The PETTICOAT Technique for Aortic Dissection: a Single-Center Experience

Masatoshi Komooka, Shnichi Higashiue, Satoshi Kuroyanagi, Onichi Furuya, Norihiko Hiramatsu, Saburo Kojima, Naohiro Wakabayashi

Department of cardiovascular surgery, Kishiwada Tokusyukai Hospital, OSAKA, Japan

Date, time and location: 2018.05.26 13:30, Congress Hall, 2F–A

Abstract

Objective: This study objective was to evaluate the early clinical outcome of the PETTICOAT technique with a new endovascular device specially designed for aortic dissection that has been available since October 2015 in Japan.

Materials and Methods:From October 2015 to November 2017, the Zenith Dissection Endovascular System (Zenith TXD) was used in 14 nonconsecutive patients with TAAD (10 men, mean age 63.9 years; 5 post-Total Arch Replacement cases, 9 post-Hemiarch replacement cases, 2 visceral ischemia), and in 14 nonconsecutive patients with TBAD (all men, mean age 62.8 years; 5 complicated cases; 4 visceral ischemia, 1 lower limb ischemia). Indications were compression and collapse of the true lumen and abdominal side branches and/or symptomatic malperfusion.Patients were studied for computed tomography imaging, operative complications, and technical aspect of the procedure.

Results: Delivery was successful in all cases. The median interval between the primary surgery for TAAD or clinical presentation of TBAD and the endovascular procedure was 88 days (range 2-772 days), 29 days (range 1-200 days) respectively.In 2 patients of TAAD and 6 patients of TBAD, the left subclavian artery revascularization by debranching was performed to obtain adequate proximal landing zone.Mean operation time was 92±21 minutes and 132±46 minutes, mean hospital stay was 22±18 days and 21±7 days, mean follow-up period was 8.1±5.2 months and 13.9±8.9 months for patients in TAAD and TBAD respectively. No 30-day complication except 1 paraparesis case were found and preoperative symptomatic malperfusion was abolished.Postoperative and follow-up imaging showed that false lumen was thrombosed and remodeled in large part of thoracic aorta and the compressed true lumen enlarged without any obstruction of the abdominal side branches.

Conclusions: The perioperative and early follow-up results showed that the PETTICOAT technique with Zenith TXD can be safely used without affecting the patency of the abdominal side branches covered by the bare stent.