The Modified Arch Landing Areas Nomenclature predicts proximal endograft failure after thoracic endovascular aortic repair.

Objectives: Our goal was to assess the value of the Modified Arch Landing Areas Nomenclature (MALAN) for thoracic endovascular aortic repair (TEVAR), in which each landing area (LA) is identified by a proximal landing zone and the type of arch (e.g. 0/I), as predictors of postoperative proximal endograft performance.

A challenging double bubble thoracic aortic and proximal subclavian aneurysm treated via transapical access.

This case report describes a patient with a distal aortic arch and left subclavian artery aneurysm who was considered unsuitable for open surgical repair because of comorbidities and previous bypass surgery. Inadequate peripheral access precluded standard transfemoral thoracic endovascular aortic repair. Nonetheless, successful endovascular repair was possible via transapical access using the new Gore cTAG deployment mechanism, which allowed precise antegrade stent graft deployment in a short proximal neck.

3D printing of aortic models as a teaching tool for improving understanding of aortic disease.

Background: A geometrical understanding of the individual patient's disease morphology is crucial in aortic surgery. The aim of our study was to validate a questionnaire addressing understanding of aortic disease and use this questionnaire to investigate the value of 3D printing as a teaching tool for surgical trainees.

Methods: Anonymized CT-angiography images of six different patients were selected as didactic cases of aortic disease and made into 3D models of transparent rigid resin with the Vat-photopolymerization technique.

Blood Flow after Endovascular Repair in the Aortic Arch: A Computational Analysis.

Background:  The benefits of thoracic endovascular aortic repair (TEVAR) have encouraged stent graft deployment more proximally in the aortic arch. This study quantifies the hemodynamic impact of TEVAR in proximal landing zone 2 on the thoracic aorta and the proximal supra-aortic branches.

Methods:  Patients treated with TEVAR in proximal landing zone 2 having available preoperative and 30-day postoperative computer tomography angiography and phase-contrast magnetic resonance imaging data were retrospectively selected.

The Modified Arch Landing Areas Nomenclature identifies hostile zones for endograft deployment: a confirmatory biomechanical study in patients treated by thoracic endovascular aortic repair†.

Objectives: Our goal was to confirm whether the Modified Arch Landing Areas Nomenclature (MALAN) for thoracic endovascular aortic repair, in which each landing area is described by indicating both the proximal landing zone (PLZ) and the type of arch (e.g. 0/I), identifies unfavourable landing zones for endograft deployment in diseased aortas.

Status of branched endovascular aortic arch repair.

Multiple medical device manufacturers are developing branched endografts for thoracic endovascular aortic repair (TEVAR), to provide a minimally invasive alternative for the treatment of aortic arch pathologies in patients who are deemed unfit for open or hybrid arch repair. Different branched endografts have been introduced, with varying number, size and orientation of the branches that redirect flow to the supra-aortic arteries. We present an overview of the currently investigated devices and review their outcomes.

Four-dimensional flow cardiovascular magnetic resonance in aortic dissection: Assessment in an ex vivo model and preliminary clinical experience.

Objective: Four-dimensional flow cardiovascular magnetic resonance may improve assessment of hemodynamics in patients with aortic dissection. The purpose of this study was to evaluate the feasibility and accuracy of 4-dimensional flow cardiovascular magnetic resonance assessment of true and false lumens flow.

Methods: Thirteen ex vivo porcine aortic dissection models were mounted to a flow loop.

The Modified Arch Landing Areas Nomenclature (MALAN) Improves Prediction of Stent Graft Displacement Forces: Proof of Concept by Computational Fluid Dynamics Modelling.

Objective: To assess whether the Modified Arch Landing Areas Nomenclature (MALAN), which merges Ishimaru's map with the Aortic Arch Classification, predicts the magnitude of displacement forces and their orientation in proximal landing zones for TEVAR.

Methods: Computational fluid dynamic (CFD) modelling was employed to prove the hypothesis. Healthy aorta CT angiography scans were selected based on aortic arch geometry to reflect Types I to III arches equally (each n = 5).

A geometric reappraisal of proximal landing zones for thoracic endovascular aortic repair according to aortic arch types.

Objective: This study assessed whether the additional use of the aortic arch classification in type I, II, and III may complement Ishimaru's aortic arch map and provide valuable information on the geometry and suitability of proximal landing zones for thoracic endovascular aortic repair.

Methods: Anonymized thoracic computed tomography scans of healthy aortas were reviewed and stratified according to the aortic arch classification, and 20 of each type of arch were selected. Further processing allowed calculation of angulation and tortuosity of each proximal landing zone.

Contemporary Management Strategies for Chronic Type B Aortic Dissections: A Systematic Review.

Background: Currently, the optimal management strategy for chronic type B aortic dissections (CBAD) is unknown. Therefore, we systematically reviewed the literature to compare results of open surgical repair (OSR), standard thoracic endovascular aortic repair (TEVAR) or branched and fenestrated TEVAR (BEVAR/FEVAR) for CBAD.

Methods: EMBASE and MEDLINE databases were searched for eligible studies between January 2000 and October 2015.

The predictive value of the exercise ECG for major adverse cardiac events in patients who presented with chest pain in the emergency department.

Background: To improve early diagnostic and therapeutic decision making, we designed the HEART score for chest pain patients in the emergency department (ED). HEART is an acronym of its components: History, ECG, Age, Risk factors and Troponin. Currently, many chest pain patients undergo exercise testing on the consecutive days after presentation.