Endovascular Surgery: The Evolving Role of the Cardiac SurgeonLee E. Errett MD, FRCSC, FRCSLee E. Errett MD, FRCSC, FRCSChief, Division of Cardiovascular and Thoracic Surgery, St. Michaels HospitalTerrence Donnelly Cardiac Centre.Professor, University of TorontoThe WorkshopImage IntensifierFixed surgical tableX-ray tube assemblySurgical ToolsThe ToolsIntravascular UltrasoundAortaAortaSubclavianSubclavianCoronaryCoronarySFASFAAndAndBelowBelowIliacIliacRenalRenalNo vessel is sageThe heart and most vessels are accessible via percutaneous approaches.Traditional ApproachOr This?Or This?Left Left common common carotidcarotidLeft Left subclaviansubclavianAortic neck Aortic neck diameters diameters ( (range range 23mm-37mm23mm-37mm) )20mm20mm20mm to20mm to celiac celiacPrinciples:Adequate vascular accessAdequate proximal and distal landing zonesnon-aneurysmal aortic segmentdiameter 24-38 mmlength 20 mmZ0Z0Z1Z1Z2Z2Z3Z3Z4Z4Initial thoracic ELGCoverage of LSCAExtra-thoracic debranchingIntra-thoracic debranching17 yo male struck by minivan Traumatic aortic transectionClose head traumaSpleen & liver injuriesOpen fracturesTraumatic Aortic TransectionPreoperative CTPostoperative CT: 1 monthAneurysmAsymptomaticContained ruptureAcute Type B dissectionChronic dissection withaneurysmPenetrating ulcerIntramural hematomaAortic coarctationPseudoaneurysm associated with previous repairAortic transectionAortobronchial fistulaPotential for Thoracic Stenting41 yo maleIncidentally discovered during hospitalization for pneumoniaRemote history of MVACase: Innominate artery aneurysmStandard vs. InnovativePostoperative CT79 yo malePHx:Prior Cardiac SxProstate CancerHTNCase: Arch AneurysmEndovascular Solution?Future of Arch EndograftingJ. L. Andersen, AustraliaInnovative Endovascular Approaches to the ArchJ. L. Andersen, AustraliaJ. L. Andersen, AustraliaFuture of Thoracoabdominal Aortic SurgeryAscending Aorta Safe from Endovascular Approaches?Not Anymore!Initial Experience with Endovascular Repair of the Ascending AortaRight coronary artery Right coronary artery bypass occludedbypass occludedPseudoaneurysm of Pseudoaneurysm of Ascending AortaAscending AortaCoils failed to close entry pointAneurysm expanded from 6-10cm in 4 monthsPreoperative CTAscending Aortic Stent GraftPostoperative CT: 1 yearTHE FUTURE IS NOW! The Future is Bright!Gore TAGMedtronic TalentCook TX2Thoracic Endografts