Patient-Tailored Therapy for Complex Aortic Arch Anatomy: An Evolving Research Field with Custom-Made Solutions

TL;DR

This paper discusses the challenges of treating complex aortic conditions and highlights the need for personalized, multidisciplinary approaches to determine the best therapies.

Contribution

The paper presents real-world case discussions from an experienced team, emphasizing the importance of patient-specific and anatomical considerations in aortic treatment decisions.

Findings

Multidisciplinary teams are essential for shared decision-making in complex aortic cases.

Endovascular solutions are often preferred for older patients with complex anatomies and comorbidities.

Treatment decisions require careful evaluation of the risk–benefit ratio for each patient.

Abstract

The treatment of complex aortic pathologies requires specialized techniques and tailored approaches due to each patient’s unique anatomical and clinical challenges. The European Association for Cardiothoracic Surgery (EACTS) and the Society of Thoracic Surgeons (STS) new guidelines identify the aorta as the body’s 24th organ and reiterate that multidisciplinary aortic teams are recommended for shared decision-making to determine optimal treatment strategies. Patients treated for conditions such as aneurysms, dissections, intramural hematomas, or penetrating aortic ulcers may develop complex forms over time, necessitating careful follow-up and timely corrective actions. Endovascular solutions can be favorable for older patients with complex anatomies and multiple comorbidities. However, when endovascular treatment is not feasible, hybrid treatments or open surgery must be considered if the patient’s condition allows it. The risk–benefit ratio of each procedure must be carefully evaluated; choosing the best intervention or deciding not to intervene becomes a critical and challenging decision. At our Cardiac Surgery Center in Verona, a multidisciplinary team with over 20 years of experience in treating complex aortic arch pathologies extensively discussed different cases of complex aortic pathologies treated with endovascular, hybrid, or surgical approaches, emphasizing the importance of considering both anatomical and patient-specific characteristics. The decisions and treatments were often challenging, and unanimity was not always achieved, reflecting the complexity of finding the best solutions.

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