RS08 - Midterm Outcomes of Laser In-Situ Fenestrated Repair (LIFE) of Complex Aortic Arch Pathology: Results from the Multicenter LIFE Registry

Objectives: 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 fenestration (LIFE) 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% female, 77% white). Select demographics of the cohort include previous stroke in 17%, COPD in 11%, renal insufficiency in 18% (dialysis 5%), and previous proximal aortic repair in 54%. Indication(s) for TEVAR was aortic dissection in 73%, aneurysm in 23%, and PAU/IMH in 18%. Repair was performed for non-elective pathologies in 42%. 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 was performed for a single branch vessel in 90% of cases and double branch vessel in 10%. Supra-aortic branch stents were successfully delivered in 98% of cases. Thirty-day mortality was 3.7% (n=3). 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%). Reinterventions occurred in 11 patients (13.4%). Kaplan-Meier estimated survival at 32 months was 90% (Figure 1) and target vessel instability at 35 months was 22% (Figure 2).

Conclusions: Results from the multicenter LIFE Registry demonstrate LIFE for complex aortic arch anatomy is 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 data is excellent, particularly given the high-risk aortic pathologies and patient demographics. Due to the wide applicability of off-the-shelf components and avoidance of a sternotomy or more complex extra-anatomic debranching, LIFE can be readily and safely performed in the appropriate clinical setting for patients unsuitable for open repair, and may be a preferred option for complex aortic repair in urgent /emergent cases.