Seema Deshpande | Perioperative Considerations in Endovascular Repair of the Ascending Aorta

Seema Deshpande, University of Maryland School of Medicine, United States Title: Perioperative Considerations in Endovascular Repair of the Ascending Aorta Abstract: With the rapid growth of endovascular techniques, the field of endovascular aortic repair has expanded to include the last frontier-the ascending aorta. Open repair with cardiopulmonary bypass and occasionally, deep hypothermic circulatory arrest remains the standard treatment for acute ascending aortic syndromes but carries high surgical and anesthetic risk. Although the outcomes for open surgical repair of the ascending aorta have improved over the years, 10-20% of patients with an emergent surgical indication such as Type A aortic dissection are prohibitive risk for open repair1. For these patients, endovascular repair offers a lifesaving alternative. Endovascular stent-grafts have become the preferred modality of treatment for the descending thoracic and abdominal aorta. The ascending aorta, however, has posed a formidable challenge, due to its unique anatomy, hemodynamic forces, and lack of an appropriately designed stent-graft. The ARISE study was a feasibility study wherein an investigational stent graft device was implanted in 19 patients with type A aortic dissection1. The results suggest that an endovascular approach to treat type I/II aortic dissections in high-risk surgical patients can achieve a high degree of technical success and reasonable safety outcomes. The multisite ARISE II trial currently underway is recruiting high-risk patients with nonacute type A pathologies of the ascending aorta and arch2. Potential perioperative complications with the endovascular approach include stroke, cardiac tamponade, occlusion of the coronary arteries, aortic valve dysfunction, aortic rupture, endoleak, distal stent migration, injury to and dissection of the aortic root, LV perforation, residual dissection, and aneurysm formation3. In conclusion, ascending aortic endovascular repair can be lifesaving for patients too high risk for surgical repair. With the expansion of this technology for use in an increasingly high-risk patient population, it is important for physicians and anesthesiologists to be aware of this new technology and understand associated surgical and anesthetic risks. References: 1. Roselli EE, Atkins MD, Brinkman W, Coselli J, Desai N, Estrera A, Johnston DR, Patel H, Preventza O, Vargo PR, Fleischman F, Taylor BS, Reardon MJ. ARISE: First-In-Human Evaluation of a Novel Stent Graft to Treat Ascending Aortic Dissection. J Endovasc Ther. 2023 Aug;30(4):550-560. doi: 10.1177/15266028221095018. Epub 2022 May 19. PMID: 35587698. 2. https://clinicaltrials.gov/study/NCT0... 3. Grewal A, Odonkor P, Ghoreishi M, Deshpande SP. Anesthetic Considerations in Endovascular Repair of the Ascending Aorta. J Cardiothorac Vasc Anesth. 2021 Oct;35(10):3085-3097. doi: 10.1053/j.jvca.2021.04.022. Epub 2021 Apr 22. PMID: 34059437. #CardioWorldCongress2026 #WCAC2026 #Cardiology2026 #Cardiology #CardiovascularResearch #Cardiologist #HeartDisease #HeartHealth #CardiologyConference #MedicalConference #Healthcare #CardiologyEducation #PreventiveCardiology #Rome #HybridConference #CardioWorldCongress