OBJECTIVES This study assesses the feasibility of acute type A dissections treatment with a dedicated aortic root endograft concept and introduces a new aortic classification. SUMMARY BACKGROUND DATA Acute type A aortic dissection (ATAAD) remains a catastrophic aortic condition with perioperative mortality ranging from 12% and 20%. Total Aortic root endovascular repair, "Endobentall concept", has been explored as an alternative but only documented on case report. METHODS Imaging study of all consecutive patients treated in three French centers were achieved. The study introduces an adapted aortic classification to report entry tear locations. Measurements included aortic annulus mensuration, coronary height, and several aortic lengths. Two treatment concepts were described "fenestrated Endobentall" and "branched Endobentall". Patients were eligible to the "fenestrated endobentall" design if their aortic root dimensions fitted the Edwards Sapien® and Corevalve Medtronic® instruction for use. Eligibility for the "branched Endobentall" required meeting the criteria for a "fenestrated Endobentall" and having a left coronary main stem length exceeding 5 mm. "Branched Endobentall" was mandatory when the entry was located in the aortic root. RESULTS A total of 250 CT scans for acute type A aortic dissection were reviewed, 116 were finally included for analysis. The primary entry tear was found in the aortic root in 9% of patients, and in 31% of cases, it was located within the first centimeter distal to the sinotubular junction (STJ). 63.7% of the patients were eligible for an Endobentall procedure, even 73.3% when considering extended criterion. Fenestrated Endobentall accounted for 2/3 of cases. CONCLUSION In our study, 63.7% of patients with aortic type A dissections are deemed eligible to an "Endobentall repair", increasing to 73.3% when considering extended anatomical criteria.

中文翻译：

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Endobentall 策略治疗急性 A 型主动脉夹层的解剖学可行性。


目的 本研究评估了使用专用主动脉根部内移植概念治疗急性 A 型夹层的可行性，并引入了一种新的主动脉分类。摘要背景数据急性 A 型主动脉夹层 （ATAAD） 仍然是一种灾难性的主动脉疾病，围手术期死亡率为 12% 至 20%。全主动脉根部血管内修复术，“Endobentall 概念”，已被探索为一种替代方案，但仅记录在病例报告中。方法 对在 3 个法国中心接受治疗的所有连续患者进行影像学研究。该研究引入了一种适应性的主动脉分类来报告入口撕裂位置。测量包括主动脉瓣环测量、冠状动脉高度和几个主动脉长度。描述了两种治疗概念 “开孔 Endobentall” 和 “分支 Endobentall”。如果患者的主动脉根部尺寸符合 Edwards Sapien® 和 Corevalve Medtronic® 的使用说明，则患者有资格采用“开孔内本托尔”设计。“分枝 Endobentall”的资格要求满足“开孔 Endobentall”的标准，并且左冠状动脉主干长度超过 5 毫米。当条目位于主动脉根部时，“分枝 Endobentall”是强制性的。结果 共回顾了 250 例急性 A 型主动脉夹层 CT 扫描，最终纳入 116 例进行分析。9% 的患者在主动脉根部发现原发性入口撕裂，在 31% 的病例中，它位于鼻窦肾小管交界处 （STJ） 远端的第一厘米内。63.7% 的患者有资格接受 Endobentall 手术，在考虑扩展标准时，甚至为 73.3%。开窗的 Endobentall 占病例的 2/3。结论 在我们的研究中，63.7% 的 A 型主动脉夹层患者被认为符合“Endobentall 修复”的条件，当考虑扩展解剖标准时，这一比例增加到 73.3%。