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Brown JA, Yousef S, Serna-Gallegos D, Sá MP, Agrawal N, Thoma F, Wang Y, Phillippi J, Sultan I. Long-term outcomes of total arch replacement with bilateral antegrade cerebral perfusion using the "arch first" approach. Perfusion 2025; 40:850-857. [PMID: 38863259 DOI: 10.1177/02676591241259622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2024]
Abstract
ObjectiveTo report outcomes of total arch replacement (TAR) with hypothermic circulatory arrest and bilateral antegrade cerebral perfusion (bACP) using an "arch first" approach for acute Type A aortic dissection (ATAAD). The "arch first" approach involved revascularization of the aortic arch branch vessels with uninterrupted ACP, before lower body circulatory arrest, while the patient was cooling.MethodsThis was an observational study of aortic surgeries from 2010 to 2021. All patients who underwent TAR with bACP for ATAAD were included. Short-term and long-term outcomes were reported utilizing descriptive statistics and Kaplan-Meier survival estimation.ResultsA total of 215 patients were identified who underwent TAR + bACP for ATAAD. Age was 59.0 [49.0-67.0] years and 35.3% were female. 73 patients (34.0%) underwent a concomitant aortic root replacement, 188 (87.4%) had aortic cannulation, circulatory arrest time was 37.0 [26.0-52.0] minutes, and nadir temperature was 20.8 [19.4-22.5] degrees Celsius. 35 patients (16.3%) had operative mortality (STS definition), 17 (7.9%) had a new stroke, 79 (36.7%) had prolonged mechanical ventilation (>24 h), 35 (16.3%) had acute renal failure (by RIFLE criteria), and 128 (59.5%) had blood product transfusions. One-year survival was 77.1%, while 5-years survival was 67.1%. During follow-up, there were 23 (10.7%) reinterventions involving the descending thoracic aorta - either thoracic endovascular aortic repair or open thoracoabdominal aortic replacement.ConclusionsAmong patients with ATAAD, short-term postoperative outcomes after TAR + bACP using the "arch first" approach are acceptable. Moreover, this operative strategy may furnish long-term durability, with a reasonably low reintervention rate and satisfactory overall survival.
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Affiliation(s)
- James A Brown
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Sarah Yousef
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Derek Serna-Gallegos
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Michel Pompeu Sá
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Nishant Agrawal
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Floyd Thoma
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Yisi Wang
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Julie Phillippi
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Ibrahim Sultan
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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Altobaishat O, Bataineh OA, Ibrahim AA, Al-Zoubi AK, Khan U, Abdelgalil MS, Abouzid M, Rezq H, Abuelazm M. Single Arterial Cannulation vs. Dual Arterial Cannulation during Acute Type A Aortic Dissection Repair: A Systematic Review and Meta-Analysis. J Cardiothorac Vasc Anesth 2025; 39:244-255. [PMID: 39551695 DOI: 10.1053/j.jvca.2024.10.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2024] [Revised: 10/04/2024] [Accepted: 10/09/2024] [Indexed: 11/19/2024]
Abstract
OBJECTIVE Acute type A aortic dissection (ATAAD) is a cardiovascular emergency with high mortality and morbidity. We compared the effects on outcomes of single arterial cannulation (SAC) via axillary, femoral, or ascending aorta with double arterial cannulation (DAC) via axillary and femoral artery during ATAAD repair. METHODS We conducted a systematic review and meta-analysis of observational studies from PubMed, Web of Science, Scopus, EMBASE, and Cochrane searches through April 30, 2024. Dichotomous data were pooled using risk ratio (RR), and continuous data were pooled using mean difference (MD), both with a 95% confidence interval (CI), using R version 4.3. The protocol is registered on PROSPERO (CRD42024535644). RESULTS Our analysis included 7 studies encompassing 3,534 patients. DAC was associated with a significantly longer intensive care unit stay than SAC (MD 0.45 days, 95% CI 0.10, 0.79, p = 0.01). However, there was no significant difference between DAC and SAC in the length of hospital stay (MD 1.39 days, 95% CI -2.70, 5.47, p = 0.51). Also, there was no significant difference between the two approaches in the incidence of stroke (RR 1.12, 95% CI 0.77, 1.64, p = 0.55), paraplegia (RR 0.59, 95% CI 0.32, 1.07, p = 0.08), or acute kidney injury (RR 0.83, 95% CI 0.55, 1.24, p = 1.24). CONCLUSION Our meta-analysis shows that during ATAAD repair, DAC was associated with slightly longer intensive care stay, which was of doubtful clinical significance. However, both approaches were comparable for hospital stay, the incidence of stroke, paraplegia, or acute kidney injury. IMPLICATIONS FOR CLINICAL PRACTICE Despite comparable overall outcomes, we observed that DAC was associated with higher risks of requiring continuous renal replacement therapy or dialysis, and reintubation. This emphasizes the need to carefully consider cannulation strategies based on patient factors to balance potential benefits and risks.
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Affiliation(s)
- Obieda Altobaishat
- Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | | | | | - Ahmad K Al-Zoubi
- Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Ubaid Khan
- Division of Cardiology, University of Maryland, School of Medicine, Baltimore, USA
| | | | - Mohamed Abouzid
- Department of Physical Pharmacy and Pharmacokinetics, Faculty of Pharmacy, Poznan University of Medical Sciences, Poznan, Poland; Doctoral School, Poznan University of Medical Sciences, Poznan, Poland.
| | - Hazem Rezq
- Faculty of Medicine, Al-Azhar University, Cairo, Egypt
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Chiariello GA, Bruno P, Heijmen R, Mecozzi G, Mariani M, Boumpouli M, Mazza A, Pavone N, Zamboni P, Massetti M, Zeitani J. A New Design for Aortic Arch Surgery: Ex Vivo Implantation and Computerized Flow Evaluation of the ISLAND Graft. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2025; 20:65-72. [PMID: 39868501 DOI: 10.1177/15569845241298624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2025]
Abstract
OBJECTIVE Both the en bloc island technique and the branched graft technique (BGT) present advantages but also limitations in aortic arch surgery. Here is the first presentation of an innovative prosthesis for aortic arch replacement, conceived to overcome the disadvantages of both techniques. METHODS The novel ISLAND graft is a tubular Dacron or hybrid prosthesis with an additional extended Dacron graft ("bubble") on the superior aspect, for en bloc island graft anastomosis. To verify the technical feasibility, following bench study, 3 prostheses were implanted in human cadavers in which the distal anastomosis was performed either in zone 2 or 3. A flow analysis and a computational simulation were performed in different configurations. The flows of the "full-bubble," the "cut-bubble," and the traditional branched grafts were compared. The wall shear stress, time-averaged wall shear stress (TAWSS), oscillatory stress index (OSI), and relative residence time (RRT) were compared in the 3 settings. RESULTS The novel prosthesis appeared easy to implant with significant technical advantages. The manipulation of epiaortic vessels was reduced with expected lower risk of neurologic events. The fenestration of the external cuff could be tailored to the island segment, thus eliminating most pathological aortic tissue. The flows in the supraortic branches were more favorable in the ISLAND graft, in which the angles of the branches were maintained, and with reduced cuff height (cut-bubble), in which higher values of TAWSS and lower values of OSI and RRT were calculated. CONCLUSIONS The novel ISLAND graft device overcomes the disadvantages of the traditional island technique and benefits from the advantages of the BGT. Given the first results, the next step would represent the in vivo implantation.
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Affiliation(s)
- Giovanni A Chiariello
- Department of Cardiovascular Sciences, Agostino Gemelli Foundation Polyclinic IRCCS, Rome, Italy
- Catholic University of the Sacred Heart, Rome, Italy
| | - Piergiorgio Bruno
- Department of Cardiovascular Sciences, Agostino Gemelli Foundation Polyclinic IRCCS, Rome, Italy
- Catholic University of the Sacred Heart, Rome, Italy
| | - Robin Heijmen
- Department of Cardiothoracic Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Gianclaudio Mecozzi
- Department of Cardiothoracic Surgery, University of Groningen, University Medical Center of Groningen, The Netherlands
| | - Massimo Mariani
- Department of Cardiothoracic Surgery, University of Groningen, University Medical Center of Groningen, The Netherlands
| | - Maria Boumpouli
- Research and Development, Terumo Aortic Ltd, Inchinnan, Glasgow, UK
| | - Andrea Mazza
- Department of Cardiovascular Sciences, Agostino Gemelli Foundation Polyclinic IRCCS, Rome, Italy
- Catholic University of the Sacred Heart, Rome, Italy
| | - Natalia Pavone
- Department of Cardiovascular Sciences, Agostino Gemelli Foundation Polyclinic IRCCS, Rome, Italy
- Catholic University of the Sacred Heart, Rome, Italy
| | - Paolo Zamboni
- Department of Translational Medicine, University of Ferrara, Italy
| | - Massimo Massetti
- Department of Cardiovascular Sciences, Agostino Gemelli Foundation Polyclinic IRCCS, Rome, Italy
- Catholic University of the Sacred Heart, Rome, Italy
| | - Jacob Zeitani
- Department of Neurosciences and Rehabilitation, Cardiac Surgery Unit, University of Ferrara, Italy
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Kwiecinski J, Uberoi R, Hadi M, Cheng CP, You Z. In vitro quantification of stent-graft behaviour during chimney thoracic endovascular aortic repair. Vascular 2024:17085381241260910. [PMID: 39033502 DOI: 10.1177/17085381241260910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/23/2024]
Abstract
OBJECTIVE To quantify dynamic gutter phenomena and endograft deformations during double chimney thoracic endovascular aortic repair (ch-TEVAR) in a physiological model of the thoracic aorta subjected to pulsatile haemodynamic conditions. METHODS Two in vitro procedures revascularizing the brachiocephalic trunk and left common carotid artery were performed representing both balloon-expandable (BE, Ankura-BeGraft) and self-expandable (SE, Ankura-Viabahn) double ch-TEVAR configurations. Retrospectively gated computed tomography (CT) was used to evaluate endograft behaviour. Device interactions were characterised according to gutter volume, gutter surface deviation, and endograft deformation (D-ratio) at end-diastolic and peak-systolic aortic pressure. RESULTS Use of BE chimney grafts resulted in three times total gutter volume compared to SE chimney grafts. Gutter volumes were observed to vary dynamically between the end-diastolic and peak-systolic phases of the cardiac cycle, with the most substantial change associated with the BE configuration. Chimney graft deformations were dependent on device type, with SE devices exhibiting up to twice the deformation as BE devices. When adjacent, SE chimney grafts were observed to support each other, and thus tended towards a more consistently circular shape. CONCLUSION Gutter and chimney graft behaviour were dependent on device type, and exhibited both spatial and temporal variability. This study emphasises notable differences between BE and SE double ch-TEVAR configurations which should be considered when evaluating risk of endoleak. The findings reported here also support the use of gated CT to better identify device-related complications with ch-TEVAR, and can be used in the design of next generation devices.
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Affiliation(s)
- Jakub Kwiecinski
- Department of Engineering Science, University of Oxford, Oxford, UK
| | - Raman Uberoi
- Department of Radiology, John Radcliffe Hospital, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Mohammed Hadi
- Department of Radiology, John Radcliffe Hospital, Oxford University Hospitals NHS Trust, Oxford, UK
| | | | - Zhong You
- Department of Engineering Science, University of Oxford, Oxford, UK
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Brown JA, Yousef S, Garvey J, Ogami T, Serna-Gallegos D, Sá MP, Thoma F, Zhu J, Phillippi J, Sultan I. Reinterventions After Repair of Acute Type A Aortic Dissection: Incidence, Outcomes, and Risk Factors. Ann Thorac Surg 2024; 117:915-921. [PMID: 38036024 PMCID: PMC11317993 DOI: 10.1016/j.athoracsur.2023.11.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 10/19/2023] [Accepted: 11/06/2023] [Indexed: 12/02/2023]
Abstract
BACKGROUND This study reports the incidence, outcomes, and risk factors for aortic reinterventions after repair of acute type A aortic dissection (ATAAD). METHODS This was an observational study of aortic operations from 2010 to 2021. All patients with ATAAD undergoing open aortic arch reconstruction were included. Patients were dichotomized by the need for reintervention, which included reinterventions proximal to or distal to the index aortic repair. Propensity matching was used to determine the impact of reintervention on long-term outcomes. The cumulative incidence function for reintervention was estimated, and multivariable Fine-Gray analysis was performed to identify variables associated with reintervention, with death treated as a competing event. RESULTS We identified 601 patients undergoing surgery for ATAAD. An aortic reintervention was required in 71 (11.8%), comprising a proximal reintervention in 12 patients, a distal reintervention in 56, and both in 3. The cumulative incidence of reintervention was 11.6% (95% CI, 8.9%-14.6%) at 5 years and was 16.0% (95% CI, 12.2%-20.3%) at 10 years, with a median time to reintervention of 4.0 years (interquartile range, 0.9-7.5 years). Multivariable analysis using the Fine-Gray method showed no operative variables were associated with reinterventions. Among the 71 reinterventions, there were 4 (5.6%) operative deaths. After propensity matching, there was no difference in Kaplan-Meier survival estimates across each group (P = .138 by log-rank statistics). CONCLUSIONS The cumulative incidence of aortic reintervention after ATAAD repair was reasonably low (16% at 10 years), reinterventions were relatively safe (6% operative mortality), and reinterventions did not significantly impact long-term survival.
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Affiliation(s)
- James A Brown
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Sarah Yousef
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Joseph Garvey
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Takuya Ogami
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Derek Serna-Gallegos
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania; Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Michel Pompeu Sá
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Floyd Thoma
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Jianhui Zhu
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Julie Phillippi
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Ibrahim Sultan
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania; Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
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Li H, Zhang L, Ke J, Wu W, Feng W, Yu C, Li X, Xiao F, Sun T, Fan R, Zhou C. A comparison of single and double arterial cannulation for cardiopulmonary bypass for acute type A aortic surgery: A single center, retrospective observational study. Perfusion 2024; 39:362-372. [PMID: 36464941 DOI: 10.1177/02676591221144170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2023]
Abstract
Background: Acute type A aortic dissection (ATAAD) is a cardiovascular emergency and has high mortality and morbidity. We retrospectively compared the effects on outcomes of single arterial cannulation via axillary artery (AAC) with double arterial cannulation via axillary and femoral artery (DAC) in patients who underwent cardiopulmonary bypass (CPB) for ATAAD.Methods: Between January 2017 and May 2021, four hundred 29 patients who underwent aortic arch repair with circulatory arrest for ATAAD were divided into AAC group (n = 283) and DAC group (n = 146). The propensity score-matched (PSM) analysis were performed to compare the characteristics and outcomes of the groups.Results: After PSM (n = 137 in each), the DAC group had a longer duration of CPB (229 vs 244, p = 0.011), aortic cross-clamp time (121 vs 149, p < 0.001), durations of Intensive Care Unit (ICU) stay (7 vs 8, p = 0.014) and hospital stay (19 vs 25, p < 0.001) compared with AAC group. The incidences of dialysis (21% vs. 31%, p = 0.073), postoperative stroke (9% vs 15%, p = 0.143), ECMO support (2% vs 7%, p = 0.077), in-hospital mortality (7% vs 14%, p = 0.071) and follow-up mortality (10% vs 19%, p = 0.059) showed no significant difference between two groups. Multivariate logistic regression analysis showed postoperative ECMO (OR: 16.69, 95% CI: 1.78-156.29; p = 0.014) or stroke (OR: 11.34, 95% CI: 2.64-48.72; p < 0.001) were associated with in-hospital mortality. Univariate Cox regression results showed stroke history (OR: 4.61, 95% CI: 1.90-11.16; p = 0.001), aortic valvuloplasty (OR: 0.21, 95% CI: 0.07-0.59; p = 0.003), postoperative ALT day1 (OR: 1.00, 95% CI: 1.00-1.00; p = 0.008), ECMO (OR: 16.30, 95% CI: 4.78-55.61; p < 0.001), tracheotomy (OR: 3.78, 95% CI: 1.08-13.20; p = 0.037), postoperative stroke (OR: 4.61, 95% CI: 1.90-11.16; p < 0.001) and re-exploration for bleeding (OR: 3.52, 95% CI: 1.01-12.27; p = 0.048) were associated to follow-up mortality.Conclusions: For surgical treatment of ATAAD with CPB when compared to double axillary and femoral artery, single axillary cannulation was associated with shorter durations of CPB and ACC as well as ICU and hospital stays but no with significant difference in mortality.
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Affiliation(s)
- Huili Li
- School of Medicine, South China University of Technology, Guangzhou, China
- Department of Cardiovascular Surgery, Guangdong provincial Cardiovascular Institute, Guangdong Academy of Medical Sciences, Guangdong Provincial People's Hospital, Guangzhou, Guangdong, China
| | - Li Zhang
- Department of Cardiovascular Surgery, Guangdong provincial Cardiovascular Institute, Guangdong Academy of Medical Sciences, Guangdong Provincial People's Hospital, Guangzhou, Guangdong, China
| | - Jun Ke
- Department of Cardiovascular Surgery, Guangdong provincial Cardiovascular Institute, Guangdong Academy of Medical Sciences, Guangdong Provincial People's Hospital, Guangzhou, Guangdong, China
| | - Wentao Wu
- Department of Cardiovascular Surgery, Guangdong provincial Cardiovascular Institute, Guangdong Academy of Medical Sciences, Guangdong Provincial People's Hospital, Guangzhou, Guangdong, China
| | - Weiqi Feng
- Department of Cardiovascular Surgery, Guangdong provincial Cardiovascular Institute, Guangdong Academy of Medical Sciences, Guangdong Provincial People's Hospital, Guangzhou, Guangdong, China
| | - Changjiang Yu
- Department of Cardiovascular Surgery, Guangdong provincial Cardiovascular Institute, Guangdong Academy of Medical Sciences, Guangdong Provincial People's Hospital, Guangzhou, Guangdong, China
| | - Xin Li
- Department of Cardiovascular Surgery, Guangdong provincial Cardiovascular Institute, Guangdong Academy of Medical Sciences, Guangdong Provincial People's Hospital, Guangzhou, Guangdong, China
| | - Fei Xiao
- Department of Cardiovascular Surgery, Guangdong provincial Cardiovascular Institute, Guangdong Academy of Medical Sciences, Guangdong Provincial People's Hospital, Guangzhou, Guangdong, China
| | - Tucheng Sun
- Department of Cardiovascular Surgery, Guangdong provincial Cardiovascular Institute, Guangdong Academy of Medical Sciences, Guangdong Provincial People's Hospital, Guangzhou, Guangdong, China
| | - Ruixin Fan
- Department of Cardiovascular Surgery, Guangdong provincial Cardiovascular Institute, Guangdong Academy of Medical Sciences, Guangdong Provincial People's Hospital, Guangzhou, Guangdong, China
| | - Chengbin Zhou
- School of Medicine, South China University of Technology, Guangzhou, China
- Department of Cardiovascular Surgery, Guangdong provincial Cardiovascular Institute, Guangdong Academy of Medical Sciences, Guangdong Provincial People's Hospital, Guangzhou, Guangdong, China
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Gao J, Yan J, Duan Y, Yu J, Li W, Luo Z, Yu W, Xie D, Liu Z, Xiong J. Aortic arch branch-prioritized reconstruction for type A aortic dissection surgery. Front Cardiovasc Med 2024; 10:1321700. [PMID: 38348137 PMCID: PMC10859855 DOI: 10.3389/fcvm.2023.1321700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Accepted: 12/26/2023] [Indexed: 02/15/2024] Open
Abstract
Background Acute Stanford type A aortic dissection (STAAD) is a fatal condition requiring urgent surgical intervention. Owing to the complexity of the surgical process, various complications, such as neurological disorders, are common. In this study, we prioritized the reconstruction of aortic arch branches during surgery and investigated the association between prioritizing the branches and the postoperative outcomes of patients with STAAD. Methods Ninety-seven patients were included in the observational study and underwent total arch replacement and frozen elephant trunk technique between January 2018 and June 2021. Of these, 35 patients underwent the branch-priority technique, and 62 patients underwent the classic technique. By analyzing the perioperative outcomes, we compared the differences between the two techniques. Results The branch priority group had significantly shorter cardiopulmonary bypass and ventilator times and earlier postoperative wake-up times than the classic group. Additionally, the ICU stay time was shorter, with a significant decrease in neurological complications and 24 h drainage in the branch priority group compared to the classic group. Conclusion The branch priority technique can effectively provide better brain protection, resulting in earlier awakening of patients after surgery, reduced neurological complications, shorter ventilation time and decreased ICU hospitalization time. Therefore, it is recommended for use in aortic dissection surgeries.
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Affiliation(s)
- Jianfeng Gao
- The First Clinical Medical College, Gannan Medical University, Ganzhou, China
| | - Jie Yan
- Department of Thoracic Surgery, The First People’s Hospital of Nankang District, Ganzhou, China
| | - Yanyu Duan
- Heart Medical Centre, First Affiliated Hospital of Gannan Medical University, Ganzhou, China
- Engineering Research Center of Intelligent Acoustic Signals of Jiangxi Province, Key Laboratory of Prevention and Treatment of Cardiovascular and Cerebrovascular Diseases, Ministry of Education, Gannan Medical University, Ganzhou, China
- Ganzhou Cardiovascular Rare Disease Diagnosis and Treatment Technology Innovation Center, Gannan Medical University, Ganzhou, China
| | - Junjian Yu
- Heart Medical Centre, First Affiliated Hospital of Gannan Medical University, Ganzhou, China
- Department of Cardiovascular Surgery, First Affiliated Hospital of Gannan Medical University, Ganzhou, China
| | - Wentong Li
- Heart Medical Centre, First Affiliated Hospital of Gannan Medical University, Ganzhou, China
- Department of Cardiovascular Surgery, First Affiliated Hospital of Gannan Medical University, Ganzhou, China
| | - Zhifang Luo
- Heart Medical Centre, First Affiliated Hospital of Gannan Medical University, Ganzhou, China
- Department of Cardiovascular Surgery, First Affiliated Hospital of Gannan Medical University, Ganzhou, China
| | - Wenbo Yu
- The First Clinical Medical College, Gannan Medical University, Ganzhou, China
| | - Dilin Xie
- The First Clinical Medical College, Gannan Medical University, Ganzhou, China
| | - Ziyou Liu
- Heart Medical Centre, First Affiliated Hospital of Gannan Medical University, Ganzhou, China
- Department of Cardiovascular Surgery, First Affiliated Hospital of Gannan Medical University, Ganzhou, China
| | - Jianxian Xiong
- Heart Medical Centre, First Affiliated Hospital of Gannan Medical University, Ganzhou, China
- Department of Cardiovascular Surgery, First Affiliated Hospital of Gannan Medical University, Ganzhou, China
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Wang X, Wu J, Zhi K, Zou S, Jin J, Bai J, Qu L. Comparative effectiveness and safety of laser, needle, and "quick fenestrater" in in situ fenestration during thoracic endovascular aortic repair. Front Cardiovasc Med 2023; 10:1250177. [PMID: 37840961 PMCID: PMC10570838 DOI: 10.3389/fcvm.2023.1250177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 09/15/2023] [Indexed: 10/17/2023] Open
Abstract
Background Special instruments are needed for the revascularization of aortic branches in in situ fenestration during thoracic endovascular aortic repair (TEVAR). This prospective study compared the effectiveness and safety of three currently used fenestraters: laser, needle, and Quick Fenestrater (QF). Methods In all, 101 patients who underwent TEVAR for aortic disease (dissection, n = 62; aneurysm, n = 16, or ulcer, n = 23) were enrolled. All patients were randomly assigned to three groups: 34 were assigned to laser fenestration, 36 to needle fenestration, and 31 to QF fenestration. The epidemiological data, treatment, imaging findings, and follow-up outcomes were analyzed using data from the medical records. Results The technical success rates of the laser, needle, and QF fenestration groups were 94.1%, 94.4%, and 100% (p > 0.05). After correction of mixed factors such as age and gender, it was showed the average operative time (Laser group: 130.01 ± 9.36 min/ Needle group: 149.80 ± 10.18 min vs. QF group: 101.10 ± 6.75 min, p < 0.001), fluoroscopy time (Laser group: 30.16 ± 9.81 min/ Needle group: 40.20 ± 9.91 min vs. QF group: 19.91 ± 5.42 min, p < 0.001), fenestration time (Laser group 5.50 ± 3.10 min / Needle group 3.50 ± 1.50 min vs. QF group 0.67 ± 0.06 min, p < 0.001), and guide wire passage time after fenestration (Laser group 5.10 ± 1.70 min / Needle group 4.28 ± 1.60 min vs. QF group 0.07 ± 0.01 min, p < 0.001) were all shorter with QF fenestration than with the other two tools. The overall perioperative complication rates of the laser, needle, and QF fenestration groups were 5.9%, 5.6%, and 0% (p > 0.05): One case of sheath thermal injury and one case of vertebral artery ischemia occurred in the laser fenestration group; one case each of access site hematoma and brachial artery thrombosis were reported in the needle fenestration group. 89 (88.1%, 89/101) patients were followed for a median of 12.6 ± 1.6 months. The overall postoperative complication rates of the laser, needle, and QF fenestration groups were 3.3%, 6.5%, and 0% (p > 0.05): In the laser fenestration group, there was one death due to postoperative ST-segment elevation myocardial infarction; in the needle fenestration group, one patient developed occlusion of the bridge stent; no complications occurred in the QF group. Conclusion All three fenestration methods were effective in reconstructing supra-arch artery during TEVAR. QF fenestration required less contrast agent, with a shorter surgery duration and fewer complications than laser and needle fenestration.
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Affiliation(s)
| | | | | | | | | | - Jun Bai
- Department of Vascular and Endovascular Surgery, Second Affiliated Hospital of Naval Medical University, Shanghai, China
| | - Lefeng Qu
- Department of Vascular and Endovascular Surgery, Second Affiliated Hospital of Naval Medical University, Shanghai, China
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Ogino H, Iida O, Akutsu K, Chiba Y, Hayashi H, Ishibashi-Ueda H, Kaji S, Kato M, Komori K, Matsuda H, Minatoya K, Morisaki H, Ohki T, Saiki Y, Shigematsu K, Shiiya N, Shimizu H, Azuma N, Higami H, Ichihashi S, Iwahashi T, Kamiya K, Katsumata T, Kawaharada N, Kinoshita Y, Matsumoto T, Miyamoto S, Morisaki T, Morota T, Nanto K, Nishibe T, Okada K, Orihashi K, Tazaki J, Toma M, Tsukube T, Uchida K, Ueda T, Usui A, Yamanaka K, Yamauchi H, Yoshioka K, Kimura T, Miyata T, Okita Y, Ono M, Ueda Y. JCS/JSCVS/JATS/JSVS 2020 Guideline on Diagnosis and Treatment of Aortic Aneurysm and Aortic Dissection. Circ J 2023; 87:1410-1621. [PMID: 37661428 DOI: 10.1253/circj.cj-22-0794] [Citation(s) in RCA: 51] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/05/2023]
Affiliation(s)
- Hitoshi Ogino
- Department of Cardiovascular Surgery, Tokyo Medical University
| | - Osamu Iida
- Cardiovascular Center, Kansai Rosai Hospital
| | - Koichi Akutsu
- Cardiovascular Medicine, Nippon Medical School Hospital
| | - Yoshiro Chiba
- Department of Cardiology, Mito Saiseikai General Hospital
| | | | | | - Shuichiro Kaji
- Department of Cardiovascular Medicine, Kansai Electric Power Hospital
| | - Masaaki Kato
- Department of Cardiovascular Surgery, Morinomiya Hospital
| | - Kimihiro Komori
- Division of Vascular and Endovascular Surgery, Department of Surgery, Nagoya University Graduate School of Medicine
| | - Hitoshi Matsuda
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center
| | - Kenji Minatoya
- Department of Cardiovascular Surgery, Graduate School of Medicine, Kyoto University
| | | | - Takao Ohki
- Division of Vascular Surgery, Department of Surgery, The Jikei University School of Medicine
| | - Yoshikatsu Saiki
- Division of Cardiovascular Surgery, Graduate School of Medicine, Tohoku University
| | - Kunihiro Shigematsu
- Department of Vascular Surgery, International University of Health and Welfare Mita Hospital
| | - Norihiko Shiiya
- First Department of Surgery, Hamamatsu University School of Medicine
| | | | - Nobuyoshi Azuma
- Department of Vascular Surgery, Asahikawa Medical University
| | - Hirooki Higami
- Department of Cardiology, Japanese Red Cross Otsu Hospital
| | | | - Toru Iwahashi
- Department of Cardiovascular Surgery, Tokyo Medical University
| | - Kentaro Kamiya
- Department of Cardiovascular Surgery, Tokyo Medical University
| | - Takahiro Katsumata
- Department of Thoracic and Cardiovascular Surgery, Osaka Medical College
| | - Nobuyoshi Kawaharada
- Department of Cardiovascular Surgery, Sapporo Medical University School of Medicine
| | | | - Takuya Matsumoto
- Department of Vascular Surgery, International University of Health and Welfare
| | | | - Takayuki Morisaki
- Department of General Medicine, IMSUT Hospital, the Institute of Medical Science, the University of Tokyo
| | - Tetsuro Morota
- Department of Cardiovascular Surgery, Nippon Medical School Hospital
| | | | - Toshiya Nishibe
- Department of Cardiovascular Surgery, Tokyo Medical University
| | - Kenji Okada
- Department of Surgery, Division of Cardiovascular Surgery, Kobe University Graduate School of Medicine
| | | | - Junichi Tazaki
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
| | - Masanao Toma
- Department of Cardiology, Hyogo Prefectural Amagasaki General Medical Center
| | - Takuro Tsukube
- Department of Cardiovascular Surgery, Japanese Red Cross Kobe Hospital
| | - Keiji Uchida
- Cardiovascular Center, Yokohama City University Medical Center
| | - Tatsuo Ueda
- Department of Radiology, Nippon Medical School
| | - Akihiko Usui
- Department of Cardiac Surgery, Nagoya University Graduate School of Medicine
| | - Kazuo Yamanaka
- Cardiovascular Center, Nara Prefecture General Medical Center
| | - Haruo Yamauchi
- Department of Cardiac Surgery, The University of Tokyo Hospital
| | | | - Takeshi Kimura
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
| | | | - Yutaka Okita
- Department of Surgery, Division of Cardiovascular Surgery, Kobe University Graduate School of Medicine
| | - Minoru Ono
- Department of Cardiac Surgery, Graduate School of Medicine, The University of Tokyo
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10
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Seghrouchni A, Atmani N, Moutakiallah Y, El Bekkali Y, Ait Houssa M. Surgical aspects of thoracic aortic aneurysms: A case series from a real-world setting. Ann Med Surg (Lond) 2021; 72:103099. [PMID: 34888044 PMCID: PMC8636763 DOI: 10.1016/j.amsu.2021.103099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 11/18/2021] [Accepted: 11/20/2021] [Indexed: 11/28/2022] Open
Abstract
Background The objective of the present study is to review different surgical features and treatment modalities of thoracic aortic aneurysms. Methods This was a retrospective study of 17 patients operated on for thoracic aortic aneurysm in the Department of Cardiovascular Surgery of the Military Hospital of Rabat (Morocco) over a 10-year period, from January 2007 to December 2016. All patients with aneurysms located in the thoracic aorta or extended to the abdominal aorta were included in the study. Results The mean age of the patients was 49 ± 6 years. 58% of the patients were symptomatic. 10 patients (62%) had an aneurysm of the ascending thoracic aorta and 2 patients had an aneurysm of the ascending aorta extended to the arch. In 2 patients, the aneurysm was located in the descending thoracic aorta. Three patients (18%) had a post-traumatic false aneurysm of the aortic isthmus. Six patients underwent a Bentall procedure. One patient underwent the Yacoub technique. Two patients underwent ascending aorta replacement using the Wheat technique. In addition, two patients underwent ascending aorta and arch replacement and five patients (29%) underwent descending thoracic aorta replacement. In-hospital mortality was 12%. Two patients (12%) developed paraplegia and two developed renal failure (12%). Conclusion Thoracic aortic aneurysms are a serious pathology requiring surgical treatment before complications arise. Replacement of the arch and the descending thoracic aorta still remain a challenge for cardiovascular surgeons because of neurological complications. Thoracic aortic aneurysm is a life threatening disease. It requires surgical treatment before complications arise. Replacement of the arch and the descending thoracic aorta is challenging because of neurological complications.
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Affiliation(s)
- Aniss Seghrouchni
- Cardiovascular Surgery Department, Mohammed V Military Training Hospital, Rabat, Morocco.,Faculty of Medicine and Pharmacy, University of Sidi Mohamed Ben Abdellah, Fes, Morocco
| | - Noureddine Atmani
- Cardiovascular Surgery Department, Mohammed V Military Training Hospital, Rabat, Morocco.,Faculty of Medicine and Pharmacy, University of Sidi Mohamed Ben Abdellah, Fes, Morocco
| | - Younes Moutakiallah
- Cardiovascular Surgery Department, Mohammed V Military Training Hospital, Rabat, Morocco
| | - Youssef El Bekkali
- Cardiovascular Surgery Department, Mohammed V Military Training Hospital, Rabat, Morocco
| | - Mahdi Ait Houssa
- Cardiovascular Surgery Department, Mohammed V Military Training Hospital, Rabat, Morocco
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11
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Barnes JA, Wanken ZJ, Columbo JA, Kuwayama DP, Fillinger MF, Suckow BD. Procedure-Associated Costs and Mid-Term Outcomes of Endovascular Zone 0 and Zone 1 Aortic Arch Repair. Ann Vasc Surg 2021; 81:98-104. [PMID: 34780945 DOI: 10.1016/j.avsg.2021.10.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 09/24/2021] [Accepted: 10/01/2021] [Indexed: 11/01/2022]
Abstract
BACKGROUND Thoracic endovascular aortic repair (TEVAR) of proximal aortic arch pathology provides a less-invasive treatment option for high-risk patients ineligible for open arch reconstruction. However, the fiscal impact of these techniques remains unclear. Therefore, our objective was to characterize the mid-term outcomes after Zone 0 and Zone 1 TEVAR and describe the associated technical costs, revenues, and net margins at a single tertiary medical center. METHODS We examined all patients who underwent TEVAR between April 2011 and August 2019 via retrospective chart review. Patients were categorized by proximal endograft extent to identify Zone 0 or Zone 1 repairs. Procedural characteristics and outcomes were described. Technical costs, revenues, and margins were obtained from the hospital finance department. RESULTS We identified 10 patients (6 Zone 0, 4 Zone 1) who were denied open arch reconstruction. Patients were predominantly female (n = 8; 80%) and the mean age was 72.8 ± 5.5 years. TEVAR was performed in 5 asymptomatic patients, urgently in 3 symptomatic patients, and emergently in 2 ruptured patients. TEVAR plus extra-anatomic bypass was performed in 4 patients. Another 4 patients also received parallel stent-grafting while 1 patient received a branched thoracic endograft and yet another an in-situ laser fenestration followed by branch stent grafting. Within the 30-day postoperative period, 1 patient experienced stroke and 1 patient died. Bypass and branch vessel patency were 100% through the duration of follow-up (mean 19.3 months). Mean total technical cost associated with all procedures or repair stages was $105,164 ± $59,338 while mean net technical margin was -$25,055 ± $18,746. The net technical margin was negative for 9 patients. CONCLUSIONS Endovascular repair of the proximal aortic arch is associated with good mid-term outcomes in patients considered too high-risk for open repair. However, reimbursement does not adequately cover treatment cost, with net technical margins being negative in nearly all cases. To remain financially sustainable, efforts should be made to both optimize aortic arch TEVAR delivery as well as advocate for reimbursement commensurate with associated costs.
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Affiliation(s)
| | - Zachary J Wanken
- Section of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - Jesse A Columbo
- Section of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - David P Kuwayama
- Section of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - Mark F Fillinger
- Section of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - Bjoern D Suckow
- Section of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH
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12
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Open aortic arch surgery: 10 years' single-center experience. POLISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2021; 18:159-164. [PMID: 34703473 PMCID: PMC8525281 DOI: 10.5114/kitp.2021.109395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 07/04/2021] [Indexed: 11/17/2022]
Abstract
Introduction Open aortic arch surgery is a complex cardiac surgical procedure. Aim We reviewed the 10-year outcomes of elective aortic arch aneurysm surgery in a single cardiac surgical center. Material and methods The analysis includes all patients who underwent elective aortic arch surgery at our institution between January 2010 and December 2020. The study population was divided into group A consisting of patients operated on during the first 5 years, and group B, including patients operated on during the subsequent 5 years. The groups were compared with regard to baseline characteristics, scope of the surgery, operative and postoperative data as well as morbidity and mortality. Results Eighty-six elective aortic arch procedures were performed during the analyzed period, including 25 (29%) patients in group A and 61 (71%) patients in group B. The hemiarch procedure was more frequently performed in group A (17 patients, 68%) in comparison to group B (21 patients, 34%) (p = 0.008). Stroke was recorded in 6 (20%) patients from group A and 5 (8.2%) patients from group B (p = 0.002). Five-year survival was 60 ±9.8% for group A, and 81 ±6.2% for group B (log-rank test, p = 0.003). Conclusions After completion of the learning curve, open aortic arch surgery is associated with acceptable early mortality, low incidence of stroke, and a high 5-year survival rate.
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13
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Ohira S, Malekan R, Kai M, Goldberg JB, Spencer PJ, Lansman SL, Spielvogel D. Reoperative Total Arch Repair Using a Trifurcated Graft and Selective Antegrade Cerebral Perfusion. Ann Thorac Surg 2021; 113:569-576. [PMID: 33857494 DOI: 10.1016/j.athoracsur.2021.03.090] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 02/23/2021] [Accepted: 03/29/2021] [Indexed: 11/01/2022]
Abstract
BACKGROUND This study reviews the outcomes of our reoperative total arch repair (TAR) technique using a trifurcated graft and selective antegrade cerebral perfusion (SACP). METHODS Fifty patients underwent reoperative TAR from January 2005 to September 2020, with either a one-stage (N=9), or two-stage repair (N=41). The two-stage technique includes minimal dissection of the mediastinal structures, an arch-first technique using a trifurcated graft, and construction of a classical elephant trunk via a partial transverse incision distally in the old-graft or in the aorta just distal to the old graft. RESULTS The median age was 63 years. Chronic dissection was the most frequent indication (88%) and 98% had undergone a previous proximal aortic repair at a median interval of 3.0 years. The median cardiopulmonary bypass, myocardial ischemic, SACP, and lower body circulatory arrest times were 226, 103, 97, and 98 minutes, respectively. The minimum nasopharyngeal and bladder temperature were 16.5 °C, and 20.0 °C. Operative mortality was 2% and the incidence of stroke, and spinal cord injury (SCI) were 2%, and 0%. Stage II repair was performed in 37 patients (open: 33 patients, endovascular: 4 patients), with two mortalities and no SCI. The median duration between stage I and II was 63 days. Survival and aortic event free rates at 3 years were 88.4 ±4.9%, and 89.8 ±5.0%. CONCLUSIONS We report a reoperative TAR technique that minimizes dissection of the cardiac structures, simplifies the distal anastomosis, and protects vital organs, such as the brain, heart, and spinal cord.
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Affiliation(s)
- Suguru Ohira
- Division of Cardiothoracic Surgery, Department of Surgery, Westchester Medical Center, New York Medical College, Valhalla, NY.
| | - Ramin Malekan
- Division of Cardiothoracic Surgery, Department of Surgery, Westchester Medical Center, New York Medical College, Valhalla, NY
| | - Masashi Kai
- Division of Cardiothoracic Surgery, Department of Surgery, Westchester Medical Center, New York Medical College, Valhalla, NY
| | - Joshua B Goldberg
- Division of Cardiothoracic Surgery, Department of Surgery, Westchester Medical Center, New York Medical College, Valhalla, NY
| | - Philip J Spencer
- Division of Cardiothoracic Surgery, Department of Surgery, Westchester Medical Center, New York Medical College, Valhalla, NY
| | - Steven L Lansman
- Division of Cardiothoracic Surgery, Department of Surgery, Westchester Medical Center, New York Medical College, Valhalla, NY
| | - David Spielvogel
- Division of Cardiothoracic Surgery, Department of Surgery, Westchester Medical Center, New York Medical College, Valhalla, NY
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14
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Chassin-Trubert L, Gandet T, Lounes Y, Ozdemir BA, Alric P, Canaud L. Double fenestrated physician-modified stent-grafts for total aortic arch repair in 50 patients. J Vasc Surg 2020; 73:1898-1905.e1. [PMID: 33227376 DOI: 10.1016/j.jvs.2020.09.041] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 09/09/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Our aim was to evaluate the early- and medium-term outcomes of using double fenestrated physician-modified endovascular grafts (PMEGs) for total endovascular aortic arch repair. METHODS The present single-center retrospective analysis of prospectively collected data included 50 patients from January 2017 through October 2019, who had undergone thoracic endovascular aortic repair (TEVAR). The fenestrations were a proximal larger fenestration that incorporated the brachiocephalic trunk and left common carotid artery and a distal smaller fenestration for the left subclavian artery (LSA). Only the LSA fenestration was stented. RESULTS The median duration for stent graft modification was 26 ± 6 minutes. Of the 50 patients, 41 were men. The mean patient age was 68 ± 11.5 years. The indications for treatment included degenerative aortic arch aneurysm (n = 17), dissecting aortic arch aneurysm after type A dissection (n = 13), type B dissection (n = 13), aortic ulcer (n = 3), and other pathologies (n = 4). The technical success rate was 94% (47 of 50) overall, and 100% (28 of 28) after a technical modification incorporating a preloaded guide wire for the LSA fenestration (P < .05). The 30-day mortality was 2% (n = 1). Two patients (4%) had a minor stroke with full recovery. One patient (2%) had a type IB and two patients (4%) had a type II endoleak from the LSA. Four patients (8%) required reintervention: one because of a type IB endoleak and three because of access-related complications. All supra-aortic trunks were patent. During a mean follow-up of 16 ± 8.3 months, no conversions to open surgical repair were required and no aortic rupture, paraplegia, or retrograde dissection occurred. CONCLUSIONS Using double fenestrated PMEGs for TEVAR is both feasible and effective for total endovascular aortic arch repair, avoiding the need for anatomic and extra-anatomic surgical revascularization. The absence of brachiocephalic trunk stenting was not associated with endoleaks or treatment failure and resulted in a lower stroke risk than alternative strategies. The midterm results suggest that stenting of the brachiocephalic trunk and right common carotid artery might not be necessary for a large proportion of patients undergoing total endovascular aortic arch repair. The persistence of the seal and ongoing durability require assessment in studies with long-term follow-up data available.
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Affiliation(s)
- Lucien Chassin-Trubert
- Department of Thoracic and Vascular Surgery, Arnaud de Villeneuve Hospital, Montpellier, France; Servicio de Cirugía Vascular y Endovascular, Clínica Universidad de los Andes, Las Condes, Chile.
| | - Thomas Gandet
- Department of Thoracic and Vascular Surgery, Arnaud de Villeneuve Hospital, Montpellier, France
| | - Youcef Lounes
- Department of Thoracic and Vascular Surgery, Arnaud de Villeneuve Hospital, Montpellier, France
| | - Baris Ata Ozdemir
- Centre for Surgical Research, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Pierre Alric
- Department of Thoracic and Vascular Surgery, Arnaud de Villeneuve Hospital, Montpellier, France
| | - Ludovic Canaud
- Department of Thoracic and Vascular Surgery, Arnaud de Villeneuve Hospital, Montpellier, France
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15
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Alnajar A, Aleong EF, Azhar MZ, Azarrafiy R, Lamelas J. Review of cerebral perfusion strategies for aortic surgery with application for minimally invasive approaches. J Card Surg 2020; 35:3539-3544. [PMID: 33025654 DOI: 10.1111/jocs.15061] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Revised: 08/23/2020] [Accepted: 09/10/2020] [Indexed: 11/30/2022]
Abstract
Aortic arch and hemiarch surgery necessitate the temporary interruption of blood perfusion to the brain. Despite its complexity, hemiarch and ascending aortic surgery can be performed via a minimally invasive approach. Due to the higher risk of neurological injury during a circulatory arrest, several techniques were developed to further protect the brain during this surgery. We searched the Embase, Medline, and Cochrane databases and identified articles reporting outcomes of antegrade and retrograde cerebral perfusion strategies. Herein, we outline surgical approaches, intra-operative technical considerations, and clinical outcomes of hemiarch and ascending aortic surgery. Hemiarch and ascending aortic surgery is associated with a higher risk of mortality and morbidity. Attention to the optimal approach and cerebral protection strategy has been shown to significantly affect outcomes and mitigate risk.
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Affiliation(s)
- Ahmed Alnajar
- Division of Cardiothoracic Surgery, Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Elizabeth F Aleong
- Division of Cardiothoracic Surgery, Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Muhammad Z Azhar
- Division of Cardiothoracic Surgery, Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Ryan Azarrafiy
- Division of Cardiothoracic Surgery, Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Joseph Lamelas
- Division of Cardiothoracic Surgery, Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
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16
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Menzà G, D'Ascenzo F, Attisani M, La Torre M, Verzini F, Rinaldi M, De Ferrari GM. Performing a PCI through a trifurcated aortic graft: a new challenging access route. Minerva Cardioangiol 2020; 68:373-375. [PMID: 32524809 DOI: 10.23736/s0026-4725.20.05258-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Gregorio Menzà
- Division of Cardiology, Department of Internal Medicine, Molinette Hospital, Città della Salute e della Scienza, Turin, Italy -
| | - Fabrizio D'Ascenzo
- Division of Cardiology, Department of Internal Medicine, Molinette Hospital, Città della Salute e della Scienza, Turin, Italy
| | - Matteo Attisani
- Department of Surgical Sciences, Molinette Hospital, Città della Salute e della Scienza, Turin, Italy
| | - Michele La Torre
- Department of Surgical Sciences, Molinette Hospital, Città della Salute e della Scienza, Turin, Italy
| | - Fabio Verzini
- Unit of Vascular Surgery, Department of Surgical Sciences, Molinette Hospital, Città della Salute e della Scienza, Turin, Italy
| | - Mauro Rinaldi
- Department of Surgical Sciences, Molinette Hospital, Città della Salute e della Scienza, Turin, Italy
| | - Gaetano M De Ferrari
- Division of Cardiology, Department of Internal Medicine, Molinette Hospital, Città della Salute e della Scienza, Turin, Italy
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17
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Yang S, Xue Y, Zhang YC, Gao HQ, Jiang WJ, Li JR, Pan XD, Dong SB, Xu SD, Zheng J, Sun LZ. Sun's total arch replacement and stent elephant trunk with modified branch-first technique for patients with Stanford type A aortic dissection. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:755. [PMID: 32647680 PMCID: PMC7333118 DOI: 10.21037/atm-20-3791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Background Stanford type A aortic dissection (STAAD) is a critical cardiovascular disease, and surgical procedure is the first-choice treatment. The classical surgical procedure still leads to a high mortality rate and neurological complications. In this study, we introduce a new modified Sun’s procedure and investigate the association between the branch-first technique and the postoperative outcomes of patients with STAAD. Methods A total of 108 consecutive patients with STAAD who underwent arch replacement and stent elephant trunk procedure at Beijing Anzhen Hospital between July, 2017 and November, 2018 were included in the analysis. The patients were divided into two groups: the branch-first group and the classic group. The branch-first group and the classic group comprised 24 patients (22.2%) and 84 patients (77.8%), respectively. Results Patients in the branch-first group had a significantly shorter cardiopulmonary bypass (CPB) duration (172.4±29.9 vs. 194.9±47.4 min; P=0.035), Intensive care unit (ICU) stay [17.0 (14.6–38.2) vs. 42.1 (19.7–87.2) hours; P<0.001], and mechanical ventilation time [15.5 (11.9–40.0) vs. 19.0 (17.0–45.6) hours; P=0.018] than patients in the classic group. The branch-first was associated with a reduction in postoperative neurological complications in all models. Conclusions The benefits of the branch-first technique, including lower CPB duration, better bilateral cerebral perfusion, and higher nasopharyngeal temperature during hypothermic arrest, contributed to a shortened recovery time for patients after surgery.
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Affiliation(s)
- Sheng Yang
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.,Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China.,Beijing Aortic Disease Center, Cardiovascular Surgery Center, Beijing, China.,Beijing Engineering Research Center for Vascular Prostheses, Beijing, China
| | - Yuan Xue
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.,Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China.,Beijing Aortic Disease Center, Cardiovascular Surgery Center, Beijing, China.,Beijing Engineering Research Center for Vascular Prostheses, Beijing, China
| | - You-Cong Zhang
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.,Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China.,Beijing Aortic Disease Center, Cardiovascular Surgery Center, Beijing, China.,Beijing Engineering Research Center for Vascular Prostheses, Beijing, China
| | - Hui-Qiang Gao
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.,Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China.,Beijing Aortic Disease Center, Cardiovascular Surgery Center, Beijing, China.,Beijing Engineering Research Center for Vascular Prostheses, Beijing, China
| | - Wen-Jian Jiang
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.,Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China.,Beijing Aortic Disease Center, Cardiovascular Surgery Center, Beijing, China.,Beijing Engineering Research Center for Vascular Prostheses, Beijing, China
| | - Jian-Rong Li
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.,Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China.,Beijing Aortic Disease Center, Cardiovascular Surgery Center, Beijing, China.,Beijing Engineering Research Center for Vascular Prostheses, Beijing, China
| | - Xu-Dong Pan
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.,Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China.,Beijing Aortic Disease Center, Cardiovascular Surgery Center, Beijing, China.,Beijing Engineering Research Center for Vascular Prostheses, Beijing, China
| | - Song-Bo Dong
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.,Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China.,Beijing Aortic Disease Center, Cardiovascular Surgery Center, Beijing, China.,Beijing Engineering Research Center for Vascular Prostheses, Beijing, China
| | - Shang-Dong Xu
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.,Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China.,Beijing Aortic Disease Center, Cardiovascular Surgery Center, Beijing, China.,Beijing Engineering Research Center for Vascular Prostheses, Beijing, China
| | - Jun Zheng
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.,Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China.,Beijing Aortic Disease Center, Cardiovascular Surgery Center, Beijing, China.,Beijing Engineering Research Center for Vascular Prostheses, Beijing, China
| | - Li-Zhong Sun
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.,Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China.,Beijing Aortic Disease Center, Cardiovascular Surgery Center, Beijing, China.,Beijing Engineering Research Center for Vascular Prostheses, Beijing, China
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18
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Sun X, Zhao Q, Huo Y, Zhou J, Zhao F, Liu Y, Du Y, He S, Liu C, Jiang D, Sun W. Short-term outcomes of modified Y-graft technique in acute type a aortic dissection using the femoral artery bypass and one minute systemic circulatory arrest technique. J Cardiothorac Surg 2020; 15:106. [PMID: 32434594 PMCID: PMC7240991 DOI: 10.1186/s13019-020-01156-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 05/12/2020] [Indexed: 11/30/2022] Open
Abstract
Objective Aortic arch replacement in acute type A aortic dissection patients remains the most challenging cardiovascular operation. Herein, we described our modified Y-graft technique using the Femoral Artery Bypass (FAB) and the One Minute Systemic Circulatory Arrest (OSCA) technique, and assessed the short-term outcomes of the patients. Methods Between February 2015 and November 2017, 51 patients with acute type A aortic dissection underwent aortic arch replacement. Among them, 23 patients underwent FAB while 28 patients underwent both FAB and OSCA. The intraoperative data and postoperative follow-up data were recorded. The follow-up data of patients with traditional Y-graft technique were collected from previously reported studies. Results In the FAB group, two patients died due to pulmonary infection (30-day survival rate, 91.3%), and two patients were paralyzed from the waist down. Hemodialysis was performed for five patients (21.7%) before hospital discharge. Fifteen patients (65.2%) received respiratory support for more than 2-days and eight patients (34.8%) for more than 5-days. These follow-up results were comparable or better than the patients with traditional Y-graft technique. Furthermore, compared to the FAB group, the morbidity due to neurological dysfunction and acute renal failure was significantly reduced in the FAB+OSCA group. Moreover, the respiratory support, length of postoperative stay and ICU stay were shortened. Conclusions This study clarified the feasibility of FAB and OSCA technique in modifying Y-graft technique. The acute type A aortic dissection patients showed less surgical complications and favorable short-term outcomes after this surgery.
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Affiliation(s)
- Xiangfei Sun
- Department of Cardiovascular Surgery, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, 250021, China.,Department of Cardiovascular Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, 250021, China
| | - Qi Zhao
- Department of Gastroenterology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, 250021, China.,Department of Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, 250021, China
| | - Yufeng Huo
- Department of Cardiovascular Surgery, Qilu Hospital of Shandong University, Qingdao, 266011, Shandong, People's Republic of China
| | - Jinfeng Zhou
- Department of Cardiovascular Surgery, Qilu Hospital of Shandong University, Qingdao, 266011, Shandong, People's Republic of China
| | - Fen Zhao
- Department of Cardiovascular Surgery, Qilu Hospital of Shandong University, Qingdao, 266011, Shandong, People's Republic of China
| | - Yimin Liu
- Department of Cardiovascular Surgery, Qilu Hospital of Shandong University, Qingdao, 266011, Shandong, People's Republic of China
| | - Yonghai Du
- Department of Cardiovascular Surgery, Qilu Hospital of Shandong University, Qingdao, 266011, Shandong, People's Republic of China
| | - Songxiong He
- Department of Cardiovascular Surgery, Qilu Hospital of Shandong University, Qingdao, 266011, Shandong, People's Republic of China
| | - Chao Liu
- Department of Cardiovascular Surgery, Qilu Hospital of Shandong University, Qingdao, 266011, Shandong, People's Republic of China
| | - Detian Jiang
- Department of Cardiovascular Surgery, Qilu Hospital of Shandong University, Qingdao, 266011, Shandong, People's Republic of China
| | - Wenyu Sun
- Department of Cardiovascular Surgery, Qilu Hospital of Shandong University, Qingdao, 266011, Shandong, People's Republic of China.
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19
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Orlov CP, Orlov OI, Shah VN, Kilcoyne M, Buckley M, Sicouri S, Plestis KA. Total Arch Replacement with Hypothermic Circulatory Arrest, Antegrade Cerebral Perfusion and the Y-graft. Semin Thorac Cardiovasc Surg 2020; 32:683-691. [PMID: 32360886 DOI: 10.1053/j.semtcvs.2020.03.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 03/23/2020] [Indexed: 11/11/2022]
Abstract
This study examines postoperative morbidity and mortality and long-term survival after total arch replacement (TAR) using deep to moderate hypothermic circulatory arrest (HCA), antegrade cerebral perfusion (ACP), and the Y-graft. Seventy-five patients underwent TAR with the Y graft. Deep to moderate HCA was initiated at 18-22°C. ACP was either initiated immediately (early ACP) or after the distal anastomosis was performed (late ACP). The arch vessels were then serially anastomosed to the individual limbs of the Y-graft. The median age was 66 years (range = 32-82). Etiology of aneurysmal dilatation included 20 (27%) patients with medial degenerations, 25 (33%) with chronic dissections, 14 (19%) with acute dissections, 9 (12%) with atherosclerosis and 2 (3%) with Marfan syndrome. In-hospital mortality was 5%. Neurologic complications occurred in 8 (11%) patients; 2 (3%) had strokes and 6 (8%) had transient neurologic deficits. Patients undergoing TAR with moderate hypothermia had a significantly higher incidence of new-onset renal insufficiency (3 [23%] vs [0%], P < 0.001) and TND (3 (23%) vs 3 (5%), P = 0.028) than the profound and deep hypothermia cohort. Excluding the 1 patient who died intraoperatively, 89% (95%CI: 79-94%) were alive at 1 year, 78% at 5 years (95%CI: 66-86%), and 73% at 10 years (95%CI: 59-82%). The combination of deep to moderate HCA, ACP, and the Y-graft is a safe and reproducible technique. Further inquiry is needed to assess if early ACP provides superior clinical outcomes.
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Affiliation(s)
- Cinthia P Orlov
- Lankenau Institute for Medical Research, Wynnewood, Pennsylvania
| | - Oleg I Orlov
- Lankenau Institute for Medical Research, Wynnewood, Pennsylvania
| | - Vishal N Shah
- Lankenau Institute for Medical Research, Wynnewood, Pennsylvania; Lankenau Heart Institute, Department of Cardiothoracic Surgery, Wynnewood, Pennsylvania
| | - Maxwell Kilcoyne
- Lankenau Institute for Medical Research, Wynnewood, Pennsylvania
| | - Meghan Buckley
- Lankenau Institute for Medical Research, Wynnewood, Pennsylvania
| | - Serge Sicouri
- Lankenau Institute for Medical Research, Wynnewood, Pennsylvania.
| | - Konstadinos A Plestis
- Lankenau Heart Institute, Department of Cardiothoracic Surgery, Wynnewood, Pennsylvania
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20
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Kudo T, Kuratani T, Shimamura K, Sawa Y. Determining the Optimal Proximal Landing Zone for TEVAR in the Aortic Arch: Comparing the Occurrence of the Bird-Beak Phenomenon in Zone 0 vs Zones 1 and 2. J Endovasc Ther 2020; 27:368-376. [DOI: 10.1177/1526602820914269] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose: To identify the optimal proximal landing zone for thoracic aortic endovascular repair (TEVAR) of aortic arch pathologies so as to avoid the bird-beak phenomenon that leads to type Ia endoleak. Materials and Methods: A retrospective single-center review was conducted of 164 patients (mean age 70.3±10.8 years, range 29–93; 127 men) who underwent repairs of the aortic arch using hybrid TEVAR from April 2008 to March 2017. The patients were divided into 2 groups according to the proximal landing zone: 43 zone 0 patients (26.2%) had total debranching TEVAR (n=18) or total endovascular aortic repair (n=25) while 121 patients (73.8%) had TEVAR landing in zones 1 (n=41) or 2 (n=80). Bird-beak configurations, endoleaks, and stent migrations were assessed on the postoperative and latest computed tomography angiography (CTA) scans. Overall survival and freedom from the bird-beak configuration, aorta-related death, and aortic events were estimated using the Kaplan-Meier method. Hazard ratios (HR) were calculated with the 95% confidence interval (CI). Results: All procedures were successful, without any 30-day mortality. There were 3 early complications (1.8%; all strokes) and 10 early endoleaks (6.1%; no type Ia). On the first postoperative CTA, 42 patients (25.6%) had a bird-beak configuration. The zone 0 patients had significantly fewer (p<0.001), shorter (p<0.004), and less angulated (p<0.001) bird-beak configurations than in zones 1–2. The mean follow-up period was 4.2 years (range 0.5–8.8). There were 18 late deaths (11.0%); only one was related to the aorta (rupture due to a type Ib endoleak in a zone 0 patient). The 5-year freedom from aorta-related death was not significantly different between groups (zone 0: 96.9% vs zones 1–2: 100%, p=0.080). On the latest CTA, 51 (31.0%) patients had a bird-beak configuration; of those, 22 (13.4%) showed >3-mm progression. The freedom from bird-beak configuration estimate was significantly higher in the zone 0 group (95.4%) vs zones 1–2 (57.8%; HR 0.10, 95% CI 0.02 to 0.31, p<0.001). There were 9 late endoleaks (4 type Ia; none in the zone 0 group). The rate of stent-graft migration was significantly lower in the zone 0 group (2.3% vs 14.1% in zones 1–2, p=0.035). Conclusion: Early and most late results in zone 0 TEVAR were equal to those in zones 1 and 2; however, there were no late type Ia endoleaks and fewer bird-beak configurations associated with zone 0 TEVAR, which suggests that zone 0 landing is advantageous for preventing these complications.
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Affiliation(s)
- Tomoaki Kudo
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Toru Kuratani
- Department of Minimally Invasive Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Kazuo Shimamura
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Yoshiki Sawa
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
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Konstantinou N, Debus ES, Vermeulen CF, Wipper S, Diener H, Larena-Avellaneda A, Kölbel T, Tsilimparis N. Cervical Debranching in the Endovascular Era: A Single Centre Experience. Eur J Vasc Endovasc Surg 2019; 58:34-40. [DOI: 10.1016/j.ejvs.2018.12.010] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Accepted: 12/09/2018] [Indexed: 11/26/2022]
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22
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Yamauchi T, Kubota S, Hasegawa K, Ueda H. Clinical results and medical costs of thoracic endovascular aortic repair in patients over 80 years of age. J Artif Organs 2018; 22:61-67. [DOI: 10.1007/s10047-018-1073-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Accepted: 10/02/2018] [Indexed: 11/24/2022]
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23
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Treatment of aortic arch aneurysms: Open surgery or hybrid procedure? TURK GOGUS KALP DAMAR CERRAHISI DERGISI-TURKISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2018; 26:351-358. [PMID: 32082763 DOI: 10.5606/tgkdc.dergisi.2018.15391] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Accepted: 03/27/2018] [Indexed: 11/21/2022]
Abstract
Background This study aims to compare the results of hybrid procedure and open surgery for the treatment of aortic arch aneurysms. Methods Twenty-six p atients (21 m ales, 5 females; m ean a ge 56.6±12.4 years; range, 20 to 83 years) who underwent total aortic arch replacement for aortic arch aneurysm between January 2004 and January 2010 were retrospectively analyzed. The patients were divided into two groups: open conventional surgery group (group 1, n=15) and hybrid procedure (total debranching of the aortic arch and simultaneous endovascular stent) group (group 2, n=11). Survival rates and need for reoperation were compared between the groups. Results The hybrid procedure was found to be more favorable in terms of postoperative revision, extubation period, and drainage amounts. However, there was no statistically significant difference in the survival rates, need for reoperation, and major adverse cardiovascular events between the groups. Conclusion Our study results suggest that conventional open surgery and hybrid procedure are similar in terms of survival and short-to-mid-term results in patients undergoing total aortic arch replacement for aortic arch aneurysm.
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24
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Cómo hacer un reemplazo total de arco aórtico sin parada circulatoria global. La técnica «branch first». CIRUGIA CARDIOVASCULAR 2018. [DOI: 10.1016/j.circv.2017.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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25
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Manetta F, Mullan CW, Catalano MA. Neuroprotective Strategies in Repair and Replacement of the Aortic Arch. Int J Angiol 2018; 27:98-109. [PMID: 29896042 PMCID: PMC5995688 DOI: 10.1055/s-0038-1649512] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Aortic arch surgery is a technical challenge, and cerebral protection during distal anastomosis is a continued topic of controversy and discussion. The physiologic effects of hypothermic arrest and adjunctive cerebral perfusion have yet to be fully defined, and the optimal strategies are still undetermined. This review highlights the historical context, physiological rationale, and clinical efficacy of various neuroprotective strategies during arch operations.
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Affiliation(s)
- Frank Manetta
- Department of Cardiovascular and Thoracic Surgery, Barbara and Donald Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York
| | - Clancy W. Mullan
- Department of Cardiovascular and Thoracic Surgery, Barbara and Donald Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York
| | - Michael A. Catalano
- Department of Cardiovascular and Thoracic Surgery, Barbara and Donald Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York
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26
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Wang L, Huang Y, Guo D, Xu X, Chen B, Jiang J, Yang J, Shi Z, Zhu T, Dong Z, Shi Y, Tang X, Yue J, Hong X, Chen G, Chen Y, Zhou X, Fu W, Wang Y. Application of triple-chimney technique using C-TAG and Viabahn or Excluder iliac extension in TEVAR treatment of aortic arch dilation diseases. J Thorac Dis 2018; 10:3783-3790. [PMID: 30069377 DOI: 10.21037/jtd.2018.06.105] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background To report the experience of a single centre regarding the application of the triple-chimney technique using C-TAG with Viabahn or Excluder iliac extension devices for the endovascular management of aortic arch dilation diseases. Methods From July 2016 to August 2017, 7 patients (5 men; mean age 56.1±10.8 years) with aortic arch dilation diseases were treated with the triple-chimney technique. All patients were followed up at 1, 3, and 6 months and every 6 months thereafter. Results Six innominate arteries were deployed with Excluder iliac extensions and one with a Viabahn cover-stent. All the left common carotid arteries and left subclavian arteries were placed with Viabahn. Reverse chimney technique was applied in four patients. Three (42.0%) type I endoleaks were found on the final angiogram. Two were apparently reduced, and one disappeared after balloon dilation. The mean follow-up time was 15.7 months (9-20 months). All the type I endoleak was found disappeared within 3 months. One patient died of myocardial infarction at 6 months after discharge. No other complications such as stent-graft migration, occlusion, type II endoleak or neurological stroke occurred. Conclusions The use of C-TAG coupled with Viabahn or Excluder iliac extension is feasible and effective for the treatment of aortic arch dilatation diseases. However, more patients and longer follow-up time are required to verify its long-term safety and efficacy.
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Affiliation(s)
- Lixin Wang
- Department of Vascular Surgery, Fudan University, Shanghai 200032, China.,Institute of Vascular Surgery, Fudan University, Shanghai 200032, China.,Department of Vascular Surgery, Xiamen Branch of Zhongshan Hospital, Fudan University, Xiamen 361015, China
| | - Yulong Huang
- Department of Vascular Surgery, Xiamen Branch of Zhongshan Hospital, Fudan University, Xiamen 361015, China
| | - Daqiao Guo
- Department of Vascular Surgery, Fudan University, Shanghai 200032, China.,Institute of Vascular Surgery, Fudan University, Shanghai 200032, China
| | - Xin Xu
- Department of Vascular Surgery, Fudan University, Shanghai 200032, China.,Institute of Vascular Surgery, Fudan University, Shanghai 200032, China
| | - Bin Chen
- Department of Vascular Surgery, Fudan University, Shanghai 200032, China.,Institute of Vascular Surgery, Fudan University, Shanghai 200032, China
| | - Junhao Jiang
- Department of Vascular Surgery, Fudan University, Shanghai 200032, China.,Institute of Vascular Surgery, Fudan University, Shanghai 200032, China
| | - Jue Yang
- Department of Vascular Surgery, Fudan University, Shanghai 200032, China.,Institute of Vascular Surgery, Fudan University, Shanghai 200032, China
| | - Zhenyu Shi
- Department of Vascular Surgery, Fudan University, Shanghai 200032, China.,Institute of Vascular Surgery, Fudan University, Shanghai 200032, China
| | - Ting Zhu
- Department of Vascular Surgery, Fudan University, Shanghai 200032, China.,Institute of Vascular Surgery, Fudan University, Shanghai 200032, China
| | - Zhihui Dong
- Department of Vascular Surgery, Fudan University, Shanghai 200032, China.,Institute of Vascular Surgery, Fudan University, Shanghai 200032, China
| | - Yun Shi
- Department of Vascular Surgery, Fudan University, Shanghai 200032, China.,Institute of Vascular Surgery, Fudan University, Shanghai 200032, China
| | - Xiao Tang
- Department of Vascular Surgery, Fudan University, Shanghai 200032, China.,Institute of Vascular Surgery, Fudan University, Shanghai 200032, China
| | - Jianing Yue
- Department of Vascular Surgery, Fudan University, Shanghai 200032, China.,Institute of Vascular Surgery, Fudan University, Shanghai 200032, China
| | - Xiang Hong
- Department of Vascular Surgery, Fudan University, Shanghai 200032, China.,Department of Vascular Surgery, Xiamen Branch of Zhongshan Hospital, Fudan University, Xiamen 361015, China
| | - Gang Chen
- Department of Vascular Surgery, Fudan University, Shanghai 200032, China.,Department of Vascular Surgery, Xiamen Branch of Zhongshan Hospital, Fudan University, Xiamen 361015, China
| | - Yihui Chen
- Department of Vascular Surgery, Fudan University, Shanghai 200032, China.,Department of Vascular Surgery, Xiamen Branch of Zhongshan Hospital, Fudan University, Xiamen 361015, China
| | - Xiushi Zhou
- Department of Vascular Surgery, Fudan University, Shanghai 200032, China.,Institute of Vascular Surgery, Fudan University, Shanghai 200032, China
| | - Weiguo Fu
- Department of Vascular Surgery, Fudan University, Shanghai 200032, China.,Institute of Vascular Surgery, Fudan University, Shanghai 200032, China.,Department of Vascular Surgery, Xiamen Branch of Zhongshan Hospital, Fudan University, Xiamen 361015, China
| | - Yuqi Wang
- Department of Vascular Surgery, Fudan University, Shanghai 200032, China.,Institute of Vascular Surgery, Fudan University, Shanghai 200032, China
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27
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Endovascular Chimney Technique for Aortic Arch Pathologies Treatment: A Systematic Review and Meta-Analysis. Ann Vasc Surg 2018; 47:305-315. [DOI: 10.1016/j.avsg.2017.09.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2017] [Revised: 07/04/2017] [Accepted: 09/05/2017] [Indexed: 11/19/2022]
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28
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Kudo T, Kuratani T, Shimamura K, Sakamoto T, Kin K, Masada K, Shijo T, Torikai K, Maeda K, Sawa Y. Type 1a endoleak following Zone 1 and Zone 2 thoracic endovascular aortic repair: effect of bird-beak configuration†. Eur J Cardiothorac Surg 2017; 52:718-724. [DOI: 10.1093/ejcts/ezx254] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Accepted: 04/30/2017] [Indexed: 11/12/2022] Open
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29
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Silva Guisasola J, Alvarez-Cabo R, Hernández-Vaquero D, Méndez RD. Ascending aorta reinterventions. J Thorac Dis 2017; 9:S448-S453. [PMID: 28616341 DOI: 10.21037/jtd.2017.05.01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Ascending aorta reinterventions present a challenge for surgeons as the technical difficulties of the procedure and the complex strategic approach can complicate successful treatment. These patients should be treated by surgical teams with ample experience in aortic diseases as they can be at high risk of mortality. The number of interventions on the ascending aorta and aortic arch and the use of biological conducts (lung autograft, homograft, etc.) have increased in recent years; therefore, the number of reinterventions can also be expected to increase, representing 10% of aortic surgical procedures. This article reviews the current status of ascending aorta reinterventions, analyzing the principal aspects of indication and surgical strategy, as well as the results published in the largest studies.
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Affiliation(s)
- Jacobo Silva Guisasola
- Department of Cardiac Surgery, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Rubén Alvarez-Cabo
- Department of Cardiac Surgery, Hospital Universitario Central de Asturias, Oviedo, Spain
| | | | - Rocío Díaz Méndez
- Department of Cardiac Surgery, Hospital Universitario Central de Asturias, Oviedo, Spain
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30
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Fadda GF, Marino M, Kasemi H, Di Angelo CL, Dionisi CP, Cammalleri V, Setacci C. Aortic aneurysm endovascular treatment with the parallel graft technique from the aortic arch to the iliac axis. THE JOURNAL OF CARDIOVASCULAR SURGERY 2017; 60:589-598. [PMID: 28548474 DOI: 10.23736/s0021-9509.17.09899-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The chimney technique has been developed for the treatment of complex aortic aneurysms. We analyzed the midterm to long-term outcomes of this approach from a single-center experience. METHODS From October 2008 to July 2016, 58 patients underwent endovascular aortic aneurysm repair using the chimney technique. Indications for treatment were thoracic aortic aneurysm (TAA) (N.=11), thoracoabdominal aortic aneurysm (TAAA) (N.=2), pararenal aortic aneurysm (PAAA) (N.=15), aortoiliac/isolated hypogastric artery aneurysm (N.=25), type I endoleak after previous TEVAR/EVAR (N.=4), proximal pseudoaneurysm after AAA open repair (N.=1). Elective (82.8%) and emergent (17.2%) procedures were included. RESULTS The immediate technical success was 100%. Single, double and triple chimneys were performed in 46, 10, and two patients, respectively. Overall, 61 target vessels (three left common carotid arteries, eight left subclavian arteries, three celiac trunks, three superior mesenteric arteries, 19 renal arteries and 25 hypogastric arteries) were involved. Postoperative mortality was 0. No neurologic complications were registered. Primary patency rate of the chimney stent/stent graft was 98.3%. Low-flow type I endoleak was observed in four patients (6.9%). Postoperative chimney graft re-intervention rate was 1.7%. The median follow-up was 32±20 months (range 3-96 months). Overall estimated survival at 12, 50, and 80 months was 100%, 89% and 44%, respectively. Estimated freedom from endoleak at 1, 12, 24, and 36 months was 96.5%, 95%, 95%, and 93%, respectively. One hypogastric artery stent-graft occluded at the 3rd month of follow-up. No reintervention was performed. CONCLUSIONS Our experience with the chimney technique for aortic aneurysms from the aortic arch to the iliac axis shows promising and durable mid- and long-term results. Endograft oversizing, associated with the chimney graft diameter and length choice remain fundamental to reduce the risk of the most frequent procedure complications: type I endoleak and CG occlusion. The wider use of this technique should be justified in patients considered at high risk for open repair and/or not suitable for the custom-made branched/fenestrated endografts.
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Affiliation(s)
- Gian Franco Fadda
- Unit of Vascular and Endovascular Surgery, Department of Surgery, San Francesco Hospital, Nuoro, Italy
| | - Mario Marino
- Unit of Vascular and Endovascular Surgery, Department of Surgery, San Francesco Hospital, Nuoro, Italy
| | - Holta Kasemi
- Unit of Vascular and Endovascular Surgery, Department of Surgery, San Francesco Hospital, Nuoro, Italy -
| | - Costantino L Di Angelo
- Unit of Vascular and Endovascular Surgery, Department of Surgery, San Francesco Hospital, Nuoro, Italy
| | - Carlo P Dionisi
- Unit of Vascular Surgery, Department of Surgery, Cardinal Panico Hospital, Tricase, Lecce, Italy
| | - Valeria Cammalleri
- Unit of Cardiology, Department of Cardiovascular Disease, Tor Vergata University, Rome, Italy
| | - Carlo Setacci
- Unit of Vascular and Endovascular Surgery, Department of Medicine, Surgery and Neurological Sciences, University of Siena, Siena, Italy
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31
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Parikh N, Trimarchi S, Gleason TG, Kamman AV, di Eusanio M, Myrmel T, Korach A, Maniar H, Ota T, Khoynezhad A, Montgomery DG, Desai ND, Eagle KA, Nienaber CA, Isselbacher EM, Bavaria J, Sundt TM, Patel HJ. Changes in operative strategy for patients enrolled in the International Registry of Acute Aortic Dissection interventional cohort program. J Thorac Cardiovasc Surg 2017; 153:S74-S79. [DOI: 10.1016/j.jtcvs.2016.12.029] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Revised: 12/12/2016] [Accepted: 12/28/2016] [Indexed: 01/12/2023]
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32
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Chiu KM, Li SJ, Lin TY, Chan CY, Chu SH. Innominate Artery Cannulation for Aortic Surgery. Asian Cardiovasc Thorac Ann 2016; 15:348-50. [PMID: 17664214 DOI: 10.1177/021849230701500419] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
When disease involving the ascending aorta or aortic arch precludes ascending aortic cannulation, axillary artery cannulation is used for cardiopulmonary bypass. An additional incision and the relatively small caliber of the axillary artery are the drawbacks of this approach. Innominate artery cannulation using the same sternotomy wound is a simple and effective alternative.
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Affiliation(s)
- Kuan-Ming Chiu
- Department of Cardiovascular Surgery, Cardiovascular Center, Far-Eastern Memorial Hospital, Nan-Ya South Road, Pan-Chiao, Taipei County 220, Taiwan
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Arnaoutakis GJ, Vallabhajosyula P, Bavaria JE, Sultan I, Siki M, Naidu S, Milewski RK, Williams ML, Hargrove WC, Desai ND, Szeto WY. The Impact of Deep Versus Moderate Hypothermia on Postoperative Kidney Function After Elective Aortic Hemiarch Repair. Ann Thorac Surg 2016; 102:1313-21. [PMID: 27318775 DOI: 10.1016/j.athoracsur.2016.04.007] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Revised: 03/31/2016] [Accepted: 04/04/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND There remains concern that moderate hypothermic circulatory arrest (MHCA) with antegrade cerebral perfusion (ACP) may provide suboptimal distal organ protection compared with deep hypothermic circulatory arrest (DHCA) with retrograde cerebral perfusion (RCP). We compared postoperative acute kidney injury (AKI) in in patients who underwent elective hemiarch repair with either DHCA/RCP or MHCA/ACP. METHODS This was a retrospective review of all patients undergoing elective aortic hemiarch reconstruction for aneurysmal disease between 2009 and 2014. Patients were stratified according to the use of DHCA/RCP versus MHCA/ACP. The primary outcome was the occurrence of AKI at 48 hours, as defined by the Risk, Injury, Failure, Loss, End-Stage (RIFLE ) criteria. A multivariable logistic regression identified risk factors for AKI. RESULTS One hundred eighteen patients who underwent ACP and 471 patients who underwent RCP were included. The mean lowest temperature was 26.4°C in patients who underwent MHCA/ACP and 17.5°C in patients who underwent DHCA/RCP. Baseline demographics were similar except that patients who underwent DHCA/RCP were more likely to have peripheral arterial disease or bicuspid aortic valves. Cardiopulmonary bypass and aortic cross-clamp times were shorter in the MHCA/ACP group. AKI occurred in 19 (16.2%) patients who underwent MHCA/ACP and 67 (14.3%) patients who underwent DHCA/RCP. Four (0.8%) patients who underwent DHCA/RCP required postoperative dialysis. In-hospital mortality tended to increase with increasing RIFLE classification (RIFLE class-0 (No AKI) = 0.41%; Risk = 1.35%, and Injury = 10.0%; p = 0.09). On multivariable analysis, the lowest temperature and cerebral perfusion strategy were not significant predictors of AKI. Lower baseline glomerular filtration rate (GFR), lower preoperative ejection fraction, and longer cardiopulmonary bypass (CPB) time were independently associated with higher AKI. CONCLUSIONS We applied the sensitive RIFLE criteria to examine AKI in patients undergoing elective aortic hemiarch replacement for aneurysmal disease. Baseline renal dysfunction, lower ejection fraction, and longer CPB time are independent predictors of AKI. Compared with DHCA/RCP, our data suggest that an MHCA/ACP cerebral protection strategy does not appear to be associated with worse postoperative renal outcomes.
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Affiliation(s)
- George J Arnaoutakis
- Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - Joseph E Bavaria
- Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ibrahim Sultan
- Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Mary Siki
- Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Suveeksha Naidu
- Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Rita K Milewski
- Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Matthew L Williams
- Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - W Clark Hargrove
- Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Nimesh D Desai
- Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Wilson Y Szeto
- Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, Pennsylvania.
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Bosiers MJ, Donas KP, Mangialardi N, Torsello G, Riambau V, Criado FJ, Veith FJ, Ronchey S, Fazzini S, Lachat M. European Multicenter Registry for the Performance of the Chimney/Snorkel Technique in the Treatment of Aortic Arch Pathologic Conditions. Ann Thorac Surg 2016; 101:2224-30. [DOI: 10.1016/j.athoracsur.2015.10.112] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Revised: 10/13/2015] [Accepted: 10/27/2015] [Indexed: 11/26/2022]
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Linardi D, Faggian G, Rungatscher A. Temperature Management During Circulatory Arrest in Cardiac Surgery. Ther Hypothermia Temp Manag 2016; 6:9-16. [DOI: 10.1089/ther.2015.0026] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Daniele Linardi
- Division of Cardiac Surgery, Department of Surgery, University of Verona, Verona, Italy
| | - Giuseppe Faggian
- Division of Cardiac Surgery, Department of Surgery, University of Verona, Verona, Italy
| | - Alessio Rungatscher
- Division of Cardiac Surgery, Department of Surgery, University of Verona, Verona, Italy
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Shijo T, Kuratani T, Torikai K, Shimamura K, Sakamoto T, Kudo T, Masada K, Takahara M, Sawa Y. Thoracic endovascular aortic repair for degenerative distal arch aneurysm can be used as a standard procedure in high-risk patients. Eur J Cardiothorac Surg 2016; 50:257-63. [DOI: 10.1093/ejcts/ezw020] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2015] [Accepted: 01/11/2016] [Indexed: 12/20/2022] Open
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Aneurismas del arco aórtico. Generalidades: epidemiología, manifestaciones clínicas y diagnóstico. Indicaciones de cirugía. Cirugía abierta. CIRUGIA CARDIOVASCULAR 2015. [DOI: 10.1016/j.circv.2014.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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De Backer O, Lönn L, Søndergaard L. Combined surgical and catheter-based treatment of extensive thoracic aortic aneurysm and aortic valve stenosis. Catheter Cardiovasc Interv 2015; 85:E95-8. [PMID: 24989848 DOI: 10.1002/ccd.25592] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Accepted: 06/29/2014] [Indexed: 11/08/2022]
Abstract
An extensive thoracic aortic aneurysm (TAA) is a potentially life-threatening condition and remains a technical challenge to surgeons. Over the past decade, repair of aortic arch aneurysms has been accomplished using both hybrid (open and endovascular) and totally endovascular techniques. Thoracic endovascular aneurysm repair (TEVAR) has changed and extended management options in thoracic aorta disease, including in those patients deemed unfit or unsuitable for open surgery. Accordingly, transcatheter aortic valve replacement (TAVR) is increasingly used to treat patients with symptomatic severe aortic valve stenosis (AS) who are considered at high risk for surgical aortic valve replacement. In this report, we describe the combined surgical and catheter-based treatment of an extensive TAA and AS. To our knowledge, this is the first report of hybrid TAA repair combined with TAVR.
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Affiliation(s)
- Ole De Backer
- Department of Cardiology, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark
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Benedetto U, Mohamed H, Vitulli P, Petrou M. Axillary versus femoral arterial cannulation in type A acute aortic dissection: evidence from a meta-analysis of comparative studies and adjusted risk estimates. Eur J Cardiothorac Surg 2015; 48:953-9. [PMID: 25661080 DOI: 10.1093/ejcts/ezv035] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Accepted: 12/29/2014] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES There is a growing perception that femoral arterial cannulation (FAC), by reversing the flow in the thoracoabdominal aorta, may increase the risk of retrograde brain embolization, dissection and organ malperfusion in type A aortic dissection. Axillary artery cannulation (AXC) has been reported to improve operative outcomes by allowing antegrade blood flow. However, FAC still remains largely utilized as a consensus for the routine use of AXC has not yet been reached. METHODS A meta-analysis on comparative studies reporting operative outcomes using AXC versus FAC was performed. Pooled weighted incidence rates for end points of interest (both adjusted and unadjusted) have been computed using an inverse variance model. RESULTS Overall, a total of 8 studies including 793 patients were analysed (AXC = 396, FAC = 397). AXC was associated with reduced risk for in-hospital mortality [risk ratio (RR): 0.41; 95% confidence interval (CI): 0.29-0.58; P < 0.001] and permanent neurological deficit (PND) (RR: 0.59; 95% CI: 37.-0.93; P = 0.02) when compared with FAC. Pooled adjusted estimates confirmed that AXC was independently associated with a significantly reduced incidence of in-hospital mortality (adjusted OR: 0.54; 95% CI: 0.36-0.82; P = 0.004; I(2) = 57%) and PND (adjusted OR: 0.19; 95%CI: 0.07-0.54; P = 0.002; I(2) = 0%). CONCLUSIONS The present meta-analysis demonstrated that AXC is superior to FAC in reducing in-hospital mortality and the incidence of PND in patients operated on for type A acute aortic dissection.
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Affiliation(s)
| | - Haider Mohamed
- Oxford Heart Centre, Oxford University Hospital, Oxford, UK
| | | | - Mario Petrou
- Oxford Heart Centre, Oxford University Hospital, Oxford, UK
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Unal M, Yilmaz O, Akar I, Ince I, Aslan C, Koc F, Kafali H. Brachiocephalic artery cannulation in proximal aortic surgery that requires circulatory arrest. Tex Heart Inst J 2014; 41:596-600. [PMID: 25593522 DOI: 10.14503/thij-13-3947] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The brachiocephalic artery is an alternative cannulation site in the repair of ascending aortic lesions that require circulatory arrest. We evaluate the effectiveness and safety of this technique. Proximal aortic surgery was performed in 32 patients from 2006 through 2012 via brachiocephalic artery cannulation and circulatory arrest. Twenty-four (75%) of the patients were men. The mean age was 48.69 ± 9.43 years (range, 30-68 yr). Twelve had type I dissection, 2 had type II dissection, and 18 had true aneurysms of the ascending aorta. All operations were performed through a median sternotomy. The arterial cannula was inserted through an 8-mm vascular graft anastomosed to the brachiocephalic artery in an end-to-side fashion. In dissections, the distal anastomosis was performed without clamping the aorta. The patients were cooled to 24 °C, and circulatory arrest was established. The brachiocephalic and left carotid arteries were clamped, and antegrade cerebral perfusion was started at a rate of 10 mL/kg/min. Cardiopulmonary bypass was resumed after completion of the distal anastomosis and the initiation of rewarming. The proximal anastomosis was then performed. None of the patients sustained a major neurologic deficit, but 5 patients experienced transient postoperative agitation (<24 hr). There were 2 early deaths (6.25%), on the 3rd and the 11th postoperative days, both unrelated to the cannulation technique. Brachiocephalic artery cannulation through a graft can be a safe and effective technique in proximal aortic surgical procedures that require circulatory arrest.
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Takashima N, Suzuki T, Asai T, Nota H, Ikegami H, Kinoshita T, Fujino S, Hosoba S. Outcome of total arch replacement with coronary artery bypass grafting. Eur J Cardiothorac Surg 2014; 47:990-4. [DOI: 10.1093/ejcts/ezu341] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Accepted: 07/21/2014] [Indexed: 11/12/2022] Open
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Nota H, Asai T, Suzuki T, Kinoshita T, Ikegami H, Takashima N. Risk factors for acute kidney injury in aortic arch surgery with selective cerebral perfusion and mild hypothermic lower body circulatory arrest. Interact Cardiovasc Thorac Surg 2014; 19:955-61. [DOI: 10.1093/icvts/ivu241] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Eslami MH, Sherburne A, Gupta A, Lazar HL. Pump‐Assisted Total Arch Replacement Using an In Situ Stent Graft Fenestration Technique. J Card Surg 2014; 29:816-20. [DOI: 10.1111/jocs.12395] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Mohammad H. Eslami
- Division of Vascular Surgery, Boston Medical CenterBoston University School of MedicineBostonMassachusetts
| | - Alan Sherburne
- Division of Vascular Surgery, Boston Medical CenterBoston University School of MedicineBostonMassachusetts
| | - Avneesh Gupta
- Division of Radiology, Boston Medical CenterBoston University School of MedicineBostonMassachusetts
| | - Harold L. Lazar
- Division of Cardiac Surgery, Boston Medical CenterBoston University School of MedicineBostonMassachusetts
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Endovascular treatment of recurring type A dissection after total aortic arch debranching. Cardiovasc Interv Ther 2014; 30:273-6. [DOI: 10.1007/s12928-014-0278-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Accepted: 06/02/2014] [Indexed: 10/25/2022]
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Song SW, Yoo KJ, Shin YR, Lim SH, Cho BK. Diffusion-weighted magnetic resonance imaging lesions after repair of acute type A aortic dissection: association with neurocognitive outcomes†‡. Eur J Cardiothorac Surg 2014; 47:367-73. [PMID: 24755104 DOI: 10.1093/ejcts/ezu169] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES We sought to analyse the preoperative status of arch vessels by postoperative diffusion-weighted magnetic resonance imaging (DWI) as a potential surrogate marker for cerebral thromboembolism and its relationship to neurocognitive outcomes. METHODS Preoperative computed tomography (CT) and postoperative DWI were available for 50 patients who received surgery for acute type A aortic dissection. Two radiologists evaluated CT and DWI scans. Mini-mental status examinations (MMSE) were performed on the same day with DWI. RESULTS Mean age of participants was 57 ± 14 years. MMSE and DWI were performed 6 ± 3 days after surgery. New cerebral embolisms were evident in 35 of 50 patients (70%) and often occurred as multiple lesions (28/35, 80%; range 2-21). Among patients with multiple lesions, 23 (66%) were clinically silent. Pathological lesions at the origin of the arch vessels correlated with the number and volume of new DWI lesions (P < 0.05). Degree of neurocognitive dysfunction tested by MMSE was negatively associated with age (r = -0.48, P < 0.0001) and left-sided DWI lesion number and volume (r = -0.74, P < 0.0001; r = -0.707, P < 0.0001). CONCLUSIONS DWI revealed new cerebral embolisms in 70% of patients following surgery for acute type A aortic dissection. Lesion number and volume significantly correlated with pathological status of arch vessels. MMSE was representative of left-sided lesions.
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Affiliation(s)
- Suk-Won Song
- Department of Cardiovascular Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Kyung-Jong Yoo
- Department of Cardiovascular Surgery, Yonsei Cardiovascular Hospital, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Yoo Rim Shin
- Department of Cardiovascular Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sun-Hee Lim
- Department of Cardiovascular Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Bum-Koo Cho
- The Korea Heart Foundation, Seoul, Republic of Korea
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Apostolakis E, Shuhaiber JH. Antegrade or retrograde cerebral perfusion as an adjunct during hypothermic circulatory arrest for aortic arch surgery. Expert Rev Cardiovasc Ther 2014; 5:1147-61. [DOI: 10.1586/14779072.5.6.1147] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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Okita Y, Okada K, Omura A, Kano H, Minami H, Inoue T, Sakamoto T, Miyahara S, Shirasaka T, Yamanaka K, Ohara T, Nomura Y, Nakai H. Total arch replacement using selective antegrade cerebral perfusion as the neuroprotection strategy. Ann Cardiothorac Surg 2013; 2:169-74. [PMID: 23977578 DOI: 10.3978/j.issn.2225-319x.2013.03.11] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2013] [Accepted: 03/20/2013] [Indexed: 11/14/2022]
Abstract
BACKGROUND Optimal neuro-protection strategy in aortic arch surgery is a controversial issue. The present study reported surgical outcomes of total arch replacement using selective antegrade cerebral perfusion (SACP). METHODS From January 2002 to December 2012, 438 consecutive patients (mean age 69.1±13.4 years) underwent total arch replacement using SACP through a median sternotomy. Acute aortic dissection was present in 86 patients (18.3; 80 type A, 6 type B) and shaggy aorta in 36 (8.2%). Emergent/urgent surgery was required in 144 (32.9%). Our current approach included: (I) meticulous selection of arterial cannulation site and type of arterial cannula; (II) selective antegrade cerebral perfusion; (III) maintenance of minimal tympanic temperature between 20 and 23 °C; (IV) early re-warming after distal anastomosis; and (V) maintaining fluid balance below 1,000 mL during cardiopulmonary bypass. A woven Dacron four branch graft was used in all patients. RESULTS Overall hospital mortality was 4.6% (20/438). Hospital mortality was 9.7% (14/144) in urgent/emergent surgery and 2.0% (6/294) in elective cases. Permanent neurological deficit occurred in 5.3% (23/438) of patients. Prolonged ventilation was necessary in 58 patients (13.2%). Multivariate analysis demonstrated that risk factors for hospital mortality were octogenarian (OR 4.45, P=0.03), brain malperfusion (OR 23.52, P=0.002) and cardiopulmonary bypass time (OR 1.07, P=0.04). The follow-up was completed in 97.9% with mean follow up of 2.3±2.3 years. Survival at 5 and 10 years after surgery was 79.6±3.3% and 71.2±5.0% respectively. In the acute type A dissection group, 10-year survival was 96.8±2.9%, while in the elective non-dissection group 5- and 10-year survival were 81.4±7.2% and 77.0±5.9% respectively. CONCLUSIONS Our current approach for total aortic arch replacement utilizing SACP was associated with low hospital mortality and morbidities leading to favorable long-term outcome.
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Affiliation(s)
- Yutaka Okita
- Division of Cardiovascular Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
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Shirakawa Y, Kuratani T, Shimamura K, Torikai K, Sakamoto T, Shijo T, Sawa Y. The efficacy and short-term results of hybrid thoracic endovascular repair into the ascending aorta for aortic arch pathologies. Eur J Cardiothorac Surg 2013; 45:298-304; discussion 304. [DOI: 10.1093/ejcts/ezt391] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Davies RA, Black D, Bannon PG, Bayfield MS, Hendel PN, Hughes CF, Wilson MK, Vallely MP. Outcomes of aortic arch replacement surgery after previous cardiac surgery. ANZ J Surg 2013; 83:827-32. [PMID: 23782742 DOI: 10.1111/ans.12299] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/19/2013] [Indexed: 11/30/2022]
Abstract
BACKGROUND Aortic arch replacement is a potentially high-risk operation and in the re-operative setting has been found to be a risk factor for poor outcome, yet there is a dearth of published data specifically on this topic. The aim of the study was to review our unit's outcomes in this re-operative setting. METHOD Data were collated for all patients who underwent aortic arch replacement surgery after previous cardiac surgery from January 1988 to November 2011. The patients were divided based primarily on elective versus non-elective and also early (≤2005) and late (≥2006) series. RESULTS Twenty-seven eligible patients (22 male; median age: 53.0 years; elective: 14, non-elective: 13) were identified. There was a mean period of 14.5 years between the first operation and the subsequent aortic arch replacement. The overall 30-day mortality rate was 22.2% - 0% elective and 46.2% non-elective (P = 0.004). Overall permanent neurological dysfunction was 21.7% - 28.6% elective and 11.1% non-elective (P = 0.463). There were 11 early-series patients and 16 late-series patients. For early-series patients, 90.9% were non-elective versus 18.8% in the late-series patients. The 30-day mortality rate was 54.5% early series versus 0% late series. CONCLUSION Aortic arch replacement is high risk in the re-operative setting. These risks are even greater for non-elective procedures. This highlights the need for aggressive first-time surgery to reduce re-operative procedures and good long-term follow-up programmes to allow elective procedures if required.
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Affiliation(s)
- Reece A Davies
- Faculty of Medicine, The University of Sydney, Sydney, New South Wales, Australia; The Baird Institute for Heart and Lung Surgical Research, Sydney, New South Wales, Australia
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Cochennec F, Tresson P, Cross J, Desgranges P, Allaire E, Becquemin JP. Hybrid repair of aortic arch dissections. J Vasc Surg 2013; 57:1560-7. [DOI: 10.1016/j.jvs.2012.11.081] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2012] [Revised: 11/05/2012] [Accepted: 11/18/2012] [Indexed: 12/13/2022]
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