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Falasa MP, Beaver TM. Commentary: Data zenith. J Thorac Cardiovasc Surg 2023; 165:566-567. [PMID: 33812686 DOI: 10.1016/j.jtcvs.2021.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 03/03/2021] [Accepted: 03/04/2021] [Indexed: 01/18/2023]
Affiliation(s)
- Matheus P Falasa
- Division of Cardiovascular Surgery, Department of Surgery, University of Florida, Gainesville, Fla
| | - Thomas M Beaver
- Division of Cardiovascular Surgery, Department of Surgery, University of Florida, Gainesville, Fla.
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Abstract
The clinical outcome of severe aortic regurgitation (AR) remains suboptimal, but surgery has been shown to have survival benefit over medical therapy. Postoperative survival is inferior in patients with reduced left ventricular function, and therefore early surgical intervention is recommended. Aortic valvuloplasty (AVP) is an attractive option to avoid the major drawbacks of prosthetic valves but has not been widely adopted. The etiology of AR is classified functionally into three groups: normal leaflet motion (type I), cusp prolapse (type II), and restriction (type III). Type I with dilatation of the sinus of Valsalva (type Ib) can be repaired by aortic valve reimplantation or aortic root remodeling with similar valve stability. Type I with dilatation of the aortic annulus (type Ic) can be managed by annuloplasty. Type II can be corrected by plication or resuspension techniques. Pericardial patch is necessary in AVP for type Id (perforation/fenestration) and type III but is associated with risk of recurrence. Bicuspid aortic valve is classified according to commissure angle: symmetrical, asymmetrical, and very asymmetrical. Tricuspidization is recommended for repair of very asymmetrical valves to avoid postoperative stenosis. Recent progress has achieved similar reoperation rates between bicuspid and tricuspid aortic valve repair. For Marfan syndrome, valve-sparing root replacement is advantageous compared to Bentall operation regarding late survival, thromboembolic and hemorrhagic events, and endocarditis. Similar findings have been reported in acute aortic dissection. Both remodeling and reimplantation procedures provide similar favorable outcomes in these settings. Recent advances in AVP are summarized by quantitative assessment of cusp configuration (effective height and geometric height), graft size decision, use of template to cut the graft, and videoscopic assessment of post-repair cusp configuration. Due to these advances, AVP shows superior results to replacement surgery. Further concrete evidence with larger case volumes and longer observation periods are necessary to popularize AVP.
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Jahanyar J, El Khoury G, de Kerchove L. Is extension of Florida Sleeve indications taking us in the right direction? Eur J Cardiothorac Surg 2022; 62:6563598. [PMID: 35380663 DOI: 10.1093/ejcts/ezac247] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 04/01/2022] [Indexed: 11/14/2022] Open
Affiliation(s)
- Jama Jahanyar
- Department of Cardiothoracic and Vascular Surgery, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Gebrine El Khoury
- Department of Cardiothoracic and Vascular Surgery, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Laurent de Kerchove
- Department of Cardiothoracic and Vascular Surgery, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
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Parameswaran S, Ziganshin BA, Zafar M, Elefteriades JA. Progress in surgical interventions for aortic root aneurysms and dissections. Expert Rev Cardiovasc Ther 2022; 20:65-79. [PMID: 35037567 DOI: 10.1080/14779072.2022.2029702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION : The aortic root is a uniquely sensitive region as it anatomically encompasses the aortic valve leaflets and gives origin to the coronary arteries. These associated structures, in addition to the aortic tube, itself, add immensely to the complexity of replacing this segment when it is aneurysmal or dissected. Given this complexity, many contemporary choices for treatment of aortic root aneurysms have evolved over the past few decades. AREAS COVERED The aim of this study was to provide an updated review of the literature regarding various surgical options for management of aortic root aneurysmal disease. A systematic search in Pubmed database was performed for articles related to various aortic root surgeries and outcomes published between 1998 to 2020. EXPERT OPINION : For multiple technical options in aortic root replacement surgery, decades of surgical investigation and development have shown favorable results, which provide a formidable armamentarium to be used at the discretion of the surgeon to suit various patient anatomic patterns and risk profile-while still durably controlling the aortic pathology and protecting from recurrence, valve dysfunction, progressive dilatation, and aortic dissection.
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Affiliation(s)
- Shamini Parameswaran
- Aortic Institute at Yale New-Haven Hospital, Yale University School of Medicine, New Haven, CT.,Department of Surgery, Texas Tech University Health Sciences Center School of Medicine, Lubbock, TX
| | - Bulat A Ziganshin
- Aortic Institute at Yale New-Haven Hospital, Yale University School of Medicine, New Haven, CT.,Department of Cardiovascular and Endovascular Surgery, Kazan State Medical University, Kazan, Russia
| | - Mohammad Zafar
- Aortic Institute at Yale New-Haven Hospital, Yale University School of Medicine, New Haven, CT
| | - John A Elefteriades
- Aortic Institute at Yale New-Haven Hospital, Yale University School of Medicine, New Haven, CT
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5
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OUP accepted manuscript. Eur J Cardiothorac Surg 2022; 62:6538731. [DOI: 10.1093/ejcts/ezac104] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Revised: 01/17/2022] [Accepted: 01/31/2022] [Indexed: 11/14/2022] Open
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Fajardo-Rodríguez E, Castro-Pinto M, López-Menéndez J, Miguelena-Hycka J, Martín-García M, Muñoz-Pérez R, Rodríguez-Roda J. [Resultados a corto y medio plazo de la técnica de Florida]. ARCHIVOS DE CARDIOLOGIA DE MEXICO 2021; 91:465-469. [PMID: 33725716 PMCID: PMC8641465 DOI: 10.24875/acm.20000448] [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] [Indexed: 11/24/2022] Open
Abstract
Introducción: La dilatación de la raíz aórtica es una patología frecuente que afecta a pacientes jóvenes y su tratamiento es quirúrgico. Las técnicas quirúrgicas de elección en pacientes jóvenes son las de preservación de la válvula aórtica para evitar el implante de una prótesis valvular. Objetivo: El presente trabajo tiene como objetivo describir la técnica de Florida Sleeve y los resultados de nuestra experiencia. Método: Entre noviembre de 2015 y enero de 2017 fueron intervenidos en nuestro centro tres casos de pacientes con insuficiencia aórtica severa secundaria a anulectasia aórtica en los que se realizó la técnica de Florida Sleeve. Resultados: En los tres casos se obtuvieron excelentes resultados postoperatorios, libres de insuficiencia aórtica residual y de reoperación por cualquier causa, resultados que se mantuvieron a los tres años de seguimiento. Conclusiones: La técnica de Florida Sleeve es una técnica segura, reproducible con una curva de aprendizaje y tiempos quirúrgicos inferiores a las técnicas tradicionales. Los resultados clínicos a medio plazo en términos de morbimortalidad son buenos.
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Affiliation(s)
| | | | - José López-Menéndez
- Servicio de Cirugía Cardiaca, Hospital Universitario Ramón y Cajal, Madrid, España
| | | | - Miren Martín-García
- Servicio de Cirugía Cardiaca, Hospital Universitario Ramón y Cajal, Madrid, España
| | - Rafael Muñoz-Pérez
- Servicio de Cirugía Cardiaca, Hospital Universitario Ramón y Cajal, Madrid, España
| | - Jorge Rodríguez-Roda
- Servicio de Cirugía Cardiaca, Hospital Universitario Ramón y Cajal, Madrid, España
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Alhussaini M, Jeng EI, Martin TD, Fillion A, Beaver TM, Arnaoutakis GJ. Florida sleeve is a safe and effective technique for valve salvage in acute stanford type A aortic dissection. J Card Surg 2021; 37:39-46. [PMID: 34652039 DOI: 10.1111/jocs.16078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 10/06/2021] [Accepted: 10/07/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Valve-sparing root replacement is commonly used for management of aortic root aneurysms in elective setting, but its technical complexity hinders its broader adoption for acute type-A aortic dissection (ATAAD). The Florida sleeve (FS) procedure is a simplified form of valve sparing aortic root reconstruction that does not require coronary reimplantation. Here, we present our outcomes of the FS repair in patients with dilated roots in the setting of an ATAAD. METHODS We retrospectively reviewed 24 consecutive patients (2002-2018) treated with FS procedure for ATAAD. Demographic, operative, and postoperative outcomes were queried from our institutional database. Long term follow-up was obtained from clinic visits for local patients, and with telephone and telehealth measures otherwise. RESULTS Mean age was 49 ± 14 years with 19 (79%) males. Marfan syndrome was present in 4 (16.7%) patients and 14 (58.3) had ≥2+ aortic insufficiency (AI). Nine (37.2%) had preoperative mal-perfusion or shock. The FS was combined with hemi-arch replacement in 15 (62.5%) patients and a zone-2 arch replacement in 9 (37.5%) patients. There were 2 (8.3%) early postoperative mortalities. Median follow-up period was 46 months (range, 0.3-146). The median survival of the entire cohort was 143.4 months. One patient (4.2%) required redo aortic valve replacement for unrelated aortic valve endocarditis at 30 months postoperatively. CONCLUSION FS is simplified and reproducible valve-sparing root repair. In appropriate patients, it can be applied safely in acute Stanford type-A aortic dissection with excellent early and long-term results.
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Affiliation(s)
| | - Eric I Jeng
- Department of Surgery, Division of Cardiovascular Surgery, University of Florida, Gainesville, Florida, USA
| | - Tomas D Martin
- Department of Surgery, Division of Cardiovascular Surgery, University of Florida, Gainesville, Florida, USA
| | - Amber Fillion
- Department of Surgery, Division of Cardiovascular Surgery, University of Florida, Gainesville, Florida, USA
| | - Thomas M Beaver
- Department of Surgery, Division of Cardiovascular Surgery, University of Florida, Gainesville, Florida, USA
| | - George J Arnaoutakis
- Department of Surgery, Division of Cardiovascular Surgery, University of Florida, Gainesville, Florida, USA
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Surgical options for aortic root aneurysm disease: which procedure, which patient. Curr Opin Cardiol 2021; 36:683-688. [PMID: 34354008 DOI: 10.1097/hco.0000000000000902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Several surgical repair strategies are available for patients with aortic root aneurysms. This review summarizes the indications for surgery, surgical treatment options, as well their associated outcomes. RECENT FINDINGS Despite the development and increasing adoption of valve sparing aortic root replacement, most patients with aortic root aneurysms still undergo placement of a composite valved graft. Valve sparing aortic root replacement may have a lower rate of bleeding and thrombotic complications during long-term follow-up with excellent long-term survival and low rates of aortic valve reintervention. SUMMARY Patients with aortic root aneurysms who are symptomatic or reach the recommended size criteria should undergo surgical repair. Most patients receive composite valve graft conduits with good outcomes. The presence of normal aortic leaflet tissue and minimal regurgitation, including those with connective tissue disorders, should be evaluated for valve sparing aortic root replacement. Valve sparing procedures are durable and obviate the need for lifelong anticoagulation and avoid the risk of structural degeneration of bioprosthetic valves.
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Jeng EI, Martin TD. J-Mart: aortic valve replacement with Florida sleeve aortic root reconstruction. Eur J Cardiothorac Surg 2021; 58:1304-1305. [PMID: 32706876 DOI: 10.1093/ejcts/ezaa236] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Revised: 05/30/2020] [Accepted: 06/04/2020] [Indexed: 11/13/2022] Open
Abstract
We highlight a technique combining an aortic valve replacement with the Florida sleeve repair. The patient is a 68-year-old man who had a 48-mm aortic root aneurysm and a 57-mm ascending aorta, presenting with symptomatic tri-leaflet severe aortic valve stenosis. He underwent a hemiarch, aortic valve replacement and Florida sleeve aortic root reconstruction. The patient recovered uneventfully and is now, at over 1 year postoperation, without evidence of recurrent aortic pathology.
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Affiliation(s)
- Eric I Jeng
- Division of Cardiovascular Surgery, Department of Surgery, University of Florida, Gainesville, FL, USA
| | - Tomas D Martin
- Division of Cardiovascular Surgery, Department of Surgery, University of Florida, Gainesville, FL, USA
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Tasca G, Jaworek M, Lucherini F, Trinca F, Redaelli P, Antona C, Vismara R. Leaflet kinematics after the Yacoub and Florida-sleeve operations: results of an in vitro study. Eur J Cardiothorac Surg 2021; 59:674-679. [PMID: 33236049 DOI: 10.1093/ejcts/ezaa370] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 08/14/2020] [Accepted: 09/05/2020] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES The Florida-sleeve is a valve-sparing technique that causes minimal interference to leaflet kinematics and aortic root dynamism. The aim of this in vitro study was to evaluate the effects of the Florida-sleeve and Yacoub techniques on aortic leaflet kinematics. METHODS Two groups of 6 whole porcine hearts were treated with either the Florida-sleeve technique or the Yacoub technique and tested in a pulsatile loop. Valve fluid dynamics, coronary flow analysis and valve echocardiograms were performed both before and after the procedures. RESULTS Both procedures showed no difference in rapid valve opening time as compared with their respective baseline values. The Florida-sleeve procedure showed a shorter slow closing time (192 ± 19 ms vs baseline 244 ± 14 ms, P = 0.016) and increased slow closing velocity (-1.5 ± 0.4 cm/s vs baseline -0.8 ± 0.4 cm/s, P = 0.038). In the rapid valve closing phase, the Yacoub procedure showed a trend towards slower closing valve velocity (-16 ± 9 cm/s vs baseline -25 ± 9 cm/s, P = 0.07). The Yacoub procedure showed larger leaflet displacement at the end of the slow valve closing time that was 2.0 ± 0.5 cm vs baseline 1.5 ± 0.3 cm, P = 0.044. When comparing the Florida-sleeve and Yacoub procedures, the former showed statistically significant shorter slow valve closing time (P = 0.017). CONCLUSIONS This study showed that the Florida-sleeve technique alters the slow closing phase of the aortic valve leaflet kinematics when compared with both the normal baseline and Yacoub procedure, while the latter showed a larger leaflet displacement before the rapid closing valve phase.
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Affiliation(s)
- Giordano Tasca
- Department of Cardiac Surgery, Heart Health Center, King Saud Medical City, Riyadh, Kingdom of Saudi Arabia.,Department of Electronic, Information and Bioengineering, Politecnico di Milano, Milan, Italy
| | - Michal Jaworek
- Department of Electronic, Information and Bioengineering, Politecnico di Milano, Milan, Italy
| | - Federico Lucherini
- Department of Electronic, Information and Bioengineering, Politecnico di Milano, Milan, Italy
| | - Francesco Trinca
- Cardiovascular Department, Operative Unit of Cardiac Surgery, Spedali Civili di Brescia, Brescia, Italy
| | - Paola Redaelli
- Cardiovascular Department, Cardiac Surgery Unit, San Raffaele Hospital, Milan, Italy
| | - Carlo Antona
- Cardiovascular Surgery Department, ASST Fatebenefratelli "Luigi Sacco" University Hospital, Milan, Italy
| | - Riccardo Vismara
- Department of Electronic, Information and Bioengineering, Politecnico di Milano, Milan, Italy
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Al-Adhami A, Islam S, Mishra V, Eleyan L, Theologou T. Valve sparing root replacement - Are we limited in our options? J Card Surg 2020; 36:188-190. [PMID: 33283335 DOI: 10.1111/jocs.15128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Accepted: 10/05/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Ahmed Al-Adhami
- Department of Cardiothoracic Surgery, Golden Jubilee National Hospital, Clydebank, Scotland.,Duke University, Durham, North Carolina, USA
| | - Samsul Islam
- The Shrewsbury and Telford NHS Trust, Telford, Shropshire, UK.,School of Medicine, St. George's University of London, London, UK
| | - Vaibhav Mishra
- School of Medicine, St. George's University of London, London, UK
| | - Loay Eleyan
- School of Medicine, University of Liverpool, Liverpool, UK
| | - Thomas Theologou
- Department of Cardiothoracic Surgery, Cardiocentro Ticino, Lugano, Switzerland
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Abstract
The natural history of aortic regurgitation is not as benign as once believed, even in asymptomatic patients with preserved left ventricular function. Aortic valve surgery can prolong survival in these patients. However, both mechanical and biological aortic valve replacement have major disadvantages, especially in young patients. Aortic valve-preserving surgery has attracted a great deal of attention because it has a significant survival benefit over replacement. Nonetheless, aortic valve-preserving surgery has not been widely adopted due to the complexity of the technique and assessment (i.e., long learning curve). With recent technical and theoretical advances, aortic valve-preserving surgery has increasingly been performed with better outcomes, and therefore earlier surgical intervention in cases of aortic regurgitation has been considered. Recent advances in aortic valve-preserving surgery include repair-oriented classification of the etiology of aortic regurgitation, objective assessment of the cusp configuration (i.e., effective height and geometric height), use of aortic annuloplasty, introduction of two reproducible valve-sparing root replacement procedures (i.e., aortic valve reimplantation and aortic root remodeling techniques), standardization of aortic valve-preserving surgery, and assessment of cusp configuration with aortoscopy. A number of prospective multicenter studies are currently underway and will clarify the role of aortic valve-preserving surgery in the treatment of aortic regurgitation in the near future.
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Affiliation(s)
- Takashi Kunihara
- Department of Cardiac Surgery, The 12839Jikei University School of Medicine, Tokyo, Japan
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Aalaei-Andabili SH, Beaver TM, Martin TD, Hess PJ, Arnaoutakis GJ. Outcomes of Florida Sleeve Procedure in Patients with Bicuspid Versus Tricuspid Aortic Valve. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2020; 15:361-368. [PMID: 32729751 DOI: 10.1177/1556984520938470] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Outcomes of the Florida Sleeve (FS) procedure in patients with bicuspid aortic valve (BAV) have not been reported before. We compared outcomes of the FS procedure between patients with BAV and those with tricuspid aortic valve (TAV). METHODS From May 1, 2002 to January 1, 2016, 177 patients including 18 BAV and 159 TAV underwent the FS procedure. Baseline characteristics, perioperative outcomes, and echocardiographic measurements were compared between the 2 groups. Kaplan-Meier and life-table analyses were used to evaluate survival and freedom from reintervention rates. RESULTS Mean ± standard deviation age and aortic root diameter were comparable in BAV and TAV groups, 47.83 ± 11.19 versus 49.59 ± 15.79 years (P = 0.55) and 56.57 ± 6.18 versus 55.17 ± 8.84 mm (P = 0.46), respectively. The 30-day mortality and stroke rates were zero in the BAV group and 1.88% (n = 3) in the TAV group (P = 1.00). One patient (5.55%) in the BAV group and 8 (5.03%) patients in the TAV group needed permanent pacemaker implantation (P = 0.62). Freedom from reoperation was 93% in the BAV group and 99% in the TAV group at 8 years (P = 0.041). Patient survival rate was 100% in the BAV group and 91% in the TAV group at 8 years (P = 0.42). Freedom from aortic insufficiency greater than mild was 93% in the BAV group and 96.5% in the TAV group at 5 years (P = 0.61). CONCLUSIONS This is the first study reporting outcomes of the FS procedure in patients with BAV. This technique is feasible, and the results appear to be durable when compared to patients with TAV.
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Affiliation(s)
- Seyed Hossein Aalaei-Andabili
- 3463 Department of Medicine, University of Florida, Gainesville, FL, USA.,Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Florida, Gainesville, FL, USA
| | - Thomas M Beaver
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Florida, Gainesville, FL, USA
| | - Tomas D Martin
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Florida, Gainesville, FL, USA
| | - Philip J Hess
- 22535 Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Indiana University, Bloomington, IN, USA
| | - George J Arnaoutakis
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Florida, Gainesville, FL, USA
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