Laser In Situ Fenestrated Endograft (LIFE) Repair of Complex Aortic Arch Pathology: Early Outcomes from the Multicenter LIFE Registry.
Academic Article
Overview
abstract
OBJECTIVE: Endovascular repair of aortic arch pathologies is limited by currently available device configurations, variation in aortic arch anatomy, access challenges, and frequent non-elective surgical acuity. The present study aims to assess the feasibility and mid-term outcomes of laser in situ fenestrated endograft (LIFE) repair for supra-aortic arch branches during TEVAR. METHODS: Patients undergoing LIFE during TEVAR for aortic arch pathologies (2017-2022) were retrospectively identified at six high-volume centers and data collected in the multicenter LIFE registry. Descriptive statistics and Kaplan-Meier analysis were used. Primary outcomes were technical success, stroke, and target vessel instability. Secondary outcomes included 30-day mortality, spinal cord ischemia, and reinterventions. RESULTS: 82 patients undergoing LIFE with supra-aortic arch involvement were included. Mean age was 62.4 years (29.3% female, 78.0% white). Select demographics of the cohort featured previous stroke in 17.1%, chronic lung disease in 12.2%, and renal insufficiency in 30.5% Indication(s) for TEVAR included type B aortic dissection in 70.7%, aneurysm in 11.0%, and PAU/IMH in 4.9%. Repair was performed for non-elective pathologies in 47.9%. 89 supra-aortic arch branch vessels (innominate, n=6; LCCA, n=9; LSA, n=74) were incorporated via LIFE to achieve proximal seal in Zone 0 (19%), Zone 1 (5%) and Zone 2 (75%). LIFE repair was performed for a single branch vessel in 90% of cases and double branch vessel in 10%. Ten patients underwent adjunctive extra-anatomic bypass. Technical success was 95.1%. Thirty-day mortality was 2.4% (n=2). Early (<30 days) neurologic outcomes included a stroke and spinal cord ischemia rate of 7.4% and 0%, respectively. At a mean follow-up of 15 months (range 1-81), there were 5 additional late deaths (6.1%). A total of 8 patients (9.8%) required 11 unplanned reinterventions at a mean of 423 ± 555 days (range, 17 - 1479) postoperatively. Kaplan-Meier estimated survival was 94.5% at 36 months and reintervention-free survival was 78.0% at 36 months. CONCLUSIONS: Results from the multicenter LIFE Registry demonstrate laser in situ fenestration of complex aortic arch anatomy to be technically feasible with a perioperative mortality and neurologic risk profile that is comparable to standard techniques. Despite a modest reintervention rate in this early experience, mid-term survival is excellent, particularly given the high-risk aortic pathologies and patient demographics featured in this cohort. While perioperative results and midterm outcomes remain promising, longitudinal data are needed to confirm durability of this technique.
