future of aortic arch repair...volodos he referred to dotter evar 1990 12 parodi palmaz barone...
TRANSCRIPT
5th Aortic Live Symposium
FUTURE OF AORTIC ARCH REPAIR
ROGER GREENHALGH
Disclosure
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Speaker name:Roger GreenhalghI have the following potential conflicts of interest to report:
ConsultingEmployment in industryStockholder of a healthcare companyOwner of a healthcare companyOther(s)
I do not have any potential conflict of interestx
This work is funded by the
Octav Botnar – Grateful Patient
Funding Acknowledgement
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Camelia Botnar Arterial Research Foundation
Learn the Future from the Past
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NothingMajor surgery
Open Medicine PreventionMinor
intervention
Tuberculosis
Stomach
Breast
Aorta
Major Open Surgery 1908-2008
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Major open surgery 1908-2008
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StanleyCrawford
1975 peak: The can opener
“Critical issues”
at the SVS
Very minor intervention
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ThomasFogarty
The tear away: medical student
Embolectomy
Lesser invasive
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Dotter
“Is he Crazy Charlie?”
Lesser procedure
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Grüntzig
Percutaneous transluminalangioplasty
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Palmaz Stent heralds EVAR
EVAR before 1990
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Volodos He referred to Dotter
EVAR 1990
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ParodiPalmazBarone
Argentina
Abdominal aortic aneurysm referral has fallen
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1994-2000
Prevention is with us already
Smoking cessation
Statins
Surgery for >75 years of age
STEP INVESTIGATORS
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Aims of the STEP Study
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To provide best practice for endovascular procedures forthe ascending aorta, aortic arch, great vessel branches andhigh TEVAR to lower the risk of cerebral embolism
Zone 0
Zone1
Zone2
- Ascending aorta: tube grafts, scalloped stent-grafts
- Arch procedures: fenestrated and branched aortic arch stent-
grafts (Great vessel involvement)
- Descending aorta: high standard TEVAR procedures landing in
zone 2 (Ishimaru)
STEP Built to learn from each other
Pathologies
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Air
Particles / Plaque
Thrombus
The 18 STEP Collaborators
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Stéphan HaulonTilo KölbelFrank Arko
Carlos BecharaAdam Beck
Dittmar BöcklerMartin CzernyMichael Dake
Matthew EagletonDennis GableWilliam JordanAhmed Koshty
Gustavo OderichJean PannetonGeert SchurinkSanti Trimarchi
Rod WhiteMarwan Youssef
2 Investigators
16 Collaborators
The STEP Advisors
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Neurologist – Hugh Markus
Interventional Cardiologist –Simon Redwood
Cardiothoracic Surgeon –Heinz Jakob
Neuroradiologist -Kyriakos Lobotesis
STEP Questionnaire
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General Questions on experience
Questions on current practice:
Pre-Procedural
Intra-Procedural
Post-Procedural
Key Findings
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STEP ResultsExperience of KOL (n = 18)
Cumulativeyears of experience
- Zone 0 = 143 years(range 3 – 15)
- Zone 1 = 193 years(range 4 – 15)
- Zone 2 = 232 years(range 6 – 20)
Manufacturers of devices used by the 18 Operators
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13 of 18
9 of 18
1 of 18
8 of 18
7 of 18
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ConsensusPre-Procedural
Interdisciplinary team central to the final decision for treatment strategy
Zone 0 Zone 2Zone 1
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MAJOR OPEN ERA 1908 - 2008
ENDOVASCULAR ERA NOW
MEDICAL ERA SLOW TO COME
PREVENTION ALREADY
THE SEQUENCE IS INEVITABLE
THE SURGEON MUST ADAPT
BE THOUGHTFUL
DRIVE ADVANCE