A feasibility study of total endovascular aortic arch replacement: From stent-graft design to preclinical testing Jian Yang, MD, PhD, Yang Liu, MD, Weixun.

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Presentation transcript:

A feasibility study of total endovascular aortic arch replacement: From stent-graft design to preclinical testing Jian Yang, MD, PhD, Yang Liu, MD, Weixun Duan, MD, Dinghua Yi, MD, PhD, Shiqiang Yu, MD, PhD, Rui Ma, MD, Jun Ren, MD, PhD The Journal of Thoracic and Cardiovascular Surgery Volume 151, Issue 4, Pages 1203-1212 (April 2016) DOI: 10.1016/j.jtcvs.2015.10.092 Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

Figure 1 Components of the Yanger stent-graft system (Lifetech Scientific, Shenzhen, China). A, Lateral view of the primary stent-graft. B, Frontal view of the primary stent-graft. C, Lateral view of the branched stent-graft. D, Frontal view of the branched stent-graft. E, Delivery system of the primary stent-graft. F, Delivery system of the branched stent-graft. G, Lateral view of the final Yanger stent-graft system. H, Cross-section of the final Yanger stent-graft system. I, Lateral view of primary stent-graft with 1 branch and 1 fenestration designed for the animal study. J, Lateral view of the final Yanger stent-graft system with 2 branches for the animal study. The red arrow denotes the native branch, and the yellow arrow denotes the in situ fenestrations. The Journal of Thoracic and Cardiovascular Surgery 2016 151, 1203-1212DOI: (10.1016/j.jtcvs.2015.10.092) Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

Figure 2 Schematic illustrations of the release procedure of Yanger stent-graft system. A, Both the delivery system and the compressed primary stent-graft were advanced into the aortic arch. B, The compressed branch was retracted into the BCT. C, The distal portion of the primary stent-graft was opened. D, The branch of the primary stent-graft was released. E, The front fixation of the primary stent-graft was opened. F, The delivery sheath of the primary stent-graft was retrieved. G, A super-slippery wire/stiff-wire was introduced into the LSCA. H, The delivery system of the derby hat branched stent-graft was advanced into the LSCA. I, The outer sheath was retrieved. J, The prebonded thread was retracted. K, The branched stent-graft was released. L, Total endovascular aortic arch reconstruction was complete. The Journal of Thoracic and Cardiovascular Surgery 2016 151, 1203-1212DOI: (10.1016/j.jtcvs.2015.10.092) Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

Figure 3 An in vitro test of the Yanger stent-graft system. A, Two wires were preloaded. B, The delivery system and compressed primary stent-graft were advanced into the aortic arch. C, The compressed branch was retracted into the BCT, and the distal portion of the stent-graft was opened. D, The branch of the primary stent-graft was released. E, A super-slippery wire/stiff-wire was introduced into the LSCA. F, The delivery system of the derby hat branched stent-graft was advanced into the LSCA. G, The branched stent-graft was released. H, Total endovascular aortic arch reconstruction was complete. The Journal of Thoracic and Cardiovascular Surgery 2016 151, 1203-1212DOI: (10.1016/j.jtcvs.2015.10.092) Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

Figure 4 The release procedure of the Yanger stent-graft system in a canine model. A, The delivery system and compressed main stent-graft were advanced into the aortic arch. B, The compressed branch was retracted into the BCT. C, The distal portion of the primary stent-graft was opened. D, The branch of the primary stent-graft was released, and the front fixation of the primary stent-graft was opened. E, Ascending aortography demonstrated that the primary body of the Yanger stent-graft system was successfully released, without obstructing brachiocephalic branches. F, A stiff-wire was introduced into the LSCA. G, The delivery system of the derby hat branched stent-graft was advanced into the LSCA. H, After retrieving the outer sheath, retracting the prebonded thread, and retrieving the delivery system of the derby hat branched stent-graft, the procedure was complete. I, Repeat angiography demonstrated excellent positioning and shaping of the Yanger stent-graft system, as well as patent brachiocephalic branches and evidence of valvular insufficiency, endoleak, or coronary artery obstruction. The Journal of Thoracic and Cardiovascular Surgery 2016 151, 1203-1212DOI: (10.1016/j.jtcvs.2015.10.092) Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

Figure 5 Blood pressure measurements at different positions pre- and postsurgery. A, Ascending aorta. B, Distal to the BCT. C, Distal to the LSCA. D, Descending aorta. The Journal of Thoracic and Cardiovascular Surgery 2016 151, 1203-1212DOI: (10.1016/j.jtcvs.2015.10.092) Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

Figure 6 Axial MSCT images after the deployment of the Yanger stent-graft system. A, Brachiocephalic branch level. B, Arch level. C, Descending aortic level. D, Sinotubular junction level. The Journal of Thoracic and Cardiovascular Surgery 2016 151, 1203-1212DOI: (10.1016/j.jtcvs.2015.10.092) Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

Figure 7 Three-dimensional reconstruction MSCT images after the deployment of the Yanger stent-graft system at 6 months of follow-up. A, Sagittal view of dog 3. B, Reconstruction image of dog 3. C, Reconstruction image of dog 9. D, Reconstruction image of dog 9, frontal view. E, Reconstruction image of dog 9, rear view. F, Reconstruction image of dog 15. The Journal of Thoracic and Cardiovascular Surgery 2016 151, 1203-1212DOI: (10.1016/j.jtcvs.2015.10.092) Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

Total endovascular aortic arch replacement is successful in a canine model. The Journal of Thoracic and Cardiovascular Surgery 2016 151, 1203-1212DOI: (10.1016/j.jtcvs.2015.10.092) Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions