Modular Endo-Bentall Procedure Using a "Rendez-Vous Access".

Area of Science:

• Cardiovascular Surgery
• Interventional Cardiology
• Medical Devices

Background:

• The endo-Bentall procedure, a single endovascular valve-carrying conduit, has limited published experience.
• Complex aortic aneurysms, particularly those involving the aortic arch and ascending aorta, pose significant challenges for endovascular repair due to inadequate proximal landing zones.

Observation:

• A case report details a modular endo-Bentall technique in an 82-year-old woman with a large distal arch and descending aorta aneurysm and an ascending aortic aneurysm.
• The technique involved a physician-modified endograft (PMEG) with coronary artery perfusion fenestrations and transcatheter aortic valve implantation (TAVI).
• A novel "rendez-vous access" technique facilitated rapid, sequential deployment of both components.

Findings:

• The modular endo-Bentall procedure, integrating PMEG and TAVI, was successfully performed.
• The PMEG was deployed in the left ventricular outflow tract, followed by TAVI placement.
• This approach allowed for simultaneous endovascular aortic arch repair.

Implications:

• The described modular endo-Bentall technique is a feasible and adaptable option for managing complex aortic aneurysms.
• The "rendez-vous access" facilitates its use in emergent situations.
• This innovative approach expands the possibilities for endovascular treatment of challenging aortic pathologies.