5th Aortic Live Symposium

FUTURE OF AORTIC ARCH REPAIR

ROGER GREENHALGH

Disclosure

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Speaker name:Roger GreenhalghI have the following potential conflicts of interest to report:

ConsultingEmployment in industryStockholder of a healthcare companyOwner of a healthcare companyOther(s)

I do not have any potential conflict of interestx

This work is funded by the

Octav Botnar – Grateful Patient

Funding Acknowledgement

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Camelia Botnar Arterial Research Foundation

Learn the Future from the Past

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NothingMajor surgery

Open Medicine PreventionMinor

intervention

Tuberculosis

Stomach

Breast

Aorta

Major Open Surgery 1908-2008

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Major open surgery 1908-2008

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StanleyCrawford

1975 peak: The can opener

“Critical issues”

at the SVS

Very minor intervention

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ThomasFogarty

The tear away: medical student

Embolectomy

Lesser invasive

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Dotter

“Is he Crazy Charlie?”

Lesser procedure

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Grüntzig

Percutaneous transluminalangioplasty

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Palmaz Stent heralds EVAR

EVAR before 1990

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Volodos He referred to Dotter

EVAR 1990

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ParodiPalmazBarone

Argentina

Abdominal aortic aneurysm referral has fallen

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1994-2000

Prevention is with us already

Smoking cessation

Statins

Surgery for >75 years of age

STEP INVESTIGATORS

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Aims of the STEP Study

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To provide best practice for endovascular procedures forthe ascending aorta, aortic arch, great vessel branches andhigh TEVAR to lower the risk of cerebral embolism

Zone 0

Zone1

Zone2

- Ascending aorta: tube grafts, scalloped stent-grafts

- Arch procedures: fenestrated and branched aortic arch stent-

grafts (Great vessel involvement)

- Descending aorta: high standard TEVAR procedures landing in

zone 2 (Ishimaru)

STEP Built to learn from each other

Pathologies

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Air

Particles / Plaque

Thrombus

The 18 STEP Collaborators

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Stéphan HaulonTilo KölbelFrank Arko

Carlos BecharaAdam Beck

Dittmar BöcklerMartin CzernyMichael Dake

Matthew EagletonDennis GableWilliam JordanAhmed Koshty

Gustavo OderichJean PannetonGeert SchurinkSanti Trimarchi

Rod WhiteMarwan Youssef

2 Investigators

16 Collaborators

The STEP Advisors

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Neurologist – Hugh Markus

Interventional Cardiologist –Simon Redwood

Cardiothoracic Surgeon –Heinz Jakob

Neuroradiologist -Kyriakos Lobotesis

STEP Questionnaire

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General Questions on experience

Questions on current practice:

Pre-Procedural

Intra-Procedural

Post-Procedural

Key Findings

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STEP ResultsExperience of KOL (n = 18)

Cumulativeyears of experience

- Zone 0 = 143 years(range 3 – 15)

- Zone 1 = 193 years(range 4 – 15)

- Zone 2 = 232 years(range 6 – 20)

Manufacturers of devices used by the 18 Operators

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13 of 18

9 of 18

1 of 18

8 of 18

7 of 18

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ConsensusPre-Procedural

Interdisciplinary team central to the final decision for treatment strategy

Zone 0 Zone 2Zone 1

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MAJOR OPEN ERA 1908 - 2008

ENDOVASCULAR ERA NOW

MEDICAL ERA SLOW TO COME

PREVENTION ALREADY

THE SEQUENCE IS INEVITABLE

THE SURGEON MUST ADAPT

BE THOUGHTFUL

DRIVE ADVANCE