title: Endovascular Repair of Saccular Ascending Aortic Aneurysm After Orthotopic Heart Transplantation Using an Investigational Zenith Ascend Stent-Graft.
abstract: OBJECTIVE
  To report the use of an investigational stent-graft to treat an ascending aortic aneurysm in a patient with a heart transplant.
  
  
  METHODS
  A 48-year-old man presented with a 3.5×1.5-cm saccular aneurysm in the mid anterior ascending aorta, abutting the sternum. The patient's history was notable for placement of a left ventricular assist device followed by orthotopic heart transplantation 2 years prior to treat end-stage familial dilated cardiomyopathy. Under compassionate use, a custom-designed ascending aortic stent-graft (Zenith Ascend) was successfully delivered via an 18-F system and deployed just distal to the origin of the left main coronary artery under pulmonary artery catheter-guided rapid ventricular pacing. The patient was discharged the next day, and 6-month follow-up was unremarkable. Imaging at 5 months showed an excluded aneurysm sac with no endoleak or migration.
  
  
  CONCLUSIONS
  The ideal ascending aortic stent-graft should be low profile, conformable to the arch anatomy, with short tip delivery system and a stepwise deployment mechanism that allows precise placement relative to the ostia of the coronary arteries and the innominate artery. This case illustrates the advancement of endovascular techniques to the most challenging segment of the aorta to decrease morbidity and mortality in high-risk patients.
authors.affiliation: Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN, USA oderich.gustavo@mayo.edu.
authors.forename: Gustavo S
authors.initials: GS
authors.lastname: Oderich
authors.affiliation: Division of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, USA.
authors.forename: Alberto
authors.initials: A
authors.lastname: Pochettino
authors.affiliation: Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN, USA.
authors.forename: Bernardo C
authors.initials: BC
authors.lastname: Mendes
authors.affiliation: MED Institute, Lafayette, IN, USA.
authors.forename: Blayne
authors.initials: B
authors.lastname: Roeder
authors.affiliation: Department of Anesthesiology, Mayo Clinic, Rochester, MN, USA.
authors.forename: Juan
authors.initials: J
authors.lastname: Pulido
authors.affiliation: Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN, USA.
authors.forename: Peter
authors.initials: P
authors.lastname: Gloviczki
mesh_terms: D017545:Aortic Aneurysm, Thoracic / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D057510:Endovascular Procedures / Q000379:methods*; D016027:Heart Transplantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D015607:Stents
keywords: ascending aorta; heart transplantation; saccular aneurysm; stent-graft; thoracic endovascular aortic repair