title: International experience with endovascular therapy of the ascending aorta with a dedicated endograft.
abstract: OBJECTIVE
  The objective of this study was to evaluate the safety and feasibility of a novel stent graft specifically designed for treatment of the ascending aorta.
  
  
  METHODS
  This was a multicenter, retrospective analysis of all consecutive patients treated with the dedicated Zenith Ascend TAA Endovascular Graft (William Cook Europe, Bjaeverskov, Denmark) for pathologic processes requiring stent grafting of the ascending aorta. The graft is short (6.5 cm), with a delivery system designed for transfemoral placement in the ascending aorta.
  
  
  RESULTS
  In 10 patients (five men; age, 67 years; range, 26-90 years), the Zenith Ascend graft was implanted for the following indications: dissection (n = 5) and aneurysm (n = 4) of the ascending aorta and fixation of an intraprocedural dislocated aortic valve (n = 1). All patients were judged to be at high risk for open surgery (nine patients were classified as American Society of Anesthesiologists class 3 or class 4). A transfemoral approach was selected in eight cases and a transapical approach in two. All endografts were successfully deployed without intraoperative adverse events at the targeted landing zone. Clinical success in coverage of the lesions was achieved in all cases with the exception of an attempted treatment of an intraprocedural aortic valve implantation dissection that resulted in early mortality. The 30-day survival was 90%. Early neurologic events included one patient with stroke and paraplegia and one patient with a transient ischemic attack. One patient underwent early evacuation of a hemopericardium. There were two late reinterventions for persisting endoleaks. At a mean follow-up of 10 months (range, 1-36 months), three late deaths occurred, with one treatment related, as a result of graft infection.
  
  
  CONCLUSIONS
  Despite the fact that in this first published series the graft was frequently used as a "rescue tool" outside its intended indication, treatment with the Zenith Ascend graft in this early experience appears to be safe and feasible for repair of ascending aorta pathologic processes in high-risk patients unsuitable for open repair.
authors.affiliation: German Aortic Center, University Heart Center, Hamburg, Germany. Electronic address: n.tsilimparis@uke.de.
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Tsilimparis
authors.affiliation: German Aortic Center, University Heart Center, Hamburg, Germany.
authors.forename: E Sebastian
authors.initials: ES
authors.lastname: Debus
authors.affiliation: Department of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, Minn.
authors.forename: Gustavo S
authors.initials: GS
authors.lastname: Oderich
authors.affiliation: Department of Vascular Surgery, Heart Center, University of Lille, Lille, France.
authors.forename: Stephan
authors.initials: S
authors.lastname: Haulon
authors.affiliation: Department of Cardiothoracic Surgery, University of Aarhus, Aarhus, Denmark.
authors.forename: Kim Allan
authors.initials: KA
authors.lastname: Terp
authors.affiliation: Cook Medical, Bloomington, Ind.
authors.forename: Blayne
authors.initials: B
authors.lastname: Roeder
authors.affiliation: German Aortic Center, University Heart Center, Hamburg, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Detter
authors.affiliation: German Aortic Center, University Heart Center, Hamburg, Germany.
authors.forename: Tilo
authors.initials: T
authors.lastname: Kölbel
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001011:Aorta / Q000000981:diagnostic imaging / Q000601:surgery*; D001018:Aortic Diseases / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D001027:Aortography / Q000379:methods; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D000072226:Computed Tomography Angiography; D057510:Endovascular Procedures / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology / Q000628:therapy; D011474:Prosthesis Design; D019233:Retreatment; D012189:Retrospective Studies; D012307:Risk Factors; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome