Anatomic Feasibility of Endo-bentall Strategies for Management of Acute Type A Aortic Dissection.

Abstract

To assess the feasibility of acute type A dissections treatment with a dedicated aortic root endograft concept and introduce a new aortic classification. Acute type A aortic dissection remains a catastrophic aortic condition with perioperative mortality ranging from 12% and 20%. Total Aortic root endovascular repair, the "Endo-Bentall concept," has been explored as an alternative but only documented in the case report. An imaging study of all consecutive patients treated in 3 French centers was achieved. The study introduces an adapted aortic classification to report entry tear locations. Measurements included aortic annulus mensuration, coronary height, and several aortic lengths. Two treatment concepts were described "fenestrated Endo-Bentall" (FEB) and "branched Endo-Bentall (BEB)." Patients were eligible for the "FEB" design if their aortic root dimensions fitted the Edwards Sapien and Corevalve Medtronic instructions for use. Eligibility for the "BEB" required meeting the criteria for a "FEB" and having a left coronary main stem length exceeding 5 mm. "BEB" was mandatory when the entry was located in the aortic root. A total of 250 computed tomography scans for acute type A aortic dissection were reviewed, and 116 were finally included for analysis. The primary entry tear was found in the aortic root in 9% of patients, and in 31% of cases, it was located within the first centimeter distal to the sinotubular junction. Of the patients, 63.7% were eligible for an Endo-Bentall procedure, even 73.3% when considering extended criteria. FEB accounted for 2/3 of cases. In our study, 63.7% of patients with aortic type A dissections are deemed eligible for an "Endo-Bentall repair," increasing to 73.3% when considering extended anatomic criteria.