Commentary: Branches of life

Central MessageDespite the challenging pathoanatomy, ascending aorta and aortic arch interventions are constantly developing opening doors for patients previously considered inoperable.“I'd rather die.”—Michael E. DeBakey, MD1Altman L.K. The man on table devised surgery. New York Times.https://www.nytimes.com/2006/12/25/health/25surgeon.htmlDate: December 25, 2006Google ScholarSee Article page 12. Despite inoperable. See With accumulating experiences, contemporary open repair both acute chronic dissection has yielded favorable outcomes. On other hand, about 10% of candidates emergency operation “inoperable” because age comorbidities.2Berretta P. Patel H.J. Gleason T.G. Sundt T.M. Myrmel T. Desai N. et al.IRAD experience surgical type A patients: results predictors mortality.Ann Cardiothorac Surg. 2016; 5: 346-351Crossref PubMed Scopus (98) Google Scholar postoperative major complication risks might also affect patient's decision, as in Dr DeBakey's own a patient.1Altman Meanwhile, in-hospital mortality with medically managed ranged from 48.6% to 64.9% according International Registry Acute Dissection database during last 2 decades.3Pape L.A. Awais M. Woznicki E.M. Suzuki Trimarchi S. Evangelista A. al.Presentation, diagnosis, outcomes dissection: 17-year trends Aortic Dissection.J Am Coll Cardiol. 2015; 66: 350-358Crossref (512) In this context, development interventional treatment pathology will be great value, especially these inoperable patients. issue Journal, Zhang colleagues4Zhang L. Lu Q. Zhu H. Jing Z. Branch stent-grafting endovascular dissection.J Thorac Cardiovasc 2021; 162: 12-22.e1Abstract Full Text PDF (6) report long-term customized, branched stent-graft insertion who had been classified being at “high risk surgery” (n = 51) between 2009 2014, follow-up their initial 5-year outcome reports published 2015.5Lu Feng J. Zhou Zhao Li Teng al.Endovascular by customized stent-graft: promising involving branches.J 150: 1631-1638.e5Abstract (51) most frequent procedure was single-branched 22) which branch graft placed left subclavian artery 18). rest were treated various modifications, such fenestrations overlapping grafts. Concomitant cervical bypass operations performed 11 During period (median 92 months), showed positive remodeling, no I or III endoleak, incidences (0.035%/patient-y), reintervention (0.015%/patient-y), all-cause (0.020%/patient-y) aorta-related (0.010%/patient-year) acceptable. There 4 deaths total, causes retrograde 2), cerebral infarction 1), cancer 1). excellent study, however, require cautious interpretation some reasons. First, although presented symptoms, it took more than month until index allow customization stent grafts preparation time 22 days). Accordingly, procedures phase, flaps walls not so fragile. Surprisingly, all survived phase successful medical treatments. Second, exclusion criteria surgery used study may generalizable current era, perceived poor baseline characteristics advanced age, history median sternotomy, severe obstructive pulmonary disease, renal insufficiency longer regarded contraindications many centers. Interestingly, younger expected (age, 65.5 ± 6.9 years) seemed that fragile, them able tolerate general anesthesia described colleagues.4Zhang caveats, there always unable standard repairs, approaches heroic option. From view, we believe information shared is valuable, commended work. Until day when ultimate intervention available, carefully selected pathoanatomy would benefit currently available devices. dissectionThe Journal Thoracic Cardiovascular SurgeryVol. 162Issue 1PreviewThe preliminary clinical novel proved its safety effectiveness. Full-Text