title: Transcardiac endograft delivery for endovascular treatment of the ascending aorta: a feasibility study in pigs.
abstract: OBJECTIVE
  To compare the technical feasibility and hemodynamic alterations during antegrade transcardiac access routes vs conventional transfemoral access (TFA) for endovascular treatment of the ascending aorta in a porcine model.
  
  
  METHODS
  Antegrade transseptal access (TSA), transapical access (TAA), and TFA were used for implantation of custom-made endografts into the ascending aorta under fluoroscopy (6 pigs each). Hemodynamic parameters, myocardial and cerebral blood flow, and carotid artery blood flow were evaluated during baseline (T1), sheath advancement (T2), after sheath retraction (T3), and after endograft deployment (T4).
  
  
  RESULTS
  Endograft deployment was feasible in all animals; all coronary arteries remained patent. Hemodynamic parameters were comparable in all 3 study groups during all measurements. During T2, transient hemodynamic alteration occurred in all groups, with transient severe valve insufficiency in TSA and TAA reflected by the higher pulmonary to mean arterial pressure ratio (p<0.05) as compared with TFA. Values stabilized again at T3 and remained stable until T4. The innominate artery was partially occluded in 4 (TSA), 3 (TAA), and 5 (TFA) animals. There was no deterioration of myocardial or cerebral perfusion during the procedures. Endograft deployment and fluoroscopy times during TAA were shorter than in TSA and TFA.
  
  
  CONCLUSIONS
  TSA, TFA, and TAA to the ascending aorta are feasible for endograft delivery to the ascending aorta in a porcine model. Transient hemodynamic instability in TSA and TAA recovered to near preoperative values. TAA appeared technically easier.
authors: Department of Vascular Medicine, German Aortic Center, University Heart Center Hamburg-Eppendorf, Hamburg, Germany s.wipper@uke.de.
authors: Sabine
authors: S
authors: Wipper
authors: Department of Vascular Medicine, German Aortic Center, University Heart Center Hamburg-Eppendorf, Hamburg, Germany.
authors: Christina
authors: C
authors: Lohrenz
authors: Department of Vascular Medicine, German Aortic Center, University Heart Center Hamburg-Eppendorf, Hamburg, Germany.
authors: Oliver
authors: O
authors: Ahlbrecht
authors: Department of Vascular Medicine, German Aortic Center, University Heart Center Hamburg-Eppendorf, Hamburg, Germany.
authors: Sebastian W
authors: SW
authors: Carpenter
authors: Department of Vascular Medicine, German Aortic Center, University Heart Center Hamburg-Eppendorf, Hamburg, Germany.
authors: Nikolaos
authors: N
authors: Tsilimparis
authors: Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors: Jan Felix
authors: JF
authors: Kersten
authors: Department of Cardiovascular Surgery, German Aortic Center, University Heart Center Hamburg Eppendorf, Hamburg, Germany.
authors: Christian
authors: C
authors: Detter
authors: Department of Vascular Medicine, German Aortic Center, University Heart Center Hamburg-Eppendorf, Hamburg, Germany.
authors: Eike S
authors: ES
authors: Debus
authors: Department of Vascular Medicine, German Aortic Center, University Heart Center Hamburg-Eppendorf, Hamburg, Germany.
authors: Tilo
authors: T
authors: Kölbel
mesh_terms: D000818:Animals; D001011:Aorta / Q000503:physiopathology / Q000601:surgery*; D001027:Aortography / Q000379:methods; D062186:Arterial Pressure; D001783:Blood Flow Velocity; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D006328:Cardiac Catheterization; D002339:Carotid Arteries / Q000503:physiopathology; D002406:Catheterization, Peripheral; D002560:Cerebrovascular Circulation; D003326:Coronary Circulation; D057510:Endovascular Procedures / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D005263:Femoral Artery / Q000000981:diagnostic imaging; D008297:Male; D023421:Models, Animal; D011474:Prosthesis Design; D011652:Pulmonary Circulation; D011677:Punctures; D015641:Radiography, Interventional; D012039:Regional Blood Flow; D015607:Stents; D034421:Sus scrofa; D013997:Time Factors; D014057:Tomography, X-Ray Computed
keywords: access route; ascending aorta; hemodynamics; porcine model; stent-graft; through-and-through wire; transapical access; transseptal access