Early and Midterm Outcomes of Endovascular Aortic Arch Repair Using In Situ Laser Fenestration

Area of Science:

• Cardiovascular Surgery
• Endovascular Repair
• Aortic Arch Pathology

Background:

• Thoracic endovascular aortic repair (TEVAR) offers an alternative to open repair for aortic arch pathologies.
• In situ laser fenestration thoracic endovascular aortic repair (LFTEVAR) is an off-the-shelf option addressing limitations of custom devices and other techniques.
• Experience is crucial for managing complex aortic anatomies with endovascular methods.

Purpose of the Study:

• To report single-center outcomes of LFTEVAR for aortic arch pathologies.
• To assess the impact of increasing surgical experience on LFTEVAR outcomes.
• To evaluate LFTEVAR as a therapeutic option for patients unfit for open repair.

Main Methods:

• Retrospective analysis of prospectively collected data from a single aortic center (April 2017–January 2023).
• Followed STrengthening the Reporting of OBservational studies in Epidemiology (STROBE) guidelines.
• Compared outcomes between early (2017-2019) and late (2020-2023) experience groups, focusing on peri-operative mortality and cerebrovascular morbidity.

Main Results:

• Thirty patients (63.3% male, mean age 69.8 years) underwent LFTEVAR for various aortic arch pathologies.
• Technical success was 93%, with 10% target vessel instability (3.8% reintervention).
• Peri-operative mortality was 13.5%, stroke rate was 10% (3.3% major), and no spinal cord ischemia occurred. Outcomes did not differ significantly between early and late experience groups.

Conclusions:

• LFTEVAR in experienced centers is associated with low early mortality and stroke rates for aortic arch pathologies.
• It represents a safe and effective therapeutic option for patients unsuitable for open repair.
• Sufficient experience in complex endovascular aortic repair is essential for acceptable outcomes in high-risk patients.