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- Title
Transcatheter closure of postsurgical aortic pseudoaneurysms guided by three-dimensional image reconstruction: a single-centre experience.
- Authors
Hegeman, Romy R. M. J. J.; Swaans, Martin J.; Kara, Basak; Heijmen, Robin H.; Smeenk, Hans G.; Timmers, Leo; Sonker, Uday; Klein, Patrick; Berg, Jurriën M. Ten
- Abstract
Background: Postsurgical thoracic aortic pseudoaneurysms (PTAPs) are a potentially lethal complication after cardiac or aortic surgery. Surgical management can pose a challenge with high in-hospital mortality rates. Transcatheter closure is a less-invasive alternative treatment option for selected patients, although current experience is limited. Aims: We aimed to evaluate procedural and imaging outcomes of our first 11 cases of transcatheter PTAP closure with the use of closure devices. Methods: Patients with a high operative risk who underwent transcatheter PTAP closure at our centre from 2019 to 2021 were retrospectively included. Suitability was evaluated on preprocedural computed tomography (CT) scans and three-dimensional (3D) reconstructions. All procedures were performed in the catheterisation laboratory. Intraprocedural aortography and postprocedural CT scans with 3D reconstructions were used to evaluate PTAP occlusion. Results: Eleven consecutive patients with a high operative risk and a history of cardiac/aortic surgery who underwent transcatheter PTAP closure were included. PTAPs were predominantly located at the proximal or distal anastomosis of a supracoronary ascending aortic vascular graft or Bentall prosthesis (82%). Implanted closure devices included Amplatzer Valvular Plug III (82%), Amplatzer septal occluder (9%) and Occlutech atrial septal defect occluder (9%). No periprocedural complications occurred. After device deployment, residual flow was absent on aortography in 64% and minimal residual flow was present in 36% of patients. Subtotal or total occlusion of the PTAP on follow-up CT ranged between 45% and 73%. Conclusions: Although subtotal or total occlusion of the PTAP was found at follow-up in only 45–73% of cases, transcatheter PTAP closure guided by preprocedural 3D reconstructions can offer a valuable minimally invasive primary treatment option for patients who otherwise would face a high-risk reoperation.
- Subjects
THREE-dimensional imaging; IMAGE reconstruction; FALSE aneurysms; AORTA; ATRIAL septal defects; BLOOD vessel prosthesis; HEART valve prosthesis implantation
- Publication
Netherlands Heart Journal, 2023, Vol 31, Issue 10, p383
- ISSN
1568-5888
- Publication type
Article
- DOI
10.1007/s12471-023-01784-1