Three-year follow-up of aortic arch endovascular stent grafting with the Nexus device: results from a prospective multicentre study.

OBJECTIVES: Endovascular aortic arch stent grafting with branched devices has shown initial promising results. The aim of this prospective, multicentre study was to evaluate 3-year outcomes of aortic arch stent grafting with NEXUS® Aortic Arch Stent Graft System (Nexus), a single-branch, bi-modular, off-the-shelf aortic arch stent graft system in high-risk patients. METHODS: Patients treated with Nexus, either under the feasibility clinical study or as compassionate use procedures in 5 centres, were included in this study. The primary end point was overall survival. The secondary end points included the incidence of procedure-related unplanned intervention, stroke, paraplegia and endoleak. Clinical and radiologic follow-up was performed at each study site at 30 days, 6 months and on a yearly basis thereafter up to 3 years postoperatively. RESULTS: We analysed data from a total of 28 patients. The overall median follow-up was 1132 (interquartile range: 809-1537). There were no device or procedure-related deaths between 1 and 3 years. Overall survival at 1 and 3 years was 89% and 71%, respectively. The cumulative incidence of unplanned reintervention at 1 and 3 years was 11% and 29%, respectively. There were no reports of stroke, paraplegia, aneurysm rupture, myocardial infarction or new aortic valve insufficiency. In this study's 1-3 year follow-up period, 1 type Ib (4%), 1 type II (4%) and 2 type III (8%; between Nexus' distal end and Thoracic endovascular aortic repair (TEVAR) extensions) endoleak were detected. CONCLUSIONS: Endovascular aortic arch exclusion with the single-branch, off-the-shelf Nexus system provides promising clinical and radiologic results at 3-year follow-up in a high-risk patient cohort.

Left atrial phasic echocardiographic functional analysis in relation to diastolic left ventricular hemodynamic parameters acquired during right heart catheterization.

Introduction: Doppler echocardiography has become the leading non-invasive tool for hemodynamic screening and follow-up in various clinical situations. Our objective was to assess whether left atrium (LA) functional echocardiographic parameters correlate with hemodynamic left ventricle (LV) filling parameters measured during right heart catheterization (RHC) in various disease states. Methods: Echocardiographic examinations of 71 consecutive patients that had RHC within 24 h were studied retrospectively using LA/LV feature tracking analysis. Echocardiographic and myocardial mechanics characteristics were then correlated with the RHC findings. Results: The best correlation were demonstrated between the trans-tricuspid gradient in the echocardiogram and the right ventricle (RV) systolic pressure in the RHC (R2 = 0.41, p < 0.0001). Mitral E/E' annular velocity ratio did not correlate with capillary wedge pressure (CWP) while E velocity correlated significantly with CWP (R2 = 0.29, p = 0.0007). Among 38 patients in sinus rhythm, echocardiographic diastolic dysfunction strongly correlated with elevated LA pressure in RHC (CWP ≥ 12 mmHg, p = 0.001), with 96% sensitivity and 80% specificity. LA minimal volume index (LAVmin-i) as measured by echocardiogram was significantly correlated with elevated LA pressure in RHC (p = 0.04, criterion ≥ 27 ml) regardless of rhythm. Conclusions: In patients with sinus rhythm, diastolic dysfunction was found to be sensitive and specific for elevated CWP ≥ 12 mmHg at RHC. In all patients regardless of rhythm, LAVmin-i was found to correlate best with elevated LA pressure at RHC. This may suggest a new tool for assessment of diastolic dysfunction in all subjects.