Current status of thoracic endografting and its adjunctive pharmacology
ABSTRACT Thoracic endovascular aortic repair is a promising treatment modality. The advantages in the short term include shorter hospital stay, avoidance of lengthy invasive procedures, and decreased anesthesia time. It has made possible the treatment of elderly patients with coexisting comorbidities who otherwise would be difficult candidates for open surgery.
Although the technical aspects of thoracic endovascular procedures have been described in the literature, the adjunct pharmacology has not been discussed. The aim of this study is therefore to review the clinical pharmacology necessary for procedural details in repair of patients with aortic aneurysms and aortic dissection.
A literature search was performed using PUBMED by combining relevant Medical Subject Heading key words. The query was subsequently limited to English language, and involving "human". The articles were assessed for their validity, importance, and applicability. The publications were analyzed and clinically important data were collected and incorporated.
Thoracic endovascular aortic repair is a complex procedure on a morbid cohort of patients with aortic pathologies. The pharmacotherapy is a crucial component of the procedure: It is aimed at facilitating the endovascular procedure and improving outcomes.
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ABSTRACT: Transcatheter heart valve implantation can be performed transapically and transfemorally. The transfemoral way to the aortic valve is significantly longer than the transapical one. The aim of this study was to analyse the intima of 15 human aortas after the deployment of different conventional valved stent delivery systems. Fifteen human aortas have been analysed (77 ± 8.4 years). These aortas were preserved with formalin and explanted from the common iliac arteries to the ascending aorta. After protocolling all relevant vascular parameters, the deployment force of different conventional valved stent delivery systems was analysed. After that, the intima was closely investigated by endoscopy. The deployment force of the old catheter was not different from the actual system. The endoscopic investigation revealed significant intimal damages in all parts of the aorta after deployment of the delivery system. This study demonstrated that the passage to the aortic valve can result in significant intimal damage regardless of the used deployment catheter. Efforts are necessary to lower the profile of the deployment devices to increase their flexibility. The intima of the aorta and possible damage have to get back into the physicians' focus to avoid possible late aortic complications.Interactive Cardiovascular and Thoracic Surgery 06/2012; 15(3):352-6. DOI:10.1093/icvts/ivs225 · 1.11 Impact Factor