Abstract
Objective
This study aimed to evaluate the safety and durability of transcatheter closure of
anastomotic leak (AL) after ascending aortic (AAo) surgery.
Methods
From 2016 to 2021, we performed transcatheter closure for 22 patients aged 56.9 ± 12
years (19 male, 86.4%) who sustained anastomotic leak in the ascending aorta (AAoAL)
after AAo surgery. Access and device were selected according to the presence of a
patent Cabrol (perigraft-to-right atrium [RA]) shunt (n = 16, 72.7%) and leak size.
Results
Fifteen patients had tricuspid regurgitation (TR; 68.2%), 13 were symptomatic (59.1%),
and 11 were in the New York Heart Association (NYHA) functional class III/IV (50%).
Mean AAoAL diameter was 3.3 ± 1.5 mm. Mean procedural time was 141 ± 53 minutes. 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 a mean duration of 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 8 years. AAoAL was
obliterated in 11, while a trace residual shunt was seen in 8 patients. The aorta
at the leak shrank significantly in all (49.1–41.4 mm, p = 0.010). Patients with Cabrol shunt showed a significant shrinkage of the RA (46.9 ± 8.8 mm
vs. 39.1 ± 8.2 mm, p = 0.030) and right ventricle (41.4 ± 4.7 mm vs. 30.4 ± 6.2 mm, p < 0.001), along with improved heart function (NHYA class III 4/12, IV 5/12 vs. class
III 4/12, IV 0/12, p = 0.032) and alleviation of TR (moderate 6/14, severe 3/14 vs. moderate 2/14, severe
1/14, p = 0.081).
Conclusion
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 midterm outcomes.
Keywords
ascending aorta/surgery - anastomotic leak - transcatheter closure
