HYBRID AORTIC ARCH SURGERY TO CREATE A LANDING ZONE IN THE ASCENDING AORTA.

Thoracic Endovascular Aortic Repair (TEVAR) has enabled the treatment of aortic pathology that previously required open surgery, with higher morbidity and mortality. The need for a favorable landing zone (Lz), without compromising the patency of the supra-aortic vessels meant that Ishimaru Lz 2 was the most proximal technically feasible Lz. We developed a hybrid technique for the creation of a more proximal Lz in high risk patients - in the first stage, debranching/ rerouting of the supra-aortic vessels, with or without ascending aorta replacement, was performed; a few weeks later, a TEVAR with a LZ in the distal ascending aorta was performed.

Elective 2nd Stage TEVAR to Complete Frozen Elephant Trunk in the Surgical Correction of Complex Multisegmental Pathology of the Thoracic Aorta.

Introduction: Classical conventional surgery to treat multi-segmental thoracic aortic disease in two operative stages, sternotomy and left thoracotomy, is associated with significant mortality and complications. The Frozen Elephant Trunk (FET) associated with an endovascular procedure (TEVAR) allows an extensible and simplified surgical approach of the descending and thoracoabdominal aorta without increasing the risk.

Methods: Retrospective study of 8 patients (pts), 5 males, mean age 67.

Ascending Aorta Aneyrysms Over 70mm.

Introduction: Current guidelines suggest that patients with aortic diameter over 55-60 mm should undergo ascending aorta replacement, depending on associated valve pathology and other comorbidities. Studies show that the risk of aortic rupture over 60 mm is over 30%. Even though, we still receive in our practice patients that present with aneurysms of greater dimensions.

Cardiac Fibroelastoma: 10-Year Experience.

Introduction: Papillary fibroelastoma is one of the most common types of primary cardiac tumour. Though a rare pathology, its importance relates to its form of presentation, with stroke and sudden death, and the questions regarding its management.

Objectives: To review the casuistic of cardiac tumours in our service, in special the papillary fibroelastomas.

Ascending Aorta Aneurysms in Octogenarians.

Introduction: Older age is often regarded as a relative contraindication for open surgery for aortic aneurysms. These individuals often have a greater comorbidity burden that predispose them for development of postoperative complications. The aim of our study is to evaluate the surgical outcomes of selected octogenarians after open aortic surgery.

Simplified Technique for Aortic Arch Replacement in Patients at High Risk for Frozen Elephant Trunk.

Introduction: Surgical approach of multisegmental pathology of the thoracic aorta, namely aortic arch / descending aorta is challenging. The Frozen Elephant Trunk (FET) has good results, with acceptable risk. However, in the subgroup of patients (pts) older than 75 years and with important comorbidities, the surgical risk is very high.

TEVAR - A Primary or Adjunct Procedure Helpful in the Surgical Correction of Complex Pathology of the Thoracic Aorta?

Introduction: Thoracic Endovascular Aortic Repair (TEVAR) made possible the treatment of aortic disease that previously could only be approached openly, associated with a considerable morbidity and mortality. However, it also brings new challenges influencing patient selection - favourable landing zone, good peripheral access, propensity for endoleak (EL) - that requires rigorous clinical and imaging follow- -up.

Objective: Review all patients that underwent TEVAR in our Department and assess morbidity and mortality.

Frozen Elephant Trunk with E-Vita Open Hybrid Prosthesis for Surgical Correction of Multisegmental Thoracic Aortic Pathology: Review of Results.

Introduction: The Frozen Elephant Trunk (FET) surgery allows correction of ascending, arch and proximal descending aortic pathology, using a hybrid prosthesis at the same time. It is a complex intervention and requires a multidisciplinary team that, besides scheduling and performing the surgery, accompanies the patient (pt) throughout the postoperative period.

Objectives: To review short and medium term clinical results with this technique.

Virtual angioscopy and 3D navigation of the aorta.

The objective of this study is to demonstrate the applicability of virtual angioscopy (VA) in different forms of aortic disease where the diagnosis is unclear or uncertain. Five cases are presented where VA helped to establish a correct diagnosis and to choose the best surgical strategy by providing an intuitive image of the aorta.