]
Lund University
Tang, Ching [Auteur]
Cheng, Stephen W. K. [Auteur]
The University of Hong Kong [HKU]
Vandenhaute, Sarah [Auteur]
Universiteit Gent = Ghent University = Université de Gand [UGENT]
Van Herzeele, Isabelle [Auteur]
Universiteit Gent = Ghent University = Université de Gand [UGENT]
Sorber, Rebecca A. [Auteur]
Johns Hopkins University School of Medicine [Baltimore]
Black, James H. [Auteur]
Johns Hopkins University School of Medicine [Baltimore]
Tenorio, Emanuel R. [Auteur]
Oderich, Gustavo S. [Auteur]
The University of Texas Health Science Center at Houston [UTHealth]
Vincent, Zoë [Auteur]
University of Auckland [Auckland]
Khashram, Manar [Auteur]
University of Auckland [Auckland]
Eagleton, Matthew J. [Auteur]
Massachusetts General Hospital [Boston, MA, USA]
Budtz-Lilly, Jacob [Auteur]
Aarhus University Hospital
Lomazzi, Chiara [Auteur]
Bissacco, Daniele [Auteur]
Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico
Trimarchi, Santi [Auteur]
Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico
Huerta, Abigail [Auteur]
Riambau, Vincent [Auteur]
Wanhainen, Anders [Auteur]
Uppsala Universitet [Uppsala]

Titre de la revue :

JAMA SURGERY

Nom court de la revue :

JAMA Surg

Numéro :

158

Pagination :

832-839

Date de publication :

2023-06-16

ISSN :

2168-6262

Mot(s)-clé(s) en anglais :

Cardiothoracic Surgery
Surgery
Vascular Surgery
Rheumatology
Pediatrics

Discipline(s) HAL :

Sciences du Vivant [q-bio]

Résumé en anglais : [en]

Importance Endovascular treatment is not recommended for aortic pathologies in patients with connective tissue diseases (CTDs) other than in redo operations and as bridging procedures in emergencies. However, recent ...
Lire la suite >Importance Endovascular treatment is not recommended for aortic pathologies in patients with connective tissue diseases (CTDs) other than in redo operations and as bridging procedures in emergencies. However, recent developments in endovascular technology may challenge this dogma. Objective To assess the midterm outcomes of endovascular aortic repair in patients with CTD. Design, Setting, and Participants For this descriptive retrospective study, data on demographics, interventions, and short-term and midterm outcomes were collected from 18 aortic centers in Europe, Asia, North America, and New Zealand. Patients with CTD who had undergone endovascular aortic repair from 2005 to 2020 were included. Data were analyzed from December 2021 to November 2022. Exposure All principal endovascular aortic repairs, including redo surgery and complex repairs of the aortic arch and visceral aorta. Main Outcomes and Measures Short-term and midterm survival, rates of secondary procedures, and conversion to open repair. Results In total, 171 patients were included: 142 with Marfan syndrome, 17 with Loeys-Dietz syndrome, and 12 with vascular Ehlers-Danlos syndrome (vEDS). Median (IQR) age was 49.9 years (37.9-59.0), and 107 patients (62.6%) were male. One hundred fifty-two (88.9%) were treated for aortic dissections and 19 (11.1%) for degenerative aneurysms. One hundred thirty-six patients (79.5%) had undergone open aortic surgery before the index endovascular repair. In 74 patients (43.3%), arch and/or visceral branches were included in the repair. Primary technical success was achieved in 168 patients (98.2%), and 30-day mortality was 2.9% (5 patients). Survival at 1 and 5 years was 96.2% and 80.6% for Marfan syndrome, 93.8% and 85.2% for Loeys-Dietz syndrome, and 75.0% and 43.8% for vEDS, respectively. After a median (IQR) follow-up of 4.7 years (1.9-9.2), 91 patients (53.2%) had undergone secondary procedures, of which 14 (8.2%) were open conversions. Conclusions and Relevance This study found that endovascular aortic interventions, including redo procedures and complex repairs of the aortic arch and visceral aorta, in patients with CTD had a high rate of early technical success, low perioperative mortality, and a midterm survival rate comparable with reports of open aortic surgery in patients with CTD. The rate of secondary procedures was high, but few patients required conversion to open repair. Improvements in devices and techniques, as well as ongoing follow-up, may result in endovascular treatment for patients with CTD being included in guideline recommendations.Lire moins >

Langue :

Anglais

Audience :

Internationale

Vulgarisation :

Non

Établissement(s) :

Université de Lille
Inserm
CHU Lille

Collections :

• Advanced Drug Delivery Systems (ADDS) - U1008

Date de dépôt :

2023-12-15T05:14:45Z
2024-02-26T10:03:33Z