title: Transapical wire-assisted endovascular repair of thoracic aortic dissection.
abstract: OBJECTIVE
  To describe a technique for transapical wire-assisted endograft deployment under rapid ventricular pacing for a type B dissection involving the proximal left subclavian artery and extending to the aortic bifurcation.
  
  
  METHODS
  A 58-year-old man presented with a symptomatic thoracic aneurysm as a complication of a chronic type B dissection, with a short proximal neck in zone 1. After arch vessel debranching, the patient underwent endoluminal repair with deployment of a closed web, tapered Valiant thoracic endograft over a through-and-through wire from the left groin to the apex of the left ventricle, using rapid ventricular pacing to reduce cardiac output. The remaining dissected aorta was covered with a second Valiant endograft down to the distal third of the descending thoracic aorta and bare Z stents down to the aortic bifurcation to re-expand the true lumen. A freeflow Valiant endograft was deployed as a proximal extension to treat a proximal type I endoleak. The recovery was complicated by retrograde type A aortic dissection, considered secondary to the bare stent. The complication was repaired surgically; postoperative computed tomography after recovery was unremarkable.
  
  
  CONCLUSIONS
  Transapical wire-assisted deployment with rapid ventricular pacing is feasible and may provide improved stability for stenting within the aortic arch. The use of a stent-graft with a proximal bare stent is associated with a higher risk of retrograde extension of the dissection and warrants lifelong imaging follow-up.
authors.affiliation: Departments of Cardiothoracic Surgery and, Royal Prince Alfred Hospital, Sydney, NSW, Australia. fabio.ramponi@fastwebnet.it
authors.forename: Fabio
authors.initials: F
authors.lastname: Ramponi
authors.forename: Michael P
authors.initials: MP
authors.lastname: Vallely
authors.forename: Michael S
authors.initials: MS
authors.lastname: Stephen
authors.forename: Paul G
authors.initials: PG
authors.lastname: Bannon
authors.forename: Matthew S
authors.initials: MS
authors.lastname: Bayfield
authors.forename: Geoffrey H
authors.initials: GH
authors.lastname: White
mesh_terms: D000784:Aortic Dissection / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D001027:Aortography / Q000379:methods; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation; D002302:Cardiac Output; D002304:Cardiac Pacing, Artificial; D057510:Endovascular Procedures / Q000009:adverse effects / Q000295:instrumentation; D006801:Humans; D008297:Male; D008875:Middle Aged; D011474:Prosthesis Design; D015607:Stents; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome