Objectives: To evaluate the safety and durability of transcatheter closure of anastomotic leak (AL) after ascending aortic (AAo) surgery.
Methods: From 2016-2021, we performed transcatheter closure for 22 patients aged 56.9±12 years (19 male, 86.4%) with AAoAL after AAo surgery. Access and device were selected according to the presence of patent Cabrol (perigraft-to-right atrium) shunt (n=16, 72.7%) and leak size.
Results: Fifteen patients had tricuspid regurgitation (TR) (68.2%); 13 were symptomatic (59.1%), and 11 in NYHA functional class III/IV (50%). Mean AAoAL diameter was 3.3±1.5mm. Mean procedural time was 141±53min. Procedural success rate was 86.4% (19/22, 14 with Cabrol shunt). AAoAL was directly closed or coiled in 12 patients. Follow-up was complete in 100% at mean 4.9±1.1 years (range 3.6-8.1). All patients were alive and two underwent reoperation. Freedom from death and reoperation was 94.7% at 2 years and 89.5% through 7 years. AAoAL was obliterated in 11, while trace residual shunt was seen in 8 patients. The aorta at the leak shrank significantly in all (49.1 to 41.4mm, P=0.010). Patients with Cabrol shunt showed a significant shrinkage of right atrium (46.9±8.8 vs 39.1±8.2mm, P=0.030) and right ventricle (41.4±4.7 vs 30.4±6.2mm, P<0.001), with improved heart function (NHYA class III 4/12, IV 5/12 vs class III 4/12, IV 0/12, P=0.032) and alleviated TR (moderate 6/14 vs 2/14, severe 3/14 vs 1/14, P=0.081).
Conclusions: Transcatheter closure may be a feasible, safe and effective approach to anastomotic leak after ascending aortic surgery in selected patients, which can achieve favorable short- to mid-term outcomes.
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