Transcatheter closure of postsurgical aortic pseudoaneurysms guided by three-dimensional image reconstruction: a single-centre experience

Romy R M J J Hegeman; Martin J Swaans; Basak Kara; Robin H Heijmen; Hans G Smeenk; Leo Timmers; Uday Sonker; Patrick Klein; Jurriën M Ten Berg

doi:10.1007/s12471-023-01784-1

Transcatheter closure of postsurgical aortic pseudoaneurysms guided by three-dimensional image reconstruction: a single-centre experience

Neth Heart J. 2023 Oct;31(10):383-389. doi: 10.1007/s12471-023-01784-1. Epub 2023 May 31.

Authors

Romy R M J J Hegeman¹, Martin J Swaans², Basak Kara², Robin H Heijmen³, Hans G Smeenk⁴, Leo Timmers², Uday Sonker⁴, Patrick Klein⁴, Jurriën M Ten Berg²

Affiliations

¹ Department of Cardiothoracic Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands. r.hegeman@antoniusziekenhuis.nl.
² Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands.
³ Department of Cardiothoracic Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands.
⁴ Department of Cardiothoracic Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands.

Abstract

Background: Postsurgical thoracic aortic pseudoaneurysms (PTAPs) are a potentially lethal complication after cardiac or aortic surgery. Surgical management can pose a challenge with high in-hospital mortality rates. Transcatheter closure is a less-invasive alternative treatment option for selected patients, although current experience is limited.

Aims: We aimed to evaluate procedural and imaging outcomes of our first 11 cases of transcatheter PTAP closure with the use of closure devices.

Methods: Patients with a high operative risk who underwent transcatheter PTAP closure at our centre from 2019 to 2021 were retrospectively included. Suitability was evaluated on preprocedural computed tomography (CT) scans and three-dimensional (3D) reconstructions. All procedures were performed in the catheterisation laboratory. Intraprocedural aortography and postprocedural CT scans with 3D reconstructions were used to evaluate PTAP occlusion.

Results: Eleven consecutive patients with a high operative risk and a history of cardiac/aortic surgery who underwent transcatheter PTAP closure were included. PTAPs were predominantly located at the proximal or distal anastomosis of a supracoronary ascending aortic vascular graft or Bentall prosthesis (82%). Implanted closure devices included Amplatzer Valvular Plug III (82%), Amplatzer septal occluder (9%) and Occlutech atrial septal defect occluder (9%). No periprocedural complications occurred. After device deployment, residual flow was absent on aortography in 64% and minimal residual flow was present in 36% of patients. Subtotal or total occlusion of the PTAP on follow-up CT ranged between 45% and 73%.

Conclusions: Although subtotal or total occlusion of the PTAP was found at follow-up in only 45-73% of cases, transcatheter PTAP closure guided by preprocedural 3D reconstructions can offer a valuable minimally invasive primary treatment option for patients who otherwise would face a high-risk reoperation.

Keywords: Closure device; False aneurysm; Pseudoaneurysm; Three-dimensional reconstruction; Transcatheter closure.