title: Endovascular repair of the ascending aorta: when and how to implement the current technology.
abstract: BACKGROUND
  The purpose of our study was to examine when and how to implement the current endoluminal stent graft technology to treat ascending aortic disease.
  
  
  METHODS
  During a 7-year period (March 2006 through July 2013), 7 consecutive patients (median age, 69 years; range, 61.5 to 80.5 years) with multiple comorbidities underwent endoluminal repair of the ascending aorta. Six had an ascending aortic pseudoaneurysm, and 1 had iatrogenic coarctation. The median number of prior sternotomies was 2 (range, 1 to 4).
  
  
  RESULTS
  Technical success was achieved in all but 1 patient, with 1 death (14.3%) at 30 days. The endoluminal technology used included the Gore TAG (W.L. Gore and Associates, Flagstaff, AZ) thoracic graft (including the new C-TAG) in 6 patients, the Talent stent graft (Medtronic, Santa Rosa, CA) in 1, an Excluder cuff (W.L. Gore) in 2, and an Amplatzer occluder (AGA Medical Corp, Plymouth, MN) in 1. More than 1 stent was placed in 4 patients. Three patients required innominate artery stenting, and 1 required additional left common carotid artery stenting. One patient (14.3%) required intraoperative conversion to open surgical repair. Median follow-up was 14.4 months (interquartile [25th to 75th percentile] range, 5.5 to 22.6 months) with 66.6% overall survival. No aortic-related death was reported during the follow-up period.
  
  
  CONCLUSIONS
  Stent grafting of the ascending aorta is feasible but limited and is reserved for high-risk individuals. Technical expertise is essential, and follow-up is mandatory. Technical points, tips, and challenges of the current endovascular technology to effectively treat the ascending aorta are described.
authors: Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas; Department of Cardiovascular Surgery, Texas Heart Institute, Houston, Texas. Electronic address: opsmile01@aol.com.
authors: Ourania
authors: O
authors: Preventza
authors: Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas; Department of Cardiovascular Surgery, Texas Heart Institute, Houston, Texas.
authors: Matthew J
authors: MJ
authors: Henry
authors: Department of Cardiology, Baylor College of Medicine, Houston, Texas; Department of Radiology, Baylor College of Medicine, Houston, Texas; Department of Cardiology, Texas Heart Institute, Houston, Texas.
authors: Benjamin Y C
authors: BY
authors: Cheong
authors: Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas; Department of Cardiovascular Surgery, Texas Heart Institute, Houston, Texas.
authors: Joseph S
authors: JS
authors: Coselli
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017541:Aneurysm, False / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery; D000792:Angiography / Q000379:methods; D001011:Aorta / Q000601:surgery*; D001018:Aortic Diseases / Q000000981:diagnostic imaging / Q000601:surgery*; D015331:Cohort Studies; D057510:Endovascular Procedures / Q000009:adverse effects / Q000379:methods* / Q000401:mortality*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011183:Postoperative Complications / Q000401:mortality / Q000503:physiopathology; D011475:Prosthesis Failure; D012189:Retrospective Studies; D015607:Stents; D015996:Survival Rate; D013997:Time Factors; D014057:Tomography, X-Ray Computed / Q000379:methods; D016896:Treatment Outcome