A team of professionals from the Parc Taulí hospital in Sabadell performed the first intervention in the world for a thoracoabdominal aortic aneurysm using a personalized, small-profile aortic prosthesis. In this way, minimally invasive surgery can be performed on patients who would otherwise have required open-heart surgery.
The implantation of aortic valves using catheters is a modern, minimally invasive procedure that is increasingly common -although it is not yet fully extended- as an alternative to open surgery, which is complicated and associated with a long recovery period.
The problem is that custom-made prostheses that are used in interventions have a large-diameter (8mm) entry catheter and 20% of patients have obstructions or deformations that prevent their passage. The Parc Taulí Angiology and Vascular Surgery service, headed by Antoni Giménez, has found a solution by commissioning the manufacture, and using for the first time, a low-profile prosthesis (small size).
Engineers from the North American company Terumo Aortic have worked for about three months on the design and manufacture of the new prosthesis commissioned by Parc Taulí, an international benchmark in the handling of these materials.
The new small-diameter valve has been successfully implanted in a 69-year-old patient who presented with occlusive lesions in the arteries. The man was not suitable to receive the standard prostheses and was not suitable to undergo open surgery, since, due to his comorbidities, it posed a risk to his life.
"We give more patients the opportunity to receive a minimally invasive treatment," explains Giménez regarding the innovation. "It is a great achievement. Now the possibility of treatment is extended, although each case must be assessed. In addition, this non-aggressive technique allows a quick recovery of the patient”.
Thoracoabdominal aneurysm is one of the most difficult to treat. It extends into both the chest (top) and abdomen (bottom), with branches that supply blood to many vital organs. Traditional intervention involves in many cases stopping the heartbeat and using an extracorporeal circulation technique, with the risk of stroke, thrombosis, heart attacks or infections. And a hospitalization of at least ten days.
The endovascular procedure consists of introducing a prosthesis (customized, with branches and holes to adapt to the anatomy of each patient) through the inguinal area in order to protect blood circulation and, inside, implanting the 'stents' that communicate the aortic prosthesis with the arteries of the kidneys, the intestines and the celiac trunk (which goes to the liver and the spleen), generating a kind of new aorta.
The requirements that cardiology departments, catheterization clinics and, especially, the professionals who perform this technique must meet are very demanding.
"The only problem we had up to now was that these prostheses, which began to be used in 1993 and custom-made prostheses later arrived, is that the size of the device was frankly too large to be used in patients with stenotic/occlusive lesions," explains Giménez. . Parc Taulí, where between 60 and 70 patients with aortic aneurysms are operated on each year, has crossed this border.
The severity of aortic dilation depends on its magnitude. It should be treated from 5.5 mm, and up to 6 mm can be accepted in the manufacturing time of custom-made prostheses for the endovascular approach. If the aneurysm reaches 8-9mm in diameter, the risk of artery rupture in one year is 50%. You have to intervene immediately.
