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Manolesou D, Papaioannou TG, Georgiopoulos G, Schizas D, Lazaris A, Stamatelopoulos K, Dimakakos E, Stergiopulos N, Stefanadis C, Liakakos T, Tousoulis D. Α systematic review and meta-analysis of the efficacy of aortic anastomotic devices. J Vasc Surg 2019; 69:598-613.e7. [PMID: 30683205 DOI: 10.1016/j.jvs.2018.08.154] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 08/09/2018] [Indexed: 01/16/2023]
Abstract
OBJECTIVE One of the factors contributing to complications related to open repair of the aorta is the construction of a hand-sewn anastomosis. Aortic anastomotic devices (AADs), such as the intraluminal ringed graft (IRG), and the anastomotic stenting technique have been developed to perform a sutureless and less complicated anastomosis. This study performed a systematic review and meta-analysis of the literature reporting clinical use of AADs and aimed to assess, primarily, the effect of each device on 30-day overall and operation-related mortality and aortic cross-clamping time and, secondarily, the rate of successful two-sided application of the IRG device and the operation-related morbidity for each device. METHODS An electronic search was performed using MEDLINE, Scopus, ScienceDirect, and Cochrane Library by two independent authors. Our exclusion criteria included studies incorporating fewer than three patients and studies reporting results solely from animals or in vitro testing, results solely from end-to-side anastomosis, and results solely from endarterectomy procedures. The last search date was February 1, 2018. RESULTS A total of 41 studies were identified that reported outcomes for the use of three different device types: IRG, anastomotic stenting technique, and surgical staplers. The last two types were classified together as the non-IRG group. The meta-analysis included 27 studies with 50 cohorts incorporating 1260 patients. The median age of the incorporated patients was 61.4 years (range, 51-73 years), and 68.9% were male. The operations were performed for the treatment of acute aortic dissection in 82.3%. The pooled overall 30-day mortality rate varied by device type; IRG devices had a mean rate of all-cause mortality of 9.71%, whereas non-IRG devices were associated with a significantly (I2 = 15.78%; P for Cochrane Q test < .19) lower rate of death (1.47%). The pooled mean aortic cross-clamping time was 35.83 minutes. Metaregression showed that the performance of two-sided anastomosis with the IRG device significantly decreased the aortic cross-clamping time. However, a successful two-sided ringed anastomosis was performed in approximately half of the cases. CONCLUSIONS Taking into account that the majority of operations were performed for the treatment of acute aortic dissection, AADs had a relatively low rate of 30-day mortality. Despite the observed heterogeneity in study protocols and the small sample size in the non-IRG group, the non-IRG group presented with the lowest 30-day mortality rate. Specific device-related complications between the different device types need further investigation.
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Affiliation(s)
- Danae Manolesou
- Biomedical Engineering Unit, First Department of Cardiology, Medical School, National and Kapodistrian University of Athens, Athens, Greece.
| | - Theodore G Papaioannou
- Biomedical Engineering Unit, First Department of Cardiology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - George Georgiopoulos
- Vascular Laboratory, Department of Therapeutics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitrios Schizas
- First Department of Surgery, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Andreas Lazaris
- Department of Vascular Surgery, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Kimonas Stamatelopoulos
- Vascular Laboratory, Department of Therapeutics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Evangelos Dimakakos
- Vascular Unit, 3rd Internal Medicine Clinic, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Nikolaos Stergiopulos
- Laboratory of Hemodynamics and Cardiovascular Technology, Institute of Biotechnology, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | | | - Theodoros Liakakos
- First Department of Surgery, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitrios Tousoulis
- Biomedical Engineering Unit, First Department of Cardiology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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Davison MA, Norton DM, Popoff AM, Seder CW, March RJ. Hemolysis following wrap aortoplasty for Type A aortic dissection repair: Case report and review of the literature. Vasc Med 2018; 23:400-406. [PMID: 29914309 DOI: 10.1177/1358863x18776106] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
A Dacron wrap aortoplasty has been described as an adjunct to reduction ascending aortoplasty for the repair of Type A aortic dissections. We report a case of an uncomplicated hemiarch repair with wrap aortoplasty of the distal anastomosis which resulted in severe acute hemolysis. Despite only minimal focal graft deformation on imaging, the patient was found to have a flow gradient across the distal anastomosis, which was reduced by > 50% following release of the outer graft wrap. To our knowledge, only 29 additional cases of hemolytic anemia following aortic dissection repair have been described in the English literature. The reported mechanisms included aortic graft stenosis (50%), graft kinking (23%), external compression of the graft (20%), and a folded elephant trunk appendage (7%). The mean onset of hemolysis following aortic dissection repair occurred 32.2 ± 44.4 months after surgery, with only 16.7% of cases occurring within 2 weeks. This review details the clinical, laboratory, and imaging findings suggestive of mechanical hemolysis following aortic surgery.
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Affiliation(s)
- Mark A Davison
- Department of Cardiovascular and Thoracic Surgery, Rush University Medical Center, IL, USA
| | - Derek M Norton
- Department of Cardiovascular and Thoracic Surgery, Rush University Medical Center, IL, USA
| | - Andrew M Popoff
- Department of Cardiovascular and Thoracic Surgery, Rush University Medical Center, IL, USA
| | - Christopher W Seder
- Department of Cardiovascular and Thoracic Surgery, Rush University Medical Center, IL, USA
| | - Robert J March
- Department of Cardiovascular and Thoracic Surgery, Rush University Medical Center, IL, USA
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Sakaguchi M, Takano T. Hemolytic anemia caused by aortic flap and inversion of felt strip after ascending aorta replacement. J Cardiothorac Surg 2016; 11:117. [PMID: 27484121 PMCID: PMC4969649 DOI: 10.1186/s13019-016-0520-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Accepted: 07/27/2016] [Indexed: 11/10/2022] Open
Abstract
Backgrounds Hemolysis related to a kinked prosthetic graft or inner felt strip is a very rare complication after aortic surgery. We describe herein a case of hemolytic anemia that developed due to aortic flap of the dissection and inversion of an inner felt strip that was applied at the proximal anastomosis of a replaced ascending aorta 10 years previously. Case presentation A 74-year-old woman presented with consistent hemolytic anemia 10 years after replacement of the ascending aorta to treat Stanford type A acute aortic dissection. The cause of hemolysis was attributed to mechanical injury of red blood cells at a site of stenosis caused by aortic flap of the dissection and inversion of the felt strip used for the proximal anastomosis. Repeated resection of the strip and graft replacement of the ascending aorta resolved this problem. Conclusions We considered that blood flow disrupted by a jet of blood at the site of the proximal inner felt strip was the cause of severe hemolysis, we describe rare hemolytic anemia at the site of aortic flap and inverted felt strip after replacement of the ascending aorta.
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Affiliation(s)
- Masayuki Sakaguchi
- Department of Cardiovascular Surgery, Suwa Red Cross Hospital, 5-11-50 Kogando-ri, Suwa City, Nagano, 392-8510, Japan.,Department of Cardiovascular Surgery, Nagano Red Cross Hospital, 5-22-1 Wakasato, Nagano City, Nagano, 380-8582, Japan
| | - Tamaki Takano
- Department of Cardiovascular Surgery, Nagano Red Cross Hospital, 5-22-1 Wakasato, Nagano City, Nagano, 380-8582, Japan.
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Kitahara H, Yoshitake A, Hachiya T, Okamoto K, Kawaguchi S, Shimizu H. Kinked Graft and Anastomotic Stenosis-Induced Hemolytic Anemia Requiring Reoperation. Ann Vasc Surg 2016; 30:308.e1-4. [DOI: 10.1016/j.avsg.2015.07.027] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Revised: 07/02/2015] [Accepted: 07/09/2015] [Indexed: 10/22/2022]
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Sekine Y, Yamamoto S, Fujikawa T, Oshima S, Ono M, Sasaguri S. Haemolytic anaemia resulting from the surgical repair of acute type A aortic dissection. Interact Cardiovasc Thorac Surg 2013; 18:230-3. [PMID: 24203981 DOI: 10.1093/icvts/ivt481] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Haemolytic anaemia after acute aortic dissection surgery is extremely rare. We report 4 cases of haemolytic anaemia with different aetiologies. METHODS Four patients underwent emergency operation for acute type A aortic dissection and subsequently developed haemolytic anaemia. RESULTS Case 1: a 41-year old man underwent hemiarch replacement. We performed total arch replacement 3 years postoperatively, which revealed that haemolytic anaemia was induced by proximal anastomotic stenosis caused by inverted internal felt strip. Case 2: a 28-year old man diagnosed with Marfan syndrome underwent total arch replacement. Five months postoperatively, we noted severe stenosis at the previous distal anastomotic site, which caused the haemolytic anaemia, and performed descending thoracic aortic replacement for a residual dissecting aneurysm. Case 3: a 49-year old man underwent hemiarch replacement. Three years postoperatively, we performed total arch replacement for a residual dissecting aortic arch aneurysm and repaired a kinked graft responsible for haemolytic anaemia. Case 4: a 42-year old man underwent total arch replacement. Eighteen months later, we performed descending thoracic aortic replacement. We repaired a portion of the ascending aorta as haemolityc anaemia was induced by kinking of a total arch replacement redundant graft. CONCLUSIONS All the haemolityc anaemia patients were successfully released after surgical reintervention.
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Affiliation(s)
- Yuji Sekine
- Department of Aortic Surgery, Kawasaki Saiwai Hospital, Kawasaki, Japan
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Wei J, Chang CY, Chuang YC, Sue SH, Lee KC, Wu CW, Chang CH. Midterm results of vascular ring connector in open surgery for aortic dissection. J Thorac Cardiovasc Surg 2012; 143:72-7, 77.e1-3. [DOI: 10.1016/j.jtcvs.2011.09.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2011] [Revised: 07/29/2011] [Accepted: 09/15/2011] [Indexed: 10/16/2022]
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Nakamura K, Kawahito K. Erythrocyte-protective effect of sarpogrelate hydrochloride (Anplag ®), a selective 5-HT2 receptor antagonist: an in vitro study. J Artif Organs 2010; 13:178-81. [PMID: 20799047 DOI: 10.1007/s10047-010-0515-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2010] [Accepted: 08/09/2010] [Indexed: 11/27/2022]
Abstract
Sarpogrelate hydrochloride (Anplag(®); Mitsubishi Tanabe Pharma Corporation, Osaka, Japan) is a selective S(2)-serotonergic receptor antagonist and is used as an antiplatelet agent. Sarpogrelate has been reported to increase erythrocyte deformability and suppress shear stress-induced hemolysis. In this study, we tested the protective effect of sarpogrelate on erythrocytes in an in vitro model. We compared the normalized index of hemolysis (NIH) between the group that was treated with sarpogrelate (n = 5) and the control group (n = 5) in a mock circulation under a shear force generated by a centrifugal pump. In the former group, 300 mg/day sarpogrelate was orally administered to a human volunteer for 2 days before blood collection. The NIH was significantly lower in the sarpogrelate group than it was in the control group (0.0012 ± 0.0009 vs. 0.0027 ± 0.0005 g/100 l, respectively; p = 0.016). Sarpogrelate suppressed shear stress-induced hemolysis in an in vitro model suggesting that sarpogrelate has a protective effect on erythrocytes under mechanical shear stress.
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Affiliation(s)
- Ken Nakamura
- Department of Cardiac Surgery, Jikei University Kashiwa Hospital, 163-1 Kashiwa-shita, Kashiwa, Chiba, 277-8567, Japan.
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