title: Complete Antegrade Transapical Deployment of a Branched Aortic Arch Endograft: A Porcine Feasibility Study.
abstract: OBJECTIVE
  To describe and prove the concept of a technique for complete transapical deployment of a single-branch aortic arch endograft in a porcine model.
  
  
  METHODS
  Eight domestic pigs underwent antegrade transapical delivery of a single-branch arch endograft, including a mating stent-graft to the innominate artery. Technical feasibility, operating time, radiation parameters, and hemodynamic changes were studied according to a standardized protocol during baseline (T0), after establishing the transapical access and through-and-through wire (T1), and after stent-graft deployment (T2). Myocardial and cerebral blood flow status was assessed using fluorescent microspheres (FM) and transit-time flow measurement (TTFM) monitoring.
  
  
  RESULTS
  Transapical access, introduction and deployment of the endograft, side branch catheterization, and deployment of the mating stent-graft were feasible in 6 of 8 animals. One animal died due to irreversible heart rhythm disorders and one due to accidental graft rotation during deployment, resulting in unintended coverage of the innominate artery. The mean operating and fluoroscopy times were 223±11 minutes and 27.2±6.3 minutes, respectively. During introduction and deployment of the stent-graft, transient aortic valve insufficiency occurred in all animals. Hemodynamic stability recovered within 10 minutes after retrieval of the delivery system in all animals. The innominate artery was patent, with unchanged TTFM measurements throughout the procedure. FM evaluation revealed stable cerebral blood flow.
  
  
  CONCLUSIONS
  An antegrade transapical access to the aortic arch for implantation of a single-branch endograft is feasible in a porcine model with reversible impact on hemodynamic measures during deployment. Transapical access allows deployment of a complex endograft through a single large-bore access site in a porcine model.
authors.affiliation: Department of Vascular Medicine, German Aortic Center, University Heart Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany s.wipper@uke.de.
authors.forename: Sabine
authors.initials: S
authors.lastname: Wipper
authors.affiliation: Department of Vascular Medicine, German Aortic Center, University Heart Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Christina
authors.initials: C
authors.lastname: Lohrenz
authors.affiliation: Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Jan F
authors.initials: JF
authors.lastname: Kersten
authors.affiliation: Department of Vascular Medicine, German Aortic Center, University Heart Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Mohamad Marwan
authors.initials: MM
authors.lastname: Akkra
authors.affiliation: Department of Vascular Medicine, German Aortic Center, University Heart Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Nikos
authors.initials: N
authors.lastname: Tsilimparis
authors.affiliation: Department of Cardiovascular Surgery, German Aortic Center, University Heart Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Detter
authors.affiliation: Department of Cardiology, German Aortic Center Hamburg, University Heart Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Yskert
authors.initials: Y
authors.lastname: von Kodolitsch
authors.affiliation: Department of Vascular Medicine, German Aortic Center, University Heart Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Axel
authors.initials: A
authors.lastname: Larena-Avellaneda
authors.affiliation: Department of Vascular Medicine, German Aortic Center, University Heart Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Eike Sebastian
authors.initials: ES
authors.lastname: Debus
authors.affiliation: Department of Vascular Medicine, German Aortic Center, University Heart Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Tilo
authors.initials: T
authors.lastname: Kölbel
mesh_terms: D000818:Animals; D001013:Aorta, Thoracic / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D001027:Aortography / Q000379:methods; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000295:instrumentation* / Q000379:methods; D002560:Cerebrovascular Circulation; D000072226:Computed Tomography Angiography; D003326:Coronary Circulation; D057510:Endovascular Procedures / Q000295:instrumentation* / Q000379:methods; D005240:Feasibility Studies; D005260:Female; D006439:Hemodynamics; D008297:Male; D023421:Models, Animal; D061646:Operative Time; D011183:Postoperative Complications / Q000209:etiology / Q000503:physiopathology; D011474:Prosthesis Design; D011829:Radiation Dosage; D000069079:Radiation Exposure; D015607:Stents; D034421:Sus scrofa; D013997:Time Factors
keywords: animal study; antegrade access; aortic arch; branched stent-graft; endovascular treatment; hemodynamics; in vivo study; transapical access