• Aurelien Vallée, Guillaume Guimbretière, Julien Guihaire, Antoine Guery, Maira Gaillard, Le Houerou Thomas, Antoine Gaudin, Ramzi Ramadan, Deleuze Phillippe, Blandine Maurel, Jean Christian Roussel, Said Ghostine, André Vincentelli, Francis Juthier, Dominique Fabre, Jonathan Sobocinski, and Stephan Haulon.
• Cardiac and vascular surgery department, Marie Lannelongue hospital, GHPSJ, Le Plessis Robinson, France.
• Ann. Surg. 2024 Oct 1.

ObjectivesThis study assesses the feasibility of acute type A dissections treatment with a dedicated aortic root endograft concept and introduces a new aortic classification.Summary Background DataAcute type A aortic dissection (ATAAD) remains a catastrophic aortic condition with perioperative mortality ranging from 12% and 20%. Total Aortic root endovascular repair, "Endobentall concept", has been explored as an alternative but only documented on case report.MethodsImaging study of all consecutive patients treated in three French centers were achieved. The study introduces an adapted aortic classification to report entry tear locations. Measurements included aortic annulus mensuration, coronary height, and several aortic lengths. Two treatment concepts were described "fenestrated Endobentall" and "branched Endobentall". Patients were eligible to the "fenestrated endobentall" design if their aortic root dimensions fitted the Edwards Sapien® and Corevalve Medtronic® instruction for use. Eligibility for the "branched Endobentall" required meeting the criteria for a "fenestrated Endobentall" and having a left coronary main stem length exceeding 5 mm. "Branched Endobentall" was mandatory when the entry was located in the aortic root.ResultsA total of 250 CT scans for acute type A aortic dissection were reviewed, 116 were finally included for analysis. The primary entry tear was found in the aortic root in 9% of patients, and in 31% of cases, it was located within the first centimeter distal to the sinotubular junction (STJ). 63.7% of the patients were eligible for an Endobentall procedure, even 73.3% when considering extended criterion. Fenestrated Endobentall accounted for 2/3 of cases.ConclusionIn our study, 63.7% of patients with aortic type A dissections are deemed eligible to an "Endobentall repair", increasing to 73.3% when considering extended anatomical criteria.Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.

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