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Chen CW, Hu J, Li YY, Chen GX, Zhang W, Chen XY. The outcomes of aortic arch repair between open surgical repair and debranching endovascular hybrid surgical repair: A systematic review and meta-analysis. J Vasc Surg 2024; 79:1510-1524. [PMID: 38122857 DOI: 10.1016/j.jvs.2023.12.025] [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] [Received: 09/05/2023] [Revised: 11/26/2023] [Accepted: 12/10/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND At present, open surgical aortic arch repair (OAR) and debranching hybrid surgical aortic arch repair (HAR) serve as significant therapeutic approaches for aortic arch aneurysm or dissection. It remains unclear which technique is preferable. Our study aimed to compare the short-term and long-term outcomes of these two procedures. METHODS To identify comparison studies of debranching HAR and OAR, a systematic search of the PubMed, Embase, Web of Science, and Cochrane Library databases was performed from January 2002 to April 2022. This study was registered on PROSPERO (CRD42020218080). RESULTS Sixteen publications (1316 patients), including six propensity score-matching (PSM) analysis papers, were included in this study. Compared with the HAR group, the patients who underwent OAR were younger (OAR vs HAR: 67.53 ± 12.81 vs 71.29 ± 11.0; P < .00001), had less coronary artery disease (OAR vs HAR: 22.45% vs 32.6%; P = .007), less chronic obstructive pulmonary disease (OAR vs HAR: 16.16% vs 23.92%; P = .001), lower rates of previous stroke (OAR vs HAR: 12.46% vs 18.02%; P = .05), and a lower EuroSCORE (European System for Cardiac Operative Risk Evaluation) score (OAR vs HAR: 6.27 ± 1.04 vs 6.9 ± 3.76; P < .00001). HAR was associated with less postoperative blood transfusion (OAR vs HAR: 12.23% vs 7.91%; P = .04), shorter length of intensive care unit stays (OAR vs HAR: 5.92 ± 7.58 days vs 4.02 ± 6.60 days; P < .00001) and hospital stays (OAR vs HAR: 21.59 ± 17.54 days vs 16.49 ± 18.45 days; P < .0001), lower incidence of reoperation for bleeding complications (OAR vs HAR: 8.07% vs 3.96%; P = .01), fewer postoperative pulmonary complication (OAR vs HAR: 14.75% vs 5.02%; P < .0001), and acute renal failure (OAR vs HAR: 7.54% vs 5.17%; P = .03). In the PSM subgroup, the rates of spinal cord ischemic (OAR vs HAR: 5.75% vs 11.49%; P = .02), stroke (OAR vs HAR: 5.1% vs 17.35%; P = .01), and permanent paraplegia (OAR vs HAR: 2.79% vs 6.08%; P = .006) were lower in the OAR group than that in the HAR group. Although there was no statistically significant difference in 1-year survival rates (HAR vs OAR: hazard ratio [HR]: 1.54; P = .10), the 3-year and 5-year survivals were significantly higher in the OAR group than that in the HAR group (HAR vs OAR: HR: 1.69; P = .01; HAR vs OAR: HR: 1.68; P = .01). In the PSM subgroup, the OAR group was also significantly superior to the HAR group in terms of 3-year and 5-year survivals (HAR vs OAR: HR: 1.73; P = .04; HAR vs OAR: HR: 1.67; P = .04). The reintervention rate in the HAR group was significantly higher than that in the OAR group (OAR vs HAR: 8.24% vs 16.01%; P = .01). The most common reintervention was postoperative bleeding (8.07%) in the OAR group and endoleak (9.67%) in the HAR group. CONCLUSIONS Our meta-analysis revealed that debranching HAR was associated with fewer perioperative complications than the OAR group, except for postoperative permanent paraplegia, reintervention, and stroke events. The OAR group demonstrated better 3-year and 5-year survivals than the debranching HAR group. However, patients in the OAR group had fewer comorbid factors and were younger than those in the HAR group. High-quality studies and well-powered randomized trials are needed to further evaluate this evolving field.
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Affiliation(s)
- Chu Wen Chen
- Division of Liver Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Jing Hu
- Division of Health Management Centre, West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Yi Yuan Li
- Division of Vascular Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Guo Xing Chen
- Division of Vascular Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Wayne Zhang
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Washington and Puget Sound VA Health Care System, Seattle, WA
| | - Xi Yang Chen
- Division of Vascular Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, China.
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Baeza C, Cho J. Aortic arch disease: Current management. REVISTA MÉDICA CLÍNICA LAS CONDES 2022. [DOI: 10.1016/j.rmclc.2022.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Atkins MD, Lumsden AB. Parallel grafts and physician modified endografts for endovascular repair of the aortic arch. Ann Cardiothorac Surg 2022; 11:16-25. [PMID: 35211381 PMCID: PMC8807419 DOI: 10.21037/acs-2021-taes-171] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 10/27/2021] [Indexed: 10/31/2023]
Abstract
Aortic arch aneurysms are a challenging clinical problem especially in high-risk patients. Open aortic arch replacement, even in the best of centers, carries significant risk of stroke or death in this high-risk population. Many high-risk patients are deemed inoperable and not offered repair. Branched and fenestrated thoracic endografts are currently undergoing clinical trials in the United States but are not yet commercially available. Many elderly and frail patients have significant brachiocephalic occlusive disease or anatomy excluding them for consideration for such clinical trials. These patients also present with acute aortic syndromes requiring urgent or emergent repair and are unable to participate in clinical trials due to the time required to have such devices available. Alternative endovascular therapies, including parallel stent grafts (including Chimneys, Snorkels and Periscopes) and physician modified thoracic endografts, have been used to treat such high-risk patients combined with commercially available thoracic endovascular aneurysm repair (TEVAR) devices. This paper aims to review the techniques and current reported outcomes from parallel stent grafts and physician modified devices used to treat high risk patients undergoing repair for aortic arch pathologies.
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Affiliation(s)
- Marvin D Atkins
- Houston Methodist Hospital and Houston Methodist DeBakey Cardiovascular Surgery Associates, Houston, TX, USA
| | - Alan B Lumsden
- Houston Methodist Hospital and Houston Methodist DeBakey Cardiovascular Surgery Associates, Houston, TX, USA
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Hori D, Kusadokoro S, Mieno MN, Fujimori T, Shimizu T, Kimura N, Yamaguchi A. The effect of aortic arch replacement on pulse wave velocity after surgery. Interact Cardiovasc Thorac Surg 2021; 34:652-659. [PMID: 34871404 PMCID: PMC8972244 DOI: 10.1093/icvts/ivab342] [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: 07/03/2021] [Revised: 09/15/2021] [Accepted: 10/29/2021] [Indexed: 12/02/2022] Open
Affiliation(s)
- Daijiro Hori
- Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Sho Kusadokoro
- Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Makiko Naka Mieno
- Department of Medical Informatics, Center for Information, Jichi Medical University, Tochigi, Japan
| | - Tomonari Fujimori
- Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Toshikazu Shimizu
- Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Naoyuki Kimura
- Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Atsushi Yamaguchi
- Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan
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Mahboub-Ahari A, Sadeghi-Ghyassi F, Heidari F. Effectiveness of endovascular versus open surgical repair for thoracic aortic aneurysm: a systematic review and meta-analysis. THE JOURNAL OF CARDIOVASCULAR SURGERY 2021; 63:25-36. [PMID: 34235903 DOI: 10.23736/s0021-9509.21.11894-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Since the approval, the TEVAR is widely used for the repair of thoracic aortic aneurysm. However, the long-term mortality and re-intervention rates compared to OSR are unclear. We aimed to compare the effectiveness of the thoracic endovascular aortic repair (TEVAR) with open surgical repair (OSR) specifically for thoracic aortic aneurysms. EVIDENCE ACQUISITION We conducted a comprehensive search in MEDLINE, PubMed, EMBASE, CINAHL, PROSPERO, Centre for Reviews and Dissemination, and the Cochrane Library up to November 2020. The main outcomes were early mortality, mid-to-long-term survival, and re-intervention. The quality of the evidence was assessed using the GRADE methodology. All analyses were performed using RevMan with the random effect model and Comprehensive Meta-Analysis software. EVIDENCE SYNTHESIS One systematic review and 15 individual studies were included. Pooled analysis showed that 30-day mortality, stroke, renal failure, and pulmonary complications were significantly lower in TEVAR vs. open surgery. The pooled rate of re-intervention significantly favored the OSR. The long-term survival and mortality favored TEVAR and OSR in one and two studies, respectively, but was non-significant in 7 analyzes. CONCLUSIONS Early clinical outcomes including the 30-day mortality, stroke, renal failure, and pulmonary complications significantly favored the TEVAR. However, the mid-to-long-term re-intervention rate favored the OSR and long-term survival was inconsistent among the studies. The quality of evidence was very low. More studies with longer follow-ups are needed. The use of TEVAR should be decided by taking into account other factors including patient characteristics and preferences, cost, and surgeon expertise.
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Affiliation(s)
- Alireza Mahboub-Ahari
- Tabriz Health Services Management Research Center, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran.,National Institute of Health Research, Tehran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Sadeghi-Ghyassi
- Research Center for Evidence-Based Medicine: A JBI Centre of Excellence, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Fariba Heidari
- Research Center for Evidence-Based Medicine: A JBI Centre of Excellence, Tabriz University of Medical Sciences, Tabriz, Iran -
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Elhelali A, Hynes N, Devane D, Sultan S, Kavanagh EP, Morris L, Veerasingam D, Jordan F. Hybrid repair versus conventional open repair for thoracic aortic arch aneurysms. Cochrane Database Syst Rev 2021; 6:CD012923. [PMID: 34085713 PMCID: PMC8407084 DOI: 10.1002/14651858.cd012923.pub2] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Thoracic aortic arch aneurysms (TAAs) can be a life-threatening condition due to the potential risk of rupture. Treatment is recommended when the risk of rupture is greater than the risk of surgical complications. Depending on the cause, size and growth rate of the TAA, treatment may vary from close observation to emergency surgery. Aneurysms of the thoracic aorta can be managed by a number of surgical techniques. Open surgical repair (OSR) of aneurysms involves either partial or total replacement of the aorta, which is dependent on the extent of the diseased segment of the aorta. During OSR, the aneurysm is replaced with a synthetic graft. Hybrid repair (HR) involves a combination of open surgery with endovascular aortic stent graft placement. Hybrid repair requires varying degrees of invasiveness, depending on the number of supra-aortic branches that require debranching. The hybrid technique that combines supra-aortic vascular debranching with stent grafting of the aortic arch has been introduced as a therapeutic alternative. However, the short- and long-term outcomes of HR remain unclear, due to technical difficulties and complications as a result of the angulation of the aortic arch as well as handling of the arch during surgery. OBJECTIVES To assess the effectiveness and safety of HR versus conventional OSR for the treatment of TAAs. SEARCH METHODS The Cochrane Vascular Information Specialist searched the Cochrane Vascular Specialised Register, CENTRAL, MEDLINE, Embase, CINAHL and AMED databases and World Health Organization International Clinical Trials Registry Platform and ClinicalTrials.gov trials registers to 22 March 2021. We also searched references of relevant articles retrieved from the electronic search for additional citations. SELECTION CRITERIA We considered for inclusion in the review all published and unpublished randomised controlled trials (RCTs) and controlled clinical trials (CCTs) comparing HR to OSR for TAAs. DATA COLLECTION AND ANALYSIS Two review authors independently screened all titles and abstracts obtained from the literature search to identify those that met the inclusion criteria. We retrieved the full text of studies deemed as potentially relevant by at least one review author. The same review authors screened the full-text articles independently for inclusion or exclusion. MAIN RESULTS No RCTs or CCTs met the inclusion criteria for this review. AUTHORS' CONCLUSIONS Due to the lack of RCTs or CCTs, we were unable to determine the safety and effectiveness of HR compared to OSR in people with TAAs, and we are unable to provide high-certainty evidence on the optimal surgical intervention for this cohort of patients. High-quality RCTs or CCTs are necessary, addressing the objective of this review.
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Affiliation(s)
- Ala Elhelali
- School of Nursing and Midwifery, National University of Ireland Galway, Galway, Ireland
| | - Niamh Hynes
- Department of Vascular and Endovascular Surgery, The Galway Clinic, Galway, Ireland
| | - Declan Devane
- School of Nursing and Midwifery, National University of Ireland Galway, Galway, Ireland
| | - Sherif Sultan
- Vascular Surgery, Galway University Hospital, Galway, Ireland
| | - Edel P Kavanagh
- Department of Vascular and Endovascular Surgery, The Galway Clinic, Galway, Ireland
| | - Liam Morris
- Mechanical and Industrial Engineering, Galway-Mayo Institute of Technology, Galway, Ireland
| | - Dave Veerasingam
- Cardiothoracic Surgery, Galway University Hospital, Galway, Ireland
| | - Fionnuala Jordan
- School of Nursing and Midwifery, National University of Ireland Galway, Galway, Ireland
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Zhu C, Piao H, Wang Y, Li B, Zhang Y, Xu J, Wang T, Zhu Z, Xu R, Li D, Liu K. A New Aortic Arch Inclusion Technique with Frozen Elephant Trunk for Aortic Arch Aneurysm Treatment. Int Heart J 2020; 61:1229-1235. [PMID: 33116020 DOI: 10.1536/ihj.20-069] [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] [Indexed: 11/18/2022]
Abstract
Various surgical techniques have been proposed for treating aortic arch aneurysm (AAA); however, the optimal treatment has not been well defined. This study introduces a new aortic arch inclusion technique with frozen elephant trunk (FET) for AAA treatment.A retrospective analysis was performed among 22 patients for AAA surgical treatment between March 2010 and March 2019. Patients were classified into Z1, Z2, and Z3 groups based on the origins of aneurysms. A stent graft with a 10 cm stented graft and 5-9 cm proximal vascular prosthesis was released into the descending thoracic aorta as FET through an incision in the aortic arch. The proximal vascular prosthesis was retracted into the aortic arch, trimmed to expose the orifices of the brachiocephalic vessels, and sutured inside the aortic arch using the inclusion technique. The proximal sealing location of the vascular graft was tailored to cover the origins of aneurysms.There was no 30-day mortality. No patient had postoperative stroke or paraplegia. Complete aneurysm thrombosis was achieved in all patients. One patient died of severe respiratory tract stenosis 3 months postoperatively. All other 21 patients were alive during 53.3 ± 36.5-month follow-up. Computed tomography angiography was obtained in 15 patients during follow-up. Endoleak was observed in one patient, and the other 14 patients were free from aneurysm-related or graft-related complications during follow-up.The aortic arch inclusion technique with FET provides an alternative technique in treating AAA with satisfactory mid-term follow-up results. A larger patient population with long-term follow-up results is warranted.
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Affiliation(s)
- Cuilin Zhu
- Department of Cardiovascular Surgery, The Second Hospital of Jilin University
| | - Hulin Piao
- Department of Cardiovascular Surgery, The Second Hospital of Jilin University
| | - Yong Wang
- Department of Cardiovascular Surgery, The Second Hospital of Jilin University
| | - Bo Li
- Department of Cardiovascular Surgery, The Second Hospital of Jilin University
| | - Yixin Zhang
- Department of Cardiovascular Surgery, The Second Hospital of Jilin University
| | - Jinyu Xu
- Department of Cardiovascular Surgery, The Second Hospital of Jilin University
| | - Tiance Wang
- Department of Cardiovascular Surgery, The Second Hospital of Jilin University
| | - Zhicheng Zhu
- Department of Cardiovascular Surgery, The Second Hospital of Jilin University
| | - Rihao Xu
- Department of Cardiovascular Surgery, The Second Hospital of Jilin University
| | - Dan Li
- Department of Cardiovascular Surgery, The Second Hospital of Jilin University
| | - Kexiang Liu
- Department of Cardiovascular Surgery, The Second Hospital of Jilin University
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Various Endoluminal Approaches Available for Treating Pathologies of the Aortic Arch. Cardiovasc Intervent Radiol 2020; 43:1756-1769. [PMID: 32588136 PMCID: PMC7649180 DOI: 10.1007/s00270-020-02561-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Accepted: 06/09/2020] [Indexed: 02/03/2023]
Abstract
Open surgical repair of the aortic arch for degenerative aortic disease in an unfit patient is associated with significant morbidity and mortality. Endoluminal techniques have advanced over the last decade. Contemporary endovascular options including a hybrid approach (supra-aortic debranching and aortic stent graft), inner branched endograft, chimney stents, and scallop or fenestrated endografts are being used frequently as an alternative to open surgical arch repair. Understanding of the available endoluminal technology along with careful planning and effective teamwork is required to minimise complications associated with the endoluminal techniques, particularly neurological ones. Custom made techniques are superior to chimney or parallel technology in terms of their complications and durability. Integration of the protective devices such as embolic protection filters into stent design may reduce the risk of poor neurological sequelae. Long-term data are needed to assess the durability of these devices.
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Hori D, Yuri K, Kusadokoro S, Shimizu T, Kimura N, Yamaguchi A. Effect of endoprostheses on pulse wave velocity and its long-term outcomes after thoracic endovascular aortic repair. Gen Thorac Cardiovasc Surg 2020; 68:1134-1141. [PMID: 32232780 DOI: 10.1007/s11748-020-01343-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Accepted: 03/15/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND The purpose of this study was to evaluate the changes in pulse wave velocity and left ventricular dimensions in patients undergoing stent-graft treatment for aortic arch aneurysm. METHODS From July 2008 to February 2019, 86 patients underwent thoracic endovascular aortic repair of an aortic arch aneurysm. Changes in pulse wave velocity (PWV), echocardiogram findings, and long-term outcomes were compared between endoskeleton type (n = 60) and exoskeleton type stent-graft (n = 26). RESULTS There was no significant difference in patient demographics except for diabetes which was more observed in endoskeleton type (p = 0.017). There was a significant increase in PWV in exoskeleton type after surgery, which further progressed at a median follow-up of 32 months (before: 2047 cm/s vs. after: 2259 cm/s vs. follow-up: 2486 cm/s, p = 0.010, p = 0.017). No significant difference was observed in endoskeleton type (before: 1980 cm/s vs. after: 2058 cm/s, vs. follow-up: 2042 cm/s, p = 0.25, p = 0.34). Echocardiogram performed at a median period of 46.3 months, revealed a significant increase in left ventricular diastolic volume (LVDV) (before: 107.4 ± 20.6 ml vs. follow-up: 127.7 ± 27.5 ml, p = 0.003) and decrease in e' (before: 5.5 ± 1.78 cm/s vs. follow-up: 4.7 ± 1.72 cm/s, p = 0.012) in exoskeleton type, while no significant change was observed in endoskeleton type (LVDV: before: 102.6 ± 32.3 ml vs. follow-up: 96.9 ± 35.4 ml, p = 0.74; e': before: 4.4 ± 1.21 cm/s vs. follow-up: 4.8 ± 1.40 cm/s, p = 0.68). At the median period of 61.3 months, there was no significant difference in long-term mortality (p = 0.89). However, the endoskeleton type was associated with a lower incidence of a cardiac event (p = 0.034) and cerebrovascular event (p = 0.029). CONCLUSION Types of endoprosthesis might affect differently on physiological changes and its accommodated risk factors after surgery.
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Affiliation(s)
- Daijiro Hori
- Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, 1-847, Amanuma-cho, Omiya-ku, Saitama, Saitama, 330-8503, Japan.
| | - Koichi Yuri
- Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, 1-847, Amanuma-cho, Omiya-ku, Saitama, Saitama, 330-8503, Japan
| | - Sho Kusadokoro
- Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, 1-847, Amanuma-cho, Omiya-ku, Saitama, Saitama, 330-8503, Japan
| | - Toshikazu Shimizu
- Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, 1-847, Amanuma-cho, Omiya-ku, Saitama, Saitama, 330-8503, Japan
| | - Naoyuki Kimura
- Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, 1-847, Amanuma-cho, Omiya-ku, Saitama, Saitama, 330-8503, Japan
| | - Atsushi Yamaguchi
- Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, 1-847, Amanuma-cho, Omiya-ku, Saitama, Saitama, 330-8503, Japan
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Yamashiro S, Kise Y, Inafuku H, Nagano T, Kuniyoshi Y. Survival and cause of death after aortic arch aneurysm repair. THE JOURNAL OF CARDIOVASCULAR SURGERY 2020; 61:784-789. [PMID: 32186170 DOI: 10.23736/s0021-9509.20.11245-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND This study aimed to identify differences in prognosis, causes of death, and outcomes between open and endovascular repair for aortic arch aneurysms. METHODS We retrospectively analyzed the survival status and causes of death determined from the medical records of 124 consecutive elderly patients (age>70 years) with aortic arch aneurysms that were treated between 2010 and 2018 at our hospital. Forty patients (male, N.=30; mean age, 76 years) underwent open repair and 84 (male, N.=68; mean age, 78 years) underwent endovascular repair. RESULTS Early postoperative complications (10.0% vs. 6.3%; P=0.4) and rates of in-hospital death (2.5% vs. 6.3%; P=0.2) did not significantly differ between open and endovascular repair. Cumulative long-term and event free survival rates at eight years were similar in both groups (78.7% vs. 66.3%, P=0.1 and 66.6% vs. 58.4%; P=0.4, respectively). The causes of death at follow-up after endovascular repair comprised malignancies in 11 (52.4%) patients and cardiopulmonary and cerebral events unrelated to aortic aneurysms in 10 (47.6%). CONCLUSIONS Early and late outcomes did not statistically differ after both procedures. However, the prevalence of cancer-related death occurring late after arch repair was significantly higher after endovascular repair. The most important observation from this series was that significantly more patients died of malignant disease during follow-up after endovascular repair than open repair.
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Affiliation(s)
- Satoshi Yamashiro
- Department of Thoracic and Cardiovascular Surgery, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan -
| | - Yuya Kise
- Department of Thoracic and Cardiovascular Surgery, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Hitoshi Inafuku
- Department of Thoracic and Cardiovascular Surgery, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Takaaki Nagano
- Department of Thoracic and Cardiovascular Surgery, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Yukio Kuniyoshi
- Department of Thoracic and Cardiovascular Surgery, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
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Lei G, Wang G, Liu Q, Zhou H, Fang Z, Zhang C, Yang L, Shi S, Li J, Chen Y, Yang X. Single-Stage Hybrid Aortic Arch Repair is Associated With a Lower Incidence of Postoperative Acute Kidney Injury Than Conventional Aortic Surgery. J Cardiothorac Vasc Anesth 2019; 33:3294-3300. [DOI: 10.1053/j.jvca.2019.05.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Revised: 05/16/2019] [Accepted: 05/20/2019] [Indexed: 12/25/2022]
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Takano T, Sakaguchi M, Terasaki T, Fujii T, Date Y, Fuke M, Machida K. Mini open stent grafting with half sternotomy for aortic arch aneurysm. J Cardiothorac Surg 2019; 14:101. [PMID: 31171013 PMCID: PMC6554927 DOI: 10.1186/s13019-019-0923-x] [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: 08/07/2018] [Accepted: 05/28/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Open stent grafting is an alternative of graft replacement and thoracic endovascular aortic repair for aortic arch aneurysm. We have performed open stent grafting with half sternotomy (mini-OSG) to reduce in-hospital stay and recovery time of patients and herein report seven cases of mini-OSG for aortic aneurysm and dissection. CASE PRESENTATION The patients' mean age was 66 years. Cardiopulmonary bypass was performed conventionally, and an open stent graft was inserted via an aortotomy on the aortic arch during circulatory arrest. No mortality occurred. The mean operation time was 387 min, and the mean blood loss was 587 ml. The patients were weaned from the ventilator 7.1 h postoperatively. No pseudoaneurysm or endoleakage was observed during the 2- to 20-month follow-up. CONCLUSIONS Mini-OSG might be less invasive, although further studies and intensive follow-up are needed.
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Affiliation(s)
- Tamaki Takano
- Department of Cardiovascular Surgery, Nagano Red-Cross Hospital, 5-22-1 Wakasato, Nagano, 3808582, Japan.
| | - Masayuki Sakaguchi
- Department of Cardiovascular Surgery, Nagano Red-Cross Hospital, 5-22-1 Wakasato, Nagano, 3808582, Japan
| | - Takamitsu Terasaki
- Department of Cardiovascular Surgery, Nagano Red-Cross Hospital, 5-22-1 Wakasato, Nagano, 3808582, Japan
| | - Taishi Fujii
- Department of Cardiovascular Surgery, Nagano Red-Cross Hospital, 5-22-1 Wakasato, Nagano, 3808582, Japan
| | - Yusuke Date
- Department of Cardiovascular Surgery, Nagano Red-Cross Hospital, 5-22-1 Wakasato, Nagano, 3808582, Japan
| | - Mugumi Fuke
- Department of Cardiovascular Surgery, Nagano Red-Cross Hospital, 5-22-1 Wakasato, Nagano, 3808582, Japan
| | - Kai Machida
- Department of Cardiovascular Surgery, Nagano Red-Cross Hospital, 5-22-1 Wakasato, Nagano, 3808582, Japan
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Gomes EN, Dias RR, Rocha BA, Santiago JAD, Dinato FJDS, Saadi EK, Gomes WJ, Jatene FB. Use of 3D Printing in Preoperative Planning and Training for Aortic Endovascular Repair and Aortic Valve Disease. Braz J Cardiovasc Surg 2019; 33:490-495. [PMID: 30517258 PMCID: PMC6257534 DOI: 10.21470/1678-9741-2018-0101] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Accepted: 08/16/2018] [Indexed: 01/12/2023] Open
Abstract
Introduction Three-dimensional (3D) printing has become an affordable tool for assisting
heart surgeons in the aorta endovascular field, both in surgical planning,
education and training of residents and students. This technique permits the
construction of physical prototypes from conventional medical images by
converting the anatomical information into computer aided design (CAD)
files. Objective To present the 3D printing feature on developing prototypes leading to
improved aortic endovascular surgical planning, as well as transcatheter
aortic valve implantation, and mainly enabling training of the surgical
procedure to be performed on patient's specific condition. Methods Six 3D printed real scale prototypes were built representing different aortic
diseases, taken from real patients, to simulate the correction of the
disease with endoprosthesis deployment. Results In the hybrid room, the 3D prototypes were examined under fluoroscopy, making
it possible to obtain images that clearly delimited the walls of the aorta
and its details. The endovascular simulation was then able to be performed,
by correctly positioning the endoprosthesis, followed by its deployment. Conclusion The 3D printing allowed the construction of aortic diseases realistic
prototypes, offering a 3D view from the two-dimensional image of computed
tomography (CT) angiography, allowing better surgical planning and surgeon
training in the specific case beforehand.
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Affiliation(s)
- Eduardo Nascimento Gomes
- Cardiovascular Surgery Division, Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InCor-HCFMUSP), São Paulo, SP, Brazil
| | - Ricardo Ribeiro Dias
- Cardiovascular Surgery Division, Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InCor-HCFMUSP), São Paulo, SP, Brazil
| | - Bruno Aragão Rocha
- Instituto de Radiologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InRad-HCFMUSP), São Paulo, SP, Brazil
| | - José Augusto Duncan Santiago
- Cardiovascular Surgery Division, Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InCor-HCFMUSP), São Paulo, SP, Brazil
| | - Fabrício José de Souza Dinato
- Cardiovascular Surgery Division, Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InCor-HCFMUSP), São Paulo, SP, Brazil
| | - Eduardo Keller Saadi
- Department of Cardiovascular Surgery, Hospital de Clínicas de Porto Alegre (HCPA), Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Walter J Gomes
- Cardiology and Cardiovascular Surgery Disciplines, Escola Paulista de Medicina da Universidade Federal de São Paulo (EPM-UNIFESP), São Paulo, SP, Brazil
| | - Fabio B Jatene
- Cardiovascular Surgery Division, Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InCor-HCFMUSP), São Paulo, SP, Brazil
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Takahashi Y, Murakami T, Sasaki Y, Bito Y, Fujii H, Nishimura S, Shibata T. Safety of perioperative cerebral oxygen saturation during debranching in patients with incomplete circle of Willis. Interact Cardiovasc Thorac Surg 2018; 26:965-971. [PMID: 29365098 DOI: 10.1093/icvts/ivx443] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Accepted: 12/23/2017] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES The consequences of common carotid artery (CCA) cross-clamping during debranching before thoracic endovascular aortic repair are unclear. We examined the safety of a simple CCA cross-clamping procedure under regional cerebral oxygen saturation monitoring (rSO2) in patients with a complete or incomplete circle of Willis (CoW) anatomy. METHODS Twenty-eight patients with thoracic aneurysm underwent elective debranching thoracic endovascular aortic repair with bilateral frontal rSO2 monitoring at our institution between January 2012 and October 2015. Before CCA cross-clamping, we maintained a systemic mean arterial pressure of >100 mm Hg with a vasopressor. We recorded the bilateral frontal rSO2 before, during and after CCA cross-clamping. RESULTS The CoW was incomplete in 11 (39.3%) patients. Of these, 6 patients had a complication of ischaemic potential. The left frontal rSO2 was <50% in 3 patients but did not fall below 40%. Compared with baseline values (mean ± SD 64.6 ± 6.9%), the left frontal rSO2 showed no significant change perioperatively in those with a complete CoW on the left CCA cross-clamping (during: 61.0 ± 7.9%, P = 0.17; after: 65.1 ± 5.9%, P = 0.09). In patients with an incomplete CoW with ischaemic potential, the left frontal rSO2 did not change significantly after cross-clamping (baseline: 59.8 ± 3.2%, during: 55.5 ± 5.0%; P = 0.10) but increased significantly on declamping (62.8 ± 4.5%, P = 0.023). The extent of the changes in the mean left frontal rSO2 on clamping and declamping decreased and increased by 7.3% and 11.7%, respectively, in patients with an incomplete CoW, when compared with 5.3% and 5.8% in those with a complete CoW (P = 0.65 and 0.31, respectively). No perioperative cerebrovascular events were observed. CONCLUSIONS Simple CCA cross-clamping during debranching was safe when arterial pressure was supported and rSO2 was monitored, even with an incomplete CoW and ischaemic potential.
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Affiliation(s)
- Yosuke Takahashi
- Department of Cardiovascular Surgery, Osaka City General Hospital, Osaka, Japan
| | - Takashi Murakami
- Department of Cardiovascular Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Yasuyuki Sasaki
- Department of Cardiovascular Surgery, Osaka City General Hospital, Osaka, Japan
| | - Yasuyuki Bito
- Department of Cardiovascular Surgery, Osaka City General Hospital, Osaka, Japan
| | - Hiromichi Fujii
- Department of Cardiovascular Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Shinsuke Nishimura
- Department of Cardiovascular Surgery, Osaka City General Hospital, Osaka, Japan
| | - Toshihiko Shibata
- Department of Cardiovascular Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
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Berger T, Kreibich M, Morlock J, Kondov S, Scheumann J, Kari FA, Rylski B, Siepe M, Beyersdorf F, Czerny M. True-lumen and false-lumen diameter changes in the downstream aorta after frozen elephant trunk implantation. Eur J Cardiothorac Surg 2018; 54:375-381. [DOI: 10.1093/ejcts/ezy031] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Accepted: 01/13/2018] [Indexed: 01/08/2023] Open
Affiliation(s)
- Tim Berger
- Department of Cardiovascular Surgery, University Heart Center Freiburg University, Freiburg, Germany
- Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Maximilian Kreibich
- Department of Cardiovascular Surgery, University Heart Center Freiburg University, Freiburg, Germany
- Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Julia Morlock
- Department of Cardiovascular Surgery, University Heart Center Freiburg University, Freiburg, Germany
- Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Stoyan Kondov
- Department of Cardiovascular Surgery, University Heart Center Freiburg University, Freiburg, Germany
- Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Johannes Scheumann
- Department of Cardiovascular Surgery, University Heart Center Freiburg University, Freiburg, Germany
- Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Fabian A Kari
- Department of Cardiovascular Surgery, University Heart Center Freiburg University, Freiburg, Germany
- Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Bartosz Rylski
- Department of Cardiovascular Surgery, University Heart Center Freiburg University, Freiburg, Germany
- Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Matthias Siepe
- Department of Cardiovascular Surgery, University Heart Center Freiburg University, Freiburg, Germany
- Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Friedhelm Beyersdorf
- Department of Cardiovascular Surgery, University Heart Center Freiburg University, Freiburg, Germany
- Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Martin Czerny
- Department of Cardiovascular Surgery, University Heart Center Freiburg University, Freiburg, Germany
- Faculty of Medicine, University of Freiburg, Freiburg, Germany
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