title: Antegrade side branch access in branched aortic arch endografts: a porcine feasibility study.
abstract: OBJECTIVE
  To describe the deployment technique for a single side branch arch endograft in a porcine model and prove the concept of transseptal or transapical antegrade access for catheterization and introduction of the mating stent-graft.
  
  
  METHODS
  Six domestic pigs were operated with retrograde delivery of a single side branch arch endograft and antegrade introduction of a mating stent-graft using transseptal access (n=3) and transapical access (n=3). Technical feasibility, operating time, radiation parameters, and hemodynamic changes were studied.
  
  
  RESULTS
  Transseptal and transapical access techniques were feasible in all animals. Catheterization and introduction of the mating stent-graft was feasible in 2 of 3 animals in the transseptal group and all animals in the transapical group. Technical feasibility was better in the transapical group, with shorter operating and fluoroscopy times and less hemodynamic impact during endograft deployment. Hemodynamic changes were short and reversible in all animals in both groups.
  
  
  CONCLUSIONS
  Antegrade transcardiac access to the aortic arch for implantation of mating stent-grafts in branched arch endografting is feasible in a porcine model with reversible impact on hemodynamic measures during deployment. Transapical access was technically easier, with shorter operating and fluoroscopy times.
authors.affiliation: Department of Vascular Medicine, University Heart Center, University Hospital Eppendorf, Hamburg, Germany.
authors.forename: Sabine
authors.initials: S
authors.lastname: Wipper
authors.forename: Christina
authors.initials: C
authors.lastname: Lohrenz
authors.forename: Oliver
authors.initials: O
authors.lastname: Ahlbrecht
authors.forename: Holger
authors.initials: H
authors.lastname: Diener
authors.forename: Sebastian W
authors.initials: SW
authors.lastname: Carpenter
authors.forename: Christian
authors.initials: C
authors.lastname: Detter
authors.forename: Axel
authors.initials: A
authors.lastname: Larena-Avellaneda
authors.forename: Eike Sebastian
authors.initials: ES
authors.lastname: Debus
authors.forename: Tilo
authors.initials: T
authors.lastname: Kölbel
mesh_terms: D000818:Animals; D001013:Aorta, Thoracic / Q000000981:diagnostic imaging / Q000502:physiology / Q000601:surgery*; D001027:Aortography / Q000379:methods; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000295:instrumentation*; D057510:Endovascular Procedures / Q000295:instrumentation*; D005240:Feasibility Studies; D005260:Female; D005471:Fluoroscopy; D006439:Hemodynamics; D008297:Male; D023421:Models, Animal; D011474:Prosthesis Design; D015641:Radiography, Interventional / Q000379:methods; D015607:Stents; D034421:Sus scrofa; D013997:Time Factors; D014057:Tomography, X-Ray Computed