Publications by authors named "Matti Jubouri"
Objectives: A multicentre European randomized control trial - European Uncomplicated Type B Aortic Repair (EU-TBAR) is being developed to compare pre-emptive TEVAR with custom-made devices vs conventional OMT. The pre-trial set-up is confluent on different pillars, including evaluation of 1) European activity, trends, and governance, 2) outcome reporting, and 3) cost evaluation. This article aimed to demonstrate the observational cross-sectional survey results from participating centres and highlight the risk assessment, activity, practices, and governance of uncomplicated type B aortic dissection (uTBAD).
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- - This article reviews current literature and expert opinions on using iliac branch endoprosthesis (IBE) for treating complex abdominal aortic aneurysms (AAA) that also involve the iliac arteries.
- - Around 25% of AAA patients have aneurysms that extend into ilac vessels, complicating standard endovascular aortic repair (EVAR) procedures and requiring careful assessment to ensure proper treatment.
- - The IBE is shown to be an effective and durable treatment option for complex aorto-iliac aneurysms, offering results comparable to open surgery but with lower risks, while also preserving pelvic circulation to avoid potential complications.
Evaluation of custom-made TEVAR device for uncomplicated type B aortic dissection.
Expert Rev Med Devices
November 2024
Article Synopsis
- Heart failure is increasingly challenging due to an ageing population, but mechanical circulatory support devices like ventricular assist devices and Extracorporeal Membrane Oxygenation (ECMO) are evolving to help manage this condition.
- This review highlights how these devices function to relieve pressure on the heart and improve physiological measures such as stroke volume and intracardiac pressure, which begin to change immediately after device implantation.
- While devices like Impella and TandemHeart have shown positive effects on heart function in patients with cardiogenic shock, more research is needed to evaluate their long-term clinical outcomes, and choosing the right device depends on individual patient circumstances.
Article Synopsis
- Cardiogenic shock (CS) is a severe condition caused by heart dysfunction leading to low blood pressure and poor blood circulation, requiring urgent medical intervention like mechanical circulatory support (MCS) devices.
- This review focuses on evaluating the effectiveness of MCS in improving survival rates, and the role of drugs and non-surgical devices in treating CS to prevent complications and improve patient outcomes.
- While MCS devices vary in their clinical outcomes, intra-aortic balloon pump (IABP) appears to offer the best short-term results, whereas ECMO is highlighted for its long-term effectiveness in managing CS.
Article Synopsis
- * A systematic review analyzed 27 studies involving 1,498 BTAI patients treated with TEVAR, finding an overall mortality rate of 12% and long-term survival rates of around 90% at 1 year post-treatment.
- * The findings suggest that while BTAI carries significant risks, TEVAR offers a safe and effective management option with a low likelihood of needing additional procedures, emphasizing the importance of timely diagnosis and transfer to trauma centers.
Article Synopsis
- Advanced endovascular techniques like fenestrated stent grafts offer minimally invasive options for treating complex abdominal aortic aneurysms, but have limitations with thoracoabdominal cases due to anatomical challenges.
- Branched endovascular aneurysm repair, specifically the Zenith t-Branch endograft, has emerged as a practical solution, providing an off-the-shelf option particularly useful in urgent situations where custom grafts may take too long.
- Although early results are promising, risks such as spinal cord ischemia and long-term durability issues need further evaluation, especially since most available data comes from high-volume centers that may present biases in reported outcomes.
Conventional elephant trunk (cET) and frozen elephant trunk (FET) are two distinct approaches to the surgical treatment of thoracic aortic aneurysms and dissections. With the advent and growing uptake of endovascular technologies, FET is becoming increasingly popular for its potential to be performed as a single-stage operation with better aortic remodeling and less risk of graft kinking than the traditional two-stage cET procedure. However, FET has been associated with a higher risk of spinal cord ischemia and its use in patients with connective tissue disorder remains controversial.
View Article and Find Full Text PDFIntroduction: Blunt thoracic aortic injury (BTAI) represents one of the most devastating scenarios of vascular trauma which warrants prompt recognition with expedited management. Clinical manifestations of BTAI may not be straightforward to detect and may be misdiagnosed. Therefore, diagnosis of BTAI requires a high index of suspicion based on the mechanism of injury along with urgent transfer to centers with appropriate expertise and facilities.
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Evidence-based frozen elephant trunk practice: a narrative review.
Cardiovasc Diagn Ther
December 2023
Background And Objective: The frozen elephant trunk (FET) allows a single-stage repair of complex arch pathologies due to its stented and non-stented hybrid prosthesis (HP) features. FET inherently has its own related complications including distal stent graft-induced new entry (dSINE), failure of aortic remodelling, endoleak, reintervention, and kinking of the stent. The aim of this narrative review is to discuss the latest evidence regarding the postoperative clinical outcomes of the FET procedure.
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- - Thoracic endovascular aortic repair (TEVAR) has improved the treatment for type B aortic dissections (TBADs), but covering the left subclavian artery is crucial for effective outcomes, necessitating an additional procedure called aortic arch debranching.
- - A study analyzed 58 TBAD patients who underwent TEVAR from 2005 to 2021, revealing that nearly half had complicated conditions, with the left subclavian artery bypass performed in 26% of cases, and highlighting a notable risk of stroke.
- - The findings showed a 17.2% reintervention rate and a 29.3% mortality rate, indicating that while TEVAR and aortic arch debranching can
Background: Abdominal aortic aneurysm (AAA) has a prevalence of 4.8%. AAA rupture is associated with significant mortality, thus surgical intervention is generally required once the aneurysm diameter exceeds 5.
View Article and Find Full Text PDFObjectives: The aim of this study was to evaluate the incidence and outcomes of ischaemic organ complications after thoracic endovascular aortic repair (TEVAR).
Methods: This is a multicentre, retrospective, observational cohort study. We analysed data from patients treated with TEVAR between 22 June 2001 and 10 December 2022.
Introduction: Endovascular aneurysm repair (EVAR) has rapidly become the preferred management of abdominal aortic aneurysm (AAA). Sac regression status post-EVAR has been linked to clinical outcomes as well as the choice of EVAR device. The aim of this narrative review is to investigate the relationship between sac regression and clinical outcomes post-EVAR in AAA.
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- - Endovascular aortic repair (EVAR) is the leading treatment for abdominal aortic aneurysms (AAA), focusing on sealing the aneurysmal sac to achieve sac regression, which is important for patient outcomes.
- - Key factors that positively affect sac regression include female sex, larger sac sizes, higher fibrinogen levels, and low intra-aneurysmal pressure, while renal impairment and ischemic heart disease tend to have negative effects.
- - Newer generation EVAR devices, particularly the Fenestrated Anaconda, show the most promising results in promoting sac regression, underscoring the importance of considering both patient conditions and device choices for optimal AAA treatment outcomes.
Background: To analyze clinical outcomes and perform a macro-costing evaluation of endovascular aortic repair (EVAR) for aorto-iliac aneurysms.
Methods: This is a retrospective, financially unsupported, physician-initiated observational cohort study. Patients with iliac artery involvement treated with EVAR between January 1st, 2014 and December 31st, 2021 were identified.
Article Synopsis
- The safety of exercise for patients with abdominal aortic aneurysms (AAA) is debated due to concerns about the risk of rupture from increased blood pressure during physical activity.
- This review involves experts from various medical fields who argue that patients should not avoid rigorous exercise and that the fear of rupture is often overstated.
- By examining the positive effects of exercise and providing tailored safety recommendations, the authors suggest that the benefits of exercise and cardiopulmonary testing exceed the short-term risks related to AAA rupture.
Background: Acute type B aortic dissection (TBAD) is a rare disease that is likely under-diagnosed in the UK. As a progressive, dynamic clinical entity, many patients initially diagnosed with uncomplicated TBAD deteriorate, developing end-organ malperfusion and aortic rupture (complicated TBAD). An evaluation of the binary approach to the diagnosis and categorisation of TBAD is needed.
View Article and Find Full Text PDFBackground: The introduction of endovascular aortic arch repair (EAR) represents a paradigm shift in the management of complex arch pathologies usually treated with open surgical repair (OSR). This shift in treatment of aortic arch disease has also been accompanied with a rise in commercial interest in EAR resulting in the development of several endografts. However, the RELAY™ Branched by Terumo Aortic can be considered the prime endograft choice.
View Article and Find Full Text PDFPatient longevity and survival with custom-made endovascular solutions: The Fenestrated Anaconda approach.
Asian Cardiovasc Thorac Ann
September 2023
Article Synopsis
- Endovascular aortic repair (EVAR) is a key treatment for abdominal aortic aneurysms with good outcomes, but the Terumo Aortic Fenestrated Anaconda™ has shown particularly impressive results in minimizing complications and enhancing survival rates.
- A 9-year international study analyzed over 5,000 patients implanted with the Fenestrated Anaconda™, confirming 100% survival and target vessel patency in the first 6 years, though rates dropped after that.
- The study concluded that the Fenestrated Anaconda™ demonstrates exceptional effectiveness as an EVAR device, with very low instances of endograft migration or need for reintervention.
Article Synopsis
- A revolution in managing type B aortic dissection (TBAD) has occurred over the past 20 years, largely due to the introduction of thoracic endovascular aortic repair (TEVAR), though there are ongoing debates about its use, especially regarding differences between genders and ethnicities in outcomes.
- An international study examined data from 58 TBAD patients treated with TEVAR over 17 years, focusing on demographic and clinical outcome disparities between male and female patients of different ethnicities.
- Results indicated that while the mean age was similar, males had more complicated cases, larger proximal stent diameters, and most patients were Caucasian, highlighting a lack of significant ethnic diversity and no established risk prediction models.
Thoraflex Hybrid vs. AMDS: To replace the arch or to stent it in type A aortic dissection?
Asian Cardiovasc Thorac Ann
September 2023
Article Synopsis
- Acute type A aortic dissection (ATAAD) is a critical emergency requiring immediate surgery, with total arch replacement (TAR) and the frozen elephant trunk (FET) procedure being key treatments, notably using the Thoraflex Hybrid Prosthesis (THP).
- A review of clinical outcomes reveals that TAR with FET generally results in lower early mortality and better long-term survival compared to the Ascyrus Medical Dissection Stent (AMDS) used with hemi-arch replacement, though data on AMDS is limited.
- The conclusion emphasizes that while AMDS is a new option, THP through TAR with FET is currently the most effective and evidence-supported treatment for ATAAD.
Article Synopsis
- Acute type B aortic dissection (TBAD) is rare, affecting up to 8 in 100,000 individuals yearly, and can lead to complications like organ malperfusion due to the unpredictable nature of the dissection.
- This study focuses on patients with TBAD who experienced organ malperfusion and were treated with thoracic endovascular aortic repair (TEVAR) at a single vascular unit over 16 years.
- Out of 28 TBAD patients, 25 underwent TEVAR, with 32% showing organ malperfusion symptoms; most had hypertension and upper/mid-thoracic pain, and the majority required additional surgical interventions.