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Yates MT, Smith A, Mistirian AA, Bigogno CM, Lee M, Lopez-Marco A. Inflammation in aortic surgery: postoperative evolution of biomarkers according pathologies and segments of the aorta. J Cardiothorac Surg 2024; 19:239. [PMID: 38632653 PMCID: PMC11022493 DOI: 10.1186/s13019-024-02672-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 03/22/2024] [Indexed: 04/19/2024] Open
Abstract
OBJECTIVES Aortic pathologies often present with elevated inflammatory biomarkers due to the nature of the disease. Open aortic surgery causes significant trauma to the body due to often mandatory ischemic periods, long cardiopulmonary bypass times and polytransfusion. We aim to determine postoperative trends on inflammation biomarkers for different aortic pathologies and type of surgery in different segments of the aorta. METHODS Retrospective review of prospectively collected data of 193 consecutive patients who underwent aortic surgery in our centre between 2017 and 2021, grouped according to the type of aortic intervention: (1) Type A aortic dissection (AD) repair with ascending aorta/hemiarch replacement, (2) Aortic root replacement (ARR), (3) Aortic arch + Frozen elephant trunk (FET), (4) Descending thoracic aorta (DTA)/Thoraco-Abdominal aortic repair (TAA). Primary outcomes were daily values of white blood cells (WBC) and C-Reactive Protein (CRP) during the first 15 postoperative days. RESULTS All groups had a similar inflammatory peak in the first 2-4 days (WBC 12-15 × 109 c/L). AD and FET groups show similar trends with WBC and CRP peaks on days 2 and 10. The ARR group didn't experience the 2nd peak as most patients were already discharged. DTA/TAA patients experienced a more prolonged inflammatory response, reaching a plateau by day 5-10. AD group shows the highest WBC levels and the DTA/TAAA group the highest CRP levels. CRP levels remain elevated (100-200 mg/L) in all groups after 15 postoperative days. CONCLUSIONS Inflammatory biomarkers show different postoperative trends depending on the clinical presentation and complexity of the aortic procedure performed. Further understanding of the inflammatory response to different aortic pathologies and surgical procedures will permit reduction on the liberal use of antibiotics that this cohort of patients are usually exposed to. An earlier version of the data included in this manuscript was presented as Oral Abstract in the UK Society of Cardiothoracic Surgery Annual meeting in 2021.
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Affiliation(s)
- Martin T Yates
- Department of Cardiothoracic Surgery, St Bartholomew's Hospital, West Smithfield, London, EC1A 7BE, UK
| | - Alexander Smith
- Department of Cardiothoracic Surgery, St Bartholomew's Hospital, West Smithfield, London, EC1A 7BE, UK
| | - Alina A Mistirian
- Department of Cardiothoracic Surgery, St Bartholomew's Hospital, West Smithfield, London, EC1A 7BE, UK
| | | | - Michelle Lee
- Department of Cardiothoracic Surgery, St Bartholomew's Hospital, West Smithfield, London, EC1A 7BE, UK
| | - Ana Lopez-Marco
- Department of Cardiothoracic Surgery, St Bartholomew's Hospital, West Smithfield, London, EC1A 7BE, UK.
- William Harvey Institute, Queen Mary University, London, UK.
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Mehta Y, Singh A, Singh M, Bhan A, Trehan N. Impact of intraoperative haemoadsorption on outcomes of patients undergoing aortic surgery: a single-centre, prospective, observational study. Interdiscip Cardiovasc Thorac Surg 2024; 38:ivae050. [PMID: 38514401 PMCID: PMC10984732 DOI: 10.1093/icvts/ivae050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Accepted: 03/19/2024] [Indexed: 03/23/2024]
Abstract
OBJECTIVES To investigate the impact of a cytokine haemoadsorption (HA) device (CytoSorb®) on inflammatory markers and patients' outcome during aortic root surgery. METHODS Prospective, observational study including all-comers with quasi-randomization by strictly alternating inclusion (1:1 basis). Sixty patients undergoing elective aortic surgery were assigned to either HA group (n = 30) with intraoperative HA, or a control (C) group (n = 30). Primary outcomes were: (i) impact of HA on haemodynamic stability and need for vasopressors (vasoactive-inotropic score) and (ii) sequential organ failure assessment (SOFA) score. Secondary parameters included the impact of HA on the course of hyperinflammation using interleukin-6 and procalcitonin, duration of mechanical ventilation, and lengths of intensive care unit and hospital stay. RESULTS Noradrenaline requirement was significantly reduced in the HA group postoperatively compared to the C group (HA: 0.03 µg/kg/min vs C: 0.08 µg/kg/min, P = 0.004 at 2 h, and HA: 0.02 µg/kg/min vs C: 0.04 µg/kg/min, P = 0.004 at 24 h). This translated into a significantly lower vasoactive-inotropic score in the HA group. SOFA score was less in the HA group at all time points and reached statistical significance 2 h postoperatively (HA: 5.77 vs C: 7.43, P < 0.001). Intraoperative HA significantly reduced interleukin-6 levels (P < 0.05) at all time points, and procalcitonin at 2 h after discontinuation from cardiopulmonary bypass (P = 0.005). The duration of ventilation, intensive care unit and hospital stays were shorter in the HA group compared to the C group. CONCLUSIONS Intraoperative HA has the potential to mitigate hyperinflammatory response leading to improved haemodynamics after aortic root surgery, thereby shortening the duration of ventilation, and lengths of intensive care unit and hospital stay. However, it must be evaluated in larger cohorts.
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Affiliation(s)
- Yatin Mehta
- Institute of Critical Care and Anesthesiology, Medanta—The Medicity, Gurugram, India
| | - Ajmer Singh
- Institute of Critical Care and Anesthesiology, Medanta—The Medicity, Gurugram, India
| | - Mandeep Singh
- Institute of Critical Care and Anesthesiology, Medanta—The Medicity, Gurugram, India
| | - Anil Bhan
- Department of Cardiac Surgery, Medanta—The Medicity, Gurugram, India
| | - Naresh Trehan
- Department of Cardiac Surgery, Medanta—The Medicity, Gurugram, India
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Kazawa M, Kabata D, Yoshida H, Minami K, Maeda T, Yoshitani K, Matsuda H, Shintani A. Amino acids to prevent cardiac surgery-associated acute kidney injury: a randomized controlled trial. JA Clin Rep 2024; 10:19. [PMID: 38528235 DOI: 10.1186/s40981-024-00703-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 03/20/2024] [Accepted: 03/20/2024] [Indexed: 03/27/2024] Open
Abstract
BACKGROUND This study aimed to examine the preventive effect of amino acids on postoperative acute kidney injury (AKI). METHODS This was single-center, patient- and assessor-blinded, randomized controlled trial. Patients who underwent aortic surgery with cardiopulmonary bypass were included. The intervention group received 60 g/day of amino acids for up to 3 days. The control group received standard care. The primary outcome was the incidence of AKI. We assessed the effect of amino acids on AKI using a Cox proportional hazards regression model. RESULTS Sixty-six patients were randomly assigned to the control or intervention group. One patient in the control group withdrew consent after randomization. The incidence of AKI was 10 patients (30.3%) in the intervention group versus 18 patients (56.2%) in the control group (adjusted hazard ratio, 0.44; 95% confidence interval, 0.20-0.95; P = 0.04). CONCLUSIONS This trial demonstrated a significant reduction in AKI incidence with amino acid supplementation. TRIAL REGISTRATION jRCT, jRCTs051210154. Registered 31 December 2021, https://jrct.niph.go.jp/re/reports/detail/69916.
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Affiliation(s)
- Masahiro Kazawa
- Department of Critical Care Medicine, National Cerebral and Cardiovascular Center, 6-1, Kishibe-Shinmachi, Suita, Osaka, Japan.
- Department of Medical Statistics, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan.
| | - Daijiro Kabata
- Department of Medical Statistics, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Hisako Yoshida
- Department of Medical Statistics, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Kimito Minami
- Department of Critical Care Medicine, National Cerebral and Cardiovascular Center, 6-1, Kishibe-Shinmachi, Suita, Osaka, Japan
| | - Takuma Maeda
- Department of Anesthesiology, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Kenji Yoshitani
- Department of Anesthesiology, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Hitoshi Matsuda
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Ayumi Shintani
- Department of Medical Statistics, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
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Budge J, Carrell T, Yaqub M, Wafa H, Waltham M, Pilecka I, Kelly J, Murphy C, Palmer S, Wang Y, Clough RE. The ARIA trial protocol: a randomised controlled trial to assess the clinical, technical, and cost-effectiveness of a cloud-based, ARtificially Intelligent image fusion system in comparison to standard treatment to guide endovascular Aortic aneurysm repair. Trials 2024; 25:214. [PMID: 38528619 DOI: 10.1186/s13063-023-07710-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 10/06/2023] [Indexed: 03/27/2024] Open
Abstract
BACKGROUND Endovascular repair of aortic aneurysmal disease is established due to perceived advantages in patient survival, reduced postoperative complications, and shorter hospital lengths of stay. High spatial and contrast resolution 3D CT angiography images are used to plan the procedures and inform device selection and manufacture, but in standard care, the surgery is performed using image-guidance from 2D X-ray fluoroscopy with injection of nephrotoxic contrast material to visualise the blood vessels. This study aims to assess the benefit to patients, practitioners, and the health service of a novel image fusion medical device (Cydar EV), which allows this high-resolution 3D information to be available to operators at the time of surgery. METHODS The trial is a multi-centre, open label, two-armed randomised controlled clinical trial of 340 patient, randomised 1:1 to either standard treatment in endovascular aneurysm repair or treatment using Cydar EV, a CE-marked medical device comprising of cloud computing, augmented intelligence, and computer vision. The primary outcome is procedural time, with secondary outcomes of procedural efficiency, technical effectiveness, patient outcomes, and cost-effectiveness. Patients with a clinical diagnosis of AAA or TAAA suitable for endovascular repair and able to provide written informed consent will be invited to participate. DISCUSSION This trial is the first randomised controlled trial evaluating advanced image fusion technology in endovascular aortic surgery and is well placed to evaluate the effect of this technology on patient outcomes and cost to the NHS. TRIAL REGISTRATION ISRCTN13832085. Dec. 3, 2021.
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Affiliation(s)
- James Budge
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
- St George's Vascular Institute, St George's University, London, UK
| | | | - Medeah Yaqub
- King's Clinical Trials Unit, King's College London, London, UK
| | - Hatem Wafa
- Department of Population Health Sciences, King's College London, London, UK
| | | | - Izabela Pilecka
- King's Clinical Trials Unit, King's College London, London, UK
| | - Joanna Kelly
- King's Clinical Trials Unit, King's College London, London, UK
| | - Caroline Murphy
- King's Clinical Trials Unit, King's College London, London, UK
| | - Stephen Palmer
- Centre for Health Economics, University of York, York, UK
| | - Yanzhong Wang
- Department of Population Health Sciences, King's College London, London, UK
| | - Rachel E Clough
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK.
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Selbst MA, Laughlin MK, Ward CR, Michelena H, Sabate-Rotes A, Bianco L, De Backer J, Mosquera LM, Yetman AT, Bissell MM, Andreassi MG, Foffa I, Hui DS, Caffarelli A, Kim YY, Guo D, Citro R, De Marco M, Tretter JT, Morris SA, McBride KL, Body SC, Prakash SK. Bicuspid Aortic Valve Disease With Early Onset Complications: Characteristics And Aortic Outcomes. medRxiv 2024:2024.03.11.24304079. [PMID: 38559132 PMCID: PMC10980111 DOI: 10.1101/2024.03.11.24304079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
Bicuspid aortic valve (BAV) is the most common congenital heart malformation in adults but can also cause childhood-onset complications. In multicenter study, we found that adults who experience significant complications of BAV disease before age 30 are distinguished from the majority of BAV cases that manifest after age 50 by a relatively severe clinical course, with higher rates of surgical interventions, more frequent second interventions, and a greater burden of congenital heart malformations. These observations highlight the need for prompt recognition, regular lifelong surveillance, and targeted interventions to address the significant health burdens of patients with early onset BAV complications.
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Affiliation(s)
- Maximilian A. Selbst
- Department of Internal Medicine, University of Texas Health Science Center at Houston, Houston, Texas
| | - Megan K. Laughlin
- Department of Internal Medicine, University of Texas Health Science Center at Houston, Houston, Texas
| | - Colin R. Ward
- Department of Internal Medicine, University of Texas Health Science Center at Houston, Houston, Texas
| | - Hector Michelena
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Anna Sabate-Rotes
- Department of Pediatric Cardiology, Hospital Vall d’Hebron, Facultad de Medicina, Universidad Autònoma Barcelona, Barcelona, Spain
| | - Lisa Bianco
- Department of Pediatric Cardiology, Hospital Vall d’Hebron, Facultad de Medicina, Universidad Autònoma Barcelona, Barcelona, Spain
| | - Julie De Backer
- Centre for Medical Genetics, Ghent University Hospital, Ghent, Belgium
| | | | - Anji T. Yetman
- Children’s Hospital and Medical Center, University of Nebraska, Omaha, Nebraska
| | - Malenka M Bissell
- Department of Biomedical Imaging Science, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, United Kingdom
| | | | - Ilenia Foffa
- Consiglio Nazionale delle Richerche (CNR), Instituto di Fisiologia Clinica, Pisa, Italy
| | - Dawn S. Hui
- Department of Cardiothoracic Surgery, University of Texas Health Science Center San Antonio, Texas
| | - Anthony Caffarelli
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, California
| | - Yuli Y. Kim
- Division of Cardiovascular Medicine, The Hospital of the University of Pennsylvania, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Dongchuan Guo
- Department of Internal Medicine, University of Texas Health Science Center at Houston, Houston, Texas
| | - Rodolfo Citro
- Cardio-Thoracic and Vascular Department, University Hospital “San Giovanni di Dio e Ruggi d’Aragona,” Salerno, Italy
| | - Margot De Marco
- Department of Medicine, Surgery and Dentistry Schola Medica Salernitana, University of Salerno, Baronissi, Italy
| | - Justin T. Tretter
- Heart Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Shaine A. Morris
- Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Kim L. McBride
- Department of Anesthesiology, Brigham and Women’s Hospital/Harvard Medical School, Boston, Massachusetts
| | | | | | - Siddharth K. Prakash
- Department of Internal Medicine, University of Texas Health Science Center at Houston, Houston, Texas
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Thilak CR, Idhrees M, Ibrahim M, Arunkumar A, Velayudhan B. Stanford type B aortic dissection in a patient with aberrant right subclavian artery. Indian J Thorac Cardiovasc Surg 2024; 40:234-237. [PMID: 38389763 PMCID: PMC10879476 DOI: 10.1007/s12055-023-01637-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Revised: 10/23/2023] [Accepted: 10/24/2023] [Indexed: 02/24/2024] Open
Abstract
An aberrant right subclavian artery is a rare aortic arch anomaly where the right subclavian artery arises from the proximal part of the descending thoracic aorta and distal to origin of left subclavian artery. It usually courses behind the esophagus. Type B aortic dissection along with aberrant right subclavian artery is not common. A middle-aged man presented with complaints of epigastric pain and on evaluation was found to have aberrant right subclavian artery with type B aortic dissection. A total arch replacement with frozen elephant trunk surgery and an extra-anatomic bypass of right subclavian artery were performed. Type B aortic dissection is more often an incidental finding and its association with aberrant right subclavian artery is unusual. Such association should be identified and treated accordingly to avert clinical complications.
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Affiliation(s)
| | - Mohammed Idhrees
- Institute of Cardiac and Aortic Disorders, SIMS Hospital, Chennai, 600026 India
| | - Mohammed Ibrahim
- Institute of Cardiac and Aortic Disorders, SIMS Hospital, Chennai, 600026 India
| | | | - Bashi Velayudhan
- Institute of Cardiac and Aortic Disorders, SIMS Hospital, Chennai, 600026 India
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Thiene G, Rizzo S, Basso C. Bicuspid aortic valve: The most frequent and not so benign congenital heart disease. Cardiovasc Pathol 2024; 70:107604. [PMID: 38253300 DOI: 10.1016/j.carpath.2024.107604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 01/10/2024] [Accepted: 01/10/2024] [Indexed: 01/24/2024] Open
Abstract
Bicuspid aortic valve (BAV) is the most frequent congenital heart disease, with an incidence of approximately 1%. It can be silent and associated with normal valve function. However, a series of complications, even catastrophic, may occur with time: valve incompetence, valve stenosis by dystrophic calcification, infective endocarditis, progressive dilatation of the ascending aorta, aortic dissection, sudden death. The problem of BAV is not just about the number of semilunar cusps, but also the aortic wall. Severe noninflammatory degenerative changes (elastic fiber fragmentation, smooth muscle cells death, mucoid extracellular matrix accumulation=MEMA) are observed in the aortic wall of BAV patients, with intrinsic weakness accounting for progressive aneurysmal dilatation of the ascending aorta, valve incompetence, and wall dissection. The link between valve and aortic wall pathology finds most probably an explanation in the embryology of the arterial pole since neurocrestal cells play a role in the development of both the ascending aorta, aortic arch, and semilunar valves. The frequent association of adult aortic coarctation and BAV provides evidence for this hypothesis. BAV has a significant genetic component as to require screening of first-degree relatives, as outlined by AHA/ACC 2022 guidelines.
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Affiliation(s)
- Gaetano Thiene
- Cardiovascular Pathology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua Medical School, Padova, Italy.
| | - Stefania Rizzo
- Cardiovascular Pathology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua Medical School, Padova, Italy
| | - Cristina Basso
- Cardiovascular Pathology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua Medical School, Padova, Italy
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Xiao H, Song L, Tao L. The relationship between uric acid and in-hospital mortality in patients with type A acute aortic dissection: A retrospective single-center study. Asian J Surg 2024; 47:229-232. [PMID: 37596211 DOI: 10.1016/j.asjsur.2023.08.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 07/16/2023] [Accepted: 08/06/2023] [Indexed: 08/20/2023] Open
Abstract
OBJECTIVE To measure the preoperative uric acid (UA) concentration in patients with type A aortic dissection (TAAD), and to assess its value in predicting in-hospital mortality. METHODS A total of 747 patients with TAAD between January 2016 and December 2022 were enrolled. The patients were divided into a survivor group and a non-survivor group. The clinical data of the two groups were compared. Univariate and multiple logistic regression analyses were performed to determine risk factors related to in-hospital mortality. RESULTS Compared with survivors, non-survivors had significantly higher serum uric acid levels (486.84 ± 127.59 vs 419.49 ± 141.02, P = 0.040). The incidence of in-hospital death increased along with higher UA levels (3.8% vs 0.7%, P = 0.007). Serum UA ≥ 373.5 μmol/L had 89.5% sensitivity and 41.3% specificity for predicting in-hospital death (area under the curve = 0.659, 95% CI: 0.554-0.765, P < 0.05). In the multivariable logistic model, Serum UA ≥ 373.5 μmol/L was independently associated with in-hospital mortality (OR = 1.022, 95% CI: 1.000-1.044, P = 0.048). CONCLUSION Serum UA resulted as an independent predictor of adverse prognosis in patients with TAAD, and thus could be used as an effective tool for the risk-stratification of patients with TAAD.
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Affiliation(s)
- Hongyan Xiao
- Department of Cardiac Surgery, Wuhan Asia Heart Hospital Affiliated with the Wuhan University of Science and Technology, Wuhan, Hubei, PR China; Wuhan Clinical Research Center for Cardiomyopathy, Wuhan, Hubei, PR China
| | - Laichun Song
- Department of Cardiac Surgery, Wuhan Asia Heart Hospital Affiliated with the Wuhan University of Science and Technology, Wuhan, Hubei, PR China; Wuhan Clinical Research Center for Cardiomyopathy, Wuhan, Hubei, PR China
| | - Liang Tao
- Department of Cardiac Surgery, Wuhan Asia Heart Hospital Affiliated with the Wuhan University of Science and Technology, Wuhan, Hubei, PR China; Wuhan Clinical Research Center for Cardiomyopathy, Wuhan, Hubei, PR China.
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Che J, Yang B, Xie Y, Wang L, Chang Y, Han J, Zhang H. A precise blood transfusion evaluation model for aortic surgery: a single-center retrospective study. J Clin Monit Comput 2023:10.1007/s10877-023-01112-3. [PMID: 38150125 DOI: 10.1007/s10877-023-01112-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 11/21/2023] [Indexed: 12/28/2023]
Abstract
Cardiac aortic surgery is an extremely complicated procedure that often requires large volume blood transfusions during the operation. Currently, it is not possible to accurately estimate the intraoperative blood transfusion volume before surgery. Therefore, in this study, to determine the clinically precise usage of blood for intraoperative blood transfusions during aortic surgery, we established a predictive model based on machine learning algorithms. We performed a retrospective analysis on 4,285 patients who received aortic surgery in Beijing Anzhen Hospital between January 2018 and September 2022. Ultimately, 3,654 patients were included in the study, including 2,557 in the training set and 1,097 in the testing set. By utilizing 13 current mainstream models and a large-scale cardiac aortic surgery dataset, we built a novel machine learning model for accurately predicting intraoperative red blood cell transfusion volume. Based on the transfusion-related risk factors that the model identified, we also established the relevant variables that affected the results. The results revealed that decision tree models were the most suitable for predicting the blood transfusion volume during aortic surgery. In particular, the mean absolute error for the best-performing extremely randomized forest model was 1.17 U, while the R2 value was 0.50. Further exploration into intraoperative blood transfusion during aortic surgery identified erythrocytes, estimated operation duration, body weight, sex, red blood cell count, and D-dimer as the six most significant risk factors. These factors were subsequently analyzed for their influence on intraoperative blood transfusion volume in relevant patients, as well as the protective threshold for prediction. The novel intraoperative blood transfusion prediction model for cardiac aorta surgery in this study effectively assists clinicians in accurately calculating blood transfusion volumes and achieving effective utilization of blood resources. Furthermore, we utilize interpretability technology to reveal the influence of critical risk factors on intraoperative blood transfusion volume, which provides an important reference for physicians to provide timely and effective interventions. It also enables personalized and precise intraoperative blood usage.
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Affiliation(s)
- Ji Che
- Department of Transfusion, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
| | - Bo Yang
- Department of Cardiovascular Surgery, Beijing Aortic Disease Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yan Xie
- Beijing HealSci Technology Co., Ltd, Beijing, China
| | - Lei Wang
- Beijing HealSci Technology Co., Ltd, Beijing, China
| | - Ying Chang
- Department of Transfusion, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Jianguo Han
- Department of Transfusion, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Hui Zhang
- Department of Transfusion, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
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Toimela JM, Sedha J, Hedman M, Valtola A, Selander T, Husso A. Twenty years' experience of type B aortic dissections: a population-based national registry study from Finland. Interdiscip Cardiovasc Thorac Surg 2023; 37:ivad184. [PMID: 37947327 PMCID: PMC10651432 DOI: 10.1093/icvts/ivad184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Revised: 08/13/2023] [Accepted: 11/06/2023] [Indexed: 11/12/2023]
Abstract
OBJECTIVES The objective of this study was to investigate the incidence, treatment and survival of Stanford type B aortic dissection (BTAD) during 20 years in the Finnish population. METHODS Data collection was made from the Nationwide Care Register for Health Care, Finnish National Institute for Health and Welfare. All patients over 15 years of age with BTAD from 2000 to 2019 were included in the study. A data search of the Registry of Death Cause (Statistic Finland) was carried out to identify the date and cause of death. RESULTS There were 1742 cases of BTAD during the study period. BTAD represented 45.6% of all aortic dissections leading to hospital admission. Incidence for BTAD was 1.62 per 100 000 inhabitants per year. The median survival was 12.7 years [95% confidence interval (CI) 9.63-14.7], 12.4 years (95% CI 10.5-14.4) and 8.6 years (95% CI 7.5-9.7) for patients treated with thoracic endovascular aortic repair (TEVAR), surgery and medical treatment (MT), respectively. Survival was significantly better after TEVAR and surgery, compared to MT only (P < 0.001). Age-adjusted survival was significantly better after TEVAR compared to patients treated with MT or surgery (hazard ratio 0.578, 95% CI 0.420-0.794, P < 0.001). Aortic-related death was the most common cause of death in all groups (41%). CONCLUSIONS The incidence of BTAD seems to be similar in the Finnish population compared to other populational studies. Patients treated with TEVAR had significantly better survival compared to other patients. A high risk for late aortic-related death should be recognized in patients with BTAD.
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Affiliation(s)
| | - Jagdeep Sedha
- Department of Medicine, University of Eastern Finland, Kuopio, Finland
| | - Marja Hedman
- Department of Cardiothoracic Surgery, Kuopio University Hospital, Kuopio, Finland
- Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Antti Valtola
- Department of Cardiothoracic Surgery, Kuopio University Hospital, Kuopio, Finland
| | - Tuomas Selander
- Science Service Center, Kuopio University Hospital, Kuopio, Finland
| | - Annastiina Husso
- Department of Cardiothoracic Surgery, Kuopio University Hospital, Kuopio, Finland
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Stonko DP, Hicks CW. Mature artificial intelligence- and machine learning-enabled medical tools impacting vascular surgical care: A scoping review of late-stage, US Food and Drug Administration-approved or cleared technologies relevant to vascular surgeons. Semin Vasc Surg 2023; 36:460-470. [PMID: 37863621 PMCID: PMC10589449 DOI: 10.1053/j.semvascsurg.2023.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 06/14/2023] [Accepted: 06/20/2023] [Indexed: 10/22/2023]
Abstract
Artificial intelligence and machine learning (AI/ML)-enabled tools are shifting from theoretical or research-only applications to mature, clinically useful tools. The goal of this article was to provide a scoping review of the most mature AI/ML-enabled technologies reviewed and cleared by the US Food and Drug Administration relevant to the field of vascular surgery. Despite decades of slow progress, this landscape is now evolving rapidly, with more than 100 AI/ML-powered tools being approved by the US Food and Drug Administration each year. Within the field of vascular surgery specifically, this review identified 17 companies with mature technologies that have at least one US Food and Drug Administration clearance, all occurring between 2016 and 2022. The maturation of these technologies appears to be accelerating, with improving regulatory clarity and clinical uptake. The early AI/ML-powered devices extend or amplify clinically entrenched platform technologies and tend to be focused on the diagnosis or evaluation of time-sensitive, clinically important pathologies (eg, reading Digital Imaging and Communications in Medicine-compliant computed tomography images to identify pulmonary embolism), or when physician efficiency or time savings is improved (eg, preoperative planning and intraoperative guidance). The majority (>75%) of these technologies are at the intersection of radiology and vascular surgery. It is becoming increasingly important that the contemporary vascular surgeon understands this shifting paradigm, as these once-nascent technologies are finally maturing and will be encountered with increasingly regularity in daily clinical practice.
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Affiliation(s)
- David P Stonko
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, The Johns Hopkins Hospital, 600 North Wolfe Street, Halsted 668, Baltimore, MD 21287
| | - Caitlin W Hicks
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, The Johns Hopkins Hospital, 600 North Wolfe Street, Halsted 668, Baltimore, MD 21287.
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12
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Haakseth L, Öster C, Wanhainen A, Mani K, Jangland E. Patients' health and quality of life after complex endovascular aortic repair: A prospective cohort study. J Vasc Nurs 2023; 41:132-143. [PMID: 37684091 DOI: 10.1016/j.jvn.2023.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 05/30/2023] [Accepted: 05/30/2023] [Indexed: 09/10/2023]
Abstract
RATIONALE Complex endovascular aortic repair often involves multiple major procedures over time with a high risk of complications and little time for recovery. This exposes patients to great stress, both physically and mentally, with potentially long-lasting effects. There is limited knowledge about these effects and who is most at risk - information on this could help vascular nurses and other healthcare professionals anticipate and meet care needs. AIM To investigate the health and quality of life effects of complex endovascular aortic repair, in relation to patients' demographic and health characteristics. DESIGN A prospective cohort study. METHODS Patients undergoing elective complex endovascular aortic repair were consecutively recruited from one university hospital during one year (n=25). Self-report questionnaires on health disability (WHODAS 2.0), quality of life (WHOQoL-BREF) and symptoms of anxiety and depression (HADS) were filled out preoperatively and repeated one and six months postoperatively. Prospective changes in health and quality of life, and associations with patient demographics and preoperative health characteristics, were assessed. Ethical approval was obtained prior to study performance. RESULTS Overall, patients had significantly greater health disability at one month (WHODAS 2.0 score median 31.5, range 1.1-63.0) than preoperatively (median 13.6, range 0.0-41.3) (n=22, p=.017); the majority had recovered at six months (median 11.4, range 3.3-58.7) (n=18, p=.042). No significant effects were seen in quality of life and symptoms of anxiety and depression (p>.05). However, the participants showed heterogeneity, with certain individuals not recovered at six months (n=8). Factors associated with worse six-month outcomes were being female, age < 70 years, postoperative complications, and history of anxiety or depression. CONCLUSIONS Complex endovascular aortic repair have limited long-term negative effects on patients' health and quality of life. However, some patients are not recovered at six months postoperatively, which could be explained by individual characteristics. To improve recovery outcomes, vascular nurses and other health care professionals should be aware of the possible recovery trajectories and factors associated with impaired recovery, and use them to anticipate and meet the patients' individual care needs.
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Affiliation(s)
- Linda Haakseth
- Department of Surgical Sciences, Nursing, Uppsala University, Entrance 15, Uppsala University Hospital, Uppsala 75185, Sweden.
| | - Caisa Öster
- Department of Medical Sciences, Psychiatry, Uppsala University, Uppsala, Sweden
| | - Anders Wanhainen
- Department of Surgical Sciences, Vascular Surgery, Uppsala University, Uppsala, Sweden; Department of Surgical and Perioperative Sciences, Surgery, Umeå University, Umeå, Sweden
| | - Kevin Mani
- Department of Surgical Sciences, Vascular Surgery, Uppsala University, Uppsala, Sweden
| | - Eva Jangland
- Department of Surgical Sciences, Nursing, Uppsala University, Entrance 15, Uppsala University Hospital, Uppsala 75185, Sweden
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13
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Mehta CK, Chiu S, Hoel AW, Vassallo P, Whippo B, Andrei AC, Schmidt MJ, Pham DT, Johnston DR, Churyla A, Malaisrie SC. Implementation of a direct-to-operating room aortic emergency transfer program: Expedited management of type A aortic dissection. Am J Emerg Med 2023; 70:113-118. [PMID: 37270850 DOI: 10.1016/j.ajem.2023.05.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 05/10/2023] [Accepted: 05/23/2023] [Indexed: 06/06/2023] Open
Abstract
INTRODUCTION Type A Aortic Dissection (TAAD) is a surgical emergency with a time-dependent rate of mortality. We hypothesized that a direct-to-operating room (DOR) transfer program for patients with TAAD would reduce time to intervention. METHODS A DOR program was started at an urban tertiary care hospital in February 2020. We performed a retrospective study of adult patients undergoing treatment for TAAD before (n = 42) and after (n = 84) implementation of DOR. Expected mortality was calculated using the International Registry of Acute Aortic Dissection risk prediction model. RESULTS Median time from acceptance of transfer from emergency physician to operating room arrival was 1.37 h (82 min) faster in DOR compared to pre-DOR (1.93 h vs 3.30 h, p < 0.001). Median time from arrival to operating room was 1.14 h (72 min) faster after DOR compared to pre-DOR (0.17 h vs 1.31 h, p < 0.001). In-hospital mortality was 16.2% in pre-DOR, with an observed-to-expected (O/E) ratio of 1.03 (p = 0.24) and 12.0% in the DOR group, with an O/E ratio of 0.59 (p < 0.001). CONCLUSION Creation of a DOR program resulted in decreased time to intervention. This was associated with a decrease in observed-to-expected operative mortality. The transfer of patients with acute type A aortic dissection to centers with direct-to-OR programs may result in decreased time from diagnosis to surgery.
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Affiliation(s)
- Christopher K Mehta
- Division of Cardiac Surgery, Northwestern Feinberg School of Medicine and Northwestern Medicine, Chicago, IL, USA.
| | - Stephen Chiu
- Division of Cardiac Surgery, Northwestern Feinberg School of Medicine and Northwestern Medicine, Chicago, IL, USA
| | - Andrew W Hoel
- Division of Vascular Surgery, Department of Surgery, Northwestern Feinberg School of Medicine and Northwestern Medicine, Chicago, IL, USA
| | - Patricia Vassallo
- Division of Cardiology, Department of Medicine, Northwestern Feinberg School of Medicine and Northwestern Medicine, Chicago, IL, USA
| | - Beth Whippo
- Division of Cardiology, Department of Medicine, Northwestern Feinberg School of Medicine and Northwestern Medicine, Chicago, IL, USA
| | - Adin Cristian Andrei
- Division of Biostatistics, Department of Preventative Medicine, Northwestern University, Chicago, IL, USA
| | - Michael J Schmidt
- Department of Emergency Medicine, Northwestern University, Chicago, IL, USA
| | - Duc Thinh Pham
- Division of Cardiac Surgery, Northwestern Feinberg School of Medicine and Northwestern Medicine, Chicago, IL, USA
| | - Douglas R Johnston
- Division of Cardiac Surgery, Northwestern Feinberg School of Medicine and Northwestern Medicine, Chicago, IL, USA
| | - Andrei Churyla
- Division of Cardiac Surgery, Northwestern Feinberg School of Medicine and Northwestern Medicine, Chicago, IL, USA
| | - S Chris Malaisrie
- Division of Cardiac Surgery, Northwestern Feinberg School of Medicine and Northwestern Medicine, Chicago, IL, USA
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14
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Filiberto AC, Miao S, Ren Y, Ozrazgat-Baslanti T, Hensley SE, Jacobs CR, Weaver ML, Upchurch GR, Bihorac A, Cooper M. Bilateral renal artery stenosis impacts postoperative complications after major vascular surgery. Surg Open Sci 2023; 14:17-21. [PMID: 37409074 PMCID: PMC10319299 DOI: 10.1016/j.sopen.2023.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 06/04/2023] [Indexed: 07/07/2023] Open
Abstract
Background Incidental atherosclerotic renal artery stenosis (RAS) is common in patients undergoing vascular surgery and has been shown to be associated with postoperative AKI among patients undergoing major non-vascular surgeries. We hypothesized that patients with RAS undergoing major vascular procedures would have a higher incidence of AKI and postoperative complications than those without RAS. Methods A single-center retrospective cohort study of 200 patients who underwent elective open aortic or visceral bypass surgery (100 with postoperative AKI; 100 without AKI) were identified. RAS was then evaluated by review of pre-surgery CTAs with readers blinded to AKI status. RAS was defined as ≥50 % stenosis. Univariate and multivariable logistic regression was used to assess association of unilateral and bilateral RAS with postoperative outcomes. Results 17.4 % (n = 28) of patients had unilateral RAS while 6.2 % (n = 10) of patients had bilateral RAS. Patients with bilateral RAS had similar preadmission creatinine and GFR as compared to unilateral RAS or no RAS. 100 % (n = 10) of patients with bilateral RAS had postoperative AKI compared with 45 % (n = 68) of patients with unilateral or no RAS (p < 0.05). In adjusted logistic regression models, bilateral RAS predicted severe AKI (OR 5.82; CI 1.33, 25.53; p = 0.02), in-hospital mortality (OR 5.71; CI 1.03, 31.53; p = 0.05), 30-day mortality (OR 10.56; CI 2.03, 54.05; p = 0.005) and 90-day mortality (OR 6.88; CI 1.40, 33.87; p = 0.02). Conclusions Bilateral RAS is associated with increased incidence of AKI as well as in-hospital, 30-day, and 90-day mortality suggesting it is a marker of poor outcomes and should be considered in preoperative risk stratification.
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Affiliation(s)
- Amanda C. Filiberto
- Department of Surgery, University of Florida, Gainesville, FL, United States of America
| | - Shunshun Miao
- Precision and Intelligent Systems in Medicine (PrismaP), University of Florida, Gainesville, FL, United States of America
- Department of Medicine, University of Florida, Gainesville, FL, United States of America
| | - Yuanfang Ren
- Precision and Intelligent Systems in Medicine (PrismaP), University of Florida, Gainesville, FL, United States of America
- Department of Medicine, University of Florida, Gainesville, FL, United States of America
| | - Tezcan Ozrazgat-Baslanti
- Precision and Intelligent Systems in Medicine (PrismaP), University of Florida, Gainesville, FL, United States of America
- Department of Medicine, University of Florida, Gainesville, FL, United States of America
| | - Sara E. Hensley
- Department of Surgery, University of Florida, Gainesville, FL, United States of America
| | - Christopher R. Jacobs
- Department of Surgery, University of Florida, Gainesville, FL, United States of America
| | - M. Libby Weaver
- Department of Surgery, University of Florida, Gainesville, FL, United States of America
| | - Gilbert R. Upchurch
- Department of Surgery, University of Florida, Gainesville, FL, United States of America
| | - Azra Bihorac
- Precision and Intelligent Systems in Medicine (PrismaP), University of Florida, Gainesville, FL, United States of America
- Department of Medicine, University of Florida, Gainesville, FL, United States of America
| | - Michol Cooper
- Department of Surgery, University of Florida, Gainesville, FL, United States of America
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15
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Nisi F, Carenzo L, Ruggieri N, Reda A, Pascucci MG, Pignataro A, Civilini E, Piccioni F, Giustiniano E. The anesthesiologist's perspective on emergency aortic surgery: Preoperative optimization, intraoperative management, and postoperative surveillance. Semin Vasc Surg 2023; 36:363-379. [PMID: 37330248 DOI: 10.1053/j.semvascsurg.2023.04.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 04/23/2023] [Accepted: 04/25/2023] [Indexed: 06/19/2023]
Abstract
The management of emergencies related to the aorta requires a multidisciplinary approach involving various health care professionals. Despite technological advancements in treatment methods, the risks and mortality rates associated with surgery remain high. In the emergency department, definitive diagnosis is usually obtained through computed tomography angiography, and management focuses on controlling blood pressure and treating symptoms to prevent further deterioration. Preoperative resuscitation is the main focus, followed by intraoperative management aimed at stabilizing the patient's hemodynamics, controlling bleeding, and protecting vital organs. After the operation, factors such as organ protection, transfusion management, pain control, and overall patient care must be taken into account. Endovascular techniques are becoming more common in surgical treatment, but they also present new challenges in terms of complications and outcomes. It is recommended that patients with suspected ruptured abdominal aortic aneurysms be transferred to facilities with both open and endovascular treatment options and a track record of successful outcomes to ensure the best patient care and long-term results. To achieve optimal patient outcomes, close collaboration and regular case discussions between health care professionals are necessary, as well as participation in educational programs to promote a culture of teamwork and continuous improvement.
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Affiliation(s)
- Fulvio Nisi
- Department of Anesthesia and Intensive Care Units, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy.
| | - Luca Carenzo
- Department of Anesthesia and Intensive Care Units, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Nadia Ruggieri
- Department of Anesthesia and Intensive Care Units, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Antonio Reda
- Department of Anesthesia and Intensive Care Units, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | | | - Arianna Pignataro
- Vascular Surgery Unit, IRCCS Humanitas Research Hospital, Rozzano, Milan Italy
| | - Efrem Civilini
- Vascular Surgery Unit, IRCCS Humanitas Research Hospital, Rozzano, Milan Italy
| | - Federico Piccioni
- Department of Anesthesia and Intensive Care Units, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Enrico Giustiniano
- Department of Anesthesia and Intensive Care Units, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy
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16
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Christodoulou KC, Karangelis D, Efenti GM, Sdrevanos P, Browning JR, Konstantinou F, Georgakarakos E, Mitropoulos FA, Mikroulis D. Current knowledge and contemporary management of non-A non-B aortic dissections. World J Cardiol 2023; 15:244-252. [PMID: 37274377 PMCID: PMC10237007 DOI: 10.4330/wjc.v15.i5.244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Revised: 04/10/2023] [Accepted: 04/25/2023] [Indexed: 05/19/2023] Open
Abstract
Non-A non-B aortic dissection (AAD) is an infrequently documented condition, comprising of only a small proportion of all AADs. The unique anatomy of the aortic arch and the failure of the existing classifications to adequately define individuals with non-A non-B AAD, have led to an ongoing controversy around the topic. It seems that the clinical progression of acute non-A non-B AAD diverges from the typical type A and B dissections, frequently leading to serious complications and thus mandating early intervention. Currently, the available treatment methods in the surgical armamentarium are conventional open, endovascular techniques and combined hybrid methods. The optimum approach is tailored in every individual case and may be determined by the dissection’s location, extent, the aortic diameter, the associated complications and the patient’s status. The management of non-A non-B dissections still remains challenging and a unanimous consensus defining the gold standard treatment has yet to be reached. In an attempt to provide further insight into this perplexing entity, we performed a minireview of the literature, aiming to elucidate the epidemiology, clinical course and the optimal treatment modality.
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Affiliation(s)
- Konstantinos C Christodoulou
- Department of Cardiac Surgery, Democritus University of Thrace, University Hospital of Alexandroupolis, Alexandroupolis 68100, Greece
| | - Dimos Karangelis
- Department of Cardiac Surgery, Democritus University of Thrace, University Hospital of Alexandroupolis, Alexandroupolis 68100, Greece
| | | | | | - Jennifer R Browning
- Department of Cardiac Surgery, Democritus University of Thrace, University Hospital of Alexandroupolis, Alexandroupolis 68100, Greece
| | - Fotis Konstantinou
- Department of Cardiac Surgery, Democritus University of Thrace, University Hospital of Alexandroupolis, Alexandroupolis 68100, Greece
| | - Efstratios Georgakarakos
- Department of Vascular Surgery, University Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis 68100, Greece
| | | | - Dimitrios Mikroulis
- Department of Cardiac Surgery, Democritus University of Thrace, University Hospital of Alexandroupolis, Alexandroupolis 68100, Greece
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17
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Jaffar-Karballai M, Kayali F, Botezatu B, Satti DI, Harky A. The Rationalisation of Intra-Operative Imaging During Cardiac Surgery: A Systematic Review. Heart Lung Circ 2023; 32:567-586. [PMID: 36870922 DOI: 10.1016/j.hlc.2023.01.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 01/25/2023] [Accepted: 01/29/2023] [Indexed: 03/05/2023]
Abstract
INTRODUCTION One critical complication of cardiac surgery is cerebrovascular accidents (CVAs). Ascending aorta atherosclerosis poses a significant risk of embolisation to distal vessels and to cerebral arteries. Epi-aortic ultrasonography (EUS) is thought to offer a safe, high-quality accurate visualisation of the diseased aorta to guide the surgeon on the best surgical approach to the planned procedure and potentially improve neurological outcomes post-cardiac surgery. METHOD The authors conducted a comprehensive search of PubMed, Scopus and Embase. Studies that reported on epi-aortic ultrasound use in cardiac surgery were included. Major exclusion criteria were: (1) abstracts, conference presentations, editorials, literature reviews; (2) case series with <5 participants; (3) epi-aortic ultrasound in trauma or other surgeries. RESULTS A total of 59 studies and 48,255 patients were included in this review. Out of the studies that reported patient co-morbidities prior to cardiac surgery, 31.6% had diabetes, 59.5% had hyperlipidaemia and 66.1% had a diagnosis of hypertension. Of those that reported significant ascending aorta atherosclerosis found on EUS, this ranged from 8.3% of patients to 95.2% with a mean percentage of 37.8%. Hospital mortality ranged from 7% to 13%; four studies reported zero deaths. Long-term mortality and stroke rate varied significantly with hospital duration. CONCLUSION Current data have shown EUS to have superiority over manual palpation and transoesophageal echocardiography in the prevention of CVAs following cardiac surgery. Yet, EUS has not been implemented as a routine standard of care. Extensive adoption of EUS in clinical practice is warranted to aid large, randomised trials before making prospective conclusions on the efficacy of this screening method.
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Affiliation(s)
| | - Fatima Kayali
- School of Medicine, University of Central Lancashire, Preston, UK
| | - Bianca Botezatu
- Queen's University Belfast, School of Medicine, Dentistry and Biomedical Sciences, Belfast, Northern Ireland
| | - Danish Iltaf Satti
- Shifa College of Medicine, Shifa Tameer-e-millat University, Islamabad, Pakistan
| | - Amer Harky
- Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK; Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart and Chest Hospital, Liverpool, UK.
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Luehr M, Gaisendrees C, Yilmaz AK, Winderl L, Schlachtenberger G, Van Linden A, Wahlers T, Walther T, Holubec T. Treatment of acute type A aortic dissection with the Ascyrus Medical Dissection Stent in a consecutive series of 57 cases. Eur J Cardiothorac Surg 2023; 63:6957090. [PMID: 36548434 DOI: 10.1093/ejcts/ezac581] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 12/18/2022] [Accepted: 12/21/2022] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES The Ascyrus Medical Dissection Stent (AMDS) has been recently introduced as an alternative for total arch replacement in acute aortic dissection type A (AADA). The aim of this study was to evaluate the postoperative outcomes after AMDS treatment in a large contemporary cohort of AADA patients. METHODS Data acquisition was performed retrospectively at 2 German aortic centres between 2020 and 2022 and comprised the perioperative parameters and postoperative results of all AADA patients. All patients treated with the AMDS for AADA were included in the study. The primary end point was in-hospital mortality. Secondary end points were defined as early postoperative and AMDS-related complications. RESULTS Fifty-seven AADA patients treated by AMDS were included in the study group. The mean age was 64.6 ± 10.8 years and 59.7% (n = 34) were males. The actual in-hospital mortality was considerably lower than the predicted mortality risk by the German registry for acute aortic dissection type A score (16% vs 22%). The median ICU and in-hospital stay were 5 (interquartile range: 3-13) and 12 (interquartile range: 10-22) days, respectively. Postoperative complications comprised acute renal insufficiency (37%) with need for temporary (16%) or permanent dialysis (5%), delirium (26%), re-exploration for bleeding (14%), tracheostomy (14%) and new stroke (4%). A new AMDS-related complication (central stent collapse) was observed in 9% (n = 5) by postoperative computed tomography and chest X-ray. The incidence of complete central AMDS collapse did not impact 30-day mortality. CONCLUSIONS The AMDS may be successfully used in AADA with acceptable 30-day mortality in accordance with the German registry for acute aortic dissection type A score. However, careful preoperative evaluation of the patient's individual aortic anatomy regarding potential contraindications and proper device implantation are strongly recommended to avoid complete central AMDS collapse.
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Affiliation(s)
- Maximilian Luehr
- Department of Cardiothoracic Surgery, Heart Centre, University of Cologne, Cologne, Germany
| | | | - Abdul Kadir Yilmaz
- Department of Cardiovascular Surgery, Goethe University and University Hospital Frankfurt, Frankfurt, Germany
| | - Leila Winderl
- Department of Cardiothoracic Surgery, Heart Centre, University of Cologne, Cologne, Germany
| | - Georg Schlachtenberger
- Department of Cardiothoracic Surgery, Heart Centre, University of Cologne, Cologne, Germany
| | - Arnaud Van Linden
- Department of Cardiovascular Surgery, Goethe University and University Hospital Frankfurt, Frankfurt, Germany
| | - Thorsten Wahlers
- Department of Cardiothoracic Surgery, Heart Centre, University of Cologne, Cologne, Germany
| | - Thomas Walther
- Department of Cardiovascular Surgery, Goethe University and University Hospital Frankfurt, Frankfurt, Germany
| | - Tomas Holubec
- Department of Cardiovascular Surgery, Goethe University and University Hospital Frankfurt, Frankfurt, Germany
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El-Sayed Ahmad A, Silaschi M, Borger M, Seidiramool V, Hamiko M, Leontyev S, Zierer A, Doss M, Etz CD, Benedikt P, Bramlage P, Bakhtiary F. The Frozen Elephant Technique Using a Novel Hybrid Prosthesis for Extensive Aortic Arch Disease: A Multicentre Study. Adv Ther 2023; 40:1104-13. [PMID: 36633731 DOI: 10.1007/s12325-022-02418-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Accepted: 12/20/2022] [Indexed: 01/13/2023]
Abstract
INTRODUCTION The frozen elephant trunk technique (FET) has become routine for aortic arch and descending aortic repair. New hybrid prosthesis models are constantly being developed to increase effectiveness and durability of aortic repair. Recently, concerns were raised regarding increased post-operative bleeding using a new-generation hybrid prosthesis (E-vita® OPEN NEO, CryoLife Inc. JOTEC GmbH, Hechingen, Germany). We report the outcomes of a multi-centre experience of using the E-vita OPEN NEO. METHODS All patients undergoing aortic surgery at five European centres using the E-vita OPEN NEO from 2020 to 2022 were included (n = 22). The primary endpoint was the amount of chest drain fluid after 24 h and re-thoracotomy rate for bleeding. RESULTS Median patient age was 62.5 ± 12.6 years, 50.0% (11/22 patients) were female and 27.3% (6/22) of procedures were re-operative cardiac surgeries. Aortic dissection was present in 54.5% (12/22). The median cardiopulmonary bypass time was 148 min and ischaemia time was 84 min. Mortality at 30 days was 4.5% (1/22) and the stroke rate was 18.2% (4/22). The rate of re-thoracotomy for bleeding was 4.5% (1/22) with a median amount of chest drain fluid within 24 h of 569 (IQR 338-910) ml. There were no device-associated adverse events. CONCLUSIONS Use of this new-generation hybrid prosthesis for FET was safe and effective. Patient follow-up was largely uneventful given the extent of the procedures performed. In particular, bleeding events were uncommon in this cohort of patients comprising many aortic dissections and re-operative procedures. No increase in oozing was observed.
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Hiremath N, Bhatnagar G, Mapara K, Younes H, Park WM. Hybrid repair of type II thoracoabdominal aortic aneurysm using modified branch-first technique. J Vasc Surg Cases Innov Tech 2023; 9:101105. [PMID: 36852319 PMCID: PMC9958055 DOI: 10.1016/j.jvscit.2023.101105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 12/17/2022] [Accepted: 01/05/2023] [Indexed: 01/20/2023] Open
Abstract
The hybrid modified branch-first technique has extended the feasibility of open thoracoabdominal aortic aneurysm (TAAA) repair in otherwise hostile aortic anatomy that is not entirely amenable for extent II open TAAA conventional repair or total endovascular repair. The modified branch-first open TAAA technique has been developed successfully at our center and has been used to treat extent III TAAAs with successful outcomes. By combining the modified technique with endovascular thoracic aortic repair, we have been able to successfully extend its use to more extensive extent II TAAAs. This could prove to be a useful technique in the armamentarium of aortic surgeons.
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Affiliation(s)
- Niranjan Hiremath
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, OH,Education Department, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates,Correspondence: Niranjan Hiremath, MCh, FVES, FACS(Aus), Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, and Education Institute, Department of Cardiac Surgery, Heart, Vascular and Thoracic Institute, Cleveland Clinic Abu Dhabi, Al Maryah Island, Abu Dhabi 112412, United Arab Emirates
| | - Gopal Bhatnagar
- Department of Cardiac Surgery, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Khubaib Mapara
- Department of Vascular Surgery, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Houssam Younes
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, OH,Department of Vascular Surgery, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Woosup Michael Park
- Department of Surgery, Case Western Reserve University, University Hospital, Cleveland, OH
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Lorenz V, Muzzi L, Tommasino G, Tucci E, Neri E. (s)INE: (soft-graft)-induced new entry tear after elephant trunk procedure. Interdiscip Cardiovasc Thorac Surg 2023; 36:6976705. [PMID: 36802253 PMCID: PMC9931071 DOI: 10.1093/icvts/ivac283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 11/17/2022] [Accepted: 11/26/2022] [Indexed: 01/10/2023]
Abstract
Elephant trunk and frozen elephant trunk are established procedures for the treatment of aortic arch pathologies, such as aneurysm or dissection. The aim of open surgery is to re-expand the true lumen, favouring correct organ perfusion and the thrombosis of the false lumen. Frozen elephant trunk, with its stented endovascular portion, is sometimes associated with a life-threatening complication: the stent graft-induced new entry. In the literature, many studies reported the incidence of such issue after thoracic endovascular prosthesis or frozen elephant trunk, but in our knowledge, there are no case studies about the occurrence of stent graft-induced new entry with the use of soft grafts. For this reason, we decided to report our experience, highlighting how the use of a Dacron graft can cause distal intimal tears. We decided to coin the term soft-graft-induced new entry to indicate the development of an intimal tear induced by the soft prosthesis in the arch and proximal descending aorta.
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Affiliation(s)
- Veronica Lorenz
- Corresponding author. Cardiac Surgery—Aortic Unit, University of Study of Siena, Viale Bracci 1, Siena 53100, Italy. Tel: +39-0577-585731; e-mail: (V. Lorenz)
| | - Luigi Muzzi
- Cardiac Surgery—Aortic Unit, University of Study of Siena, Siena, Italy
| | - Giulio Tommasino
- Cardiac Surgery—Aortic Unit, University of Study of Siena, Siena, Italy
| | - Enrico Tucci
- Cardiac Surgery—Aortic Unit, University of Study of Siena, Siena, Italy
| | - Eugenio Neri
- Cardiac Surgery—Aortic Unit, University of Study of Siena, Siena, Italy
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22
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Weissler EH, Hammill BG, Armstrong JL, Vekstein AM, Chodavadia P, Long CA, Roe M, Hughes GC. Association Between Device Type and Type IIIb Endoleaks Following Thoracic Endovascular Aortic Repair. Eur J Vasc Endovasc Surg 2023; 65:112-119. [PMID: 36209962 DOI: 10.1016/j.ejvs.2022.10.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 08/24/2022] [Accepted: 10/02/2022] [Indexed: 01/17/2023]
Abstract
OBJECTIVE Endoleaks following thoracic endovascular aortic repair (TEVAR) can lead to the need for re-intervention and aortic rupture. Given the recent recall of a specific thoracic stent graft type due to concerns about type IIIb endoleak (T3bE), in which blood leaks through the stent graft fabric, the aim was to characterise patterns of T3bEs among available TEVAR devices. METHODS Reports related to thoracic stent grafts in the Food and Drug Administration's (FDA) Manufacturer and User Facility Device Experience (MAUDE) database between 2010 and 2020 were reviewed. Proportional reporting ratios (PRRs) and chi squared tests were used to assess for the presence of a signal of association between device type and T3bE. A PRR > 2 and chi squared value > 4 with three or more reports overall constituted a signal of association. The institutional database of patients undergoing TEVAR for thoracic aneurysms since 2002 was also queried for T3bE. RESULTS There were 7 328 MAUDE reports available for analysis. When analysing T3bEs in the MAUDE database, the lowest PRR was 0.36 (95% confidence interval [CI] 0 - 1.03 in Gore CTAG, nine T3bE among 1 328 reports) and the highest was 2.07 (95% CI 1.72 - 2.42 in Medtronic Valiant, 64 T3bE among 2 520 reports). The T3bE chi squared value for Medtronic Valiant was 17.3. The relationship between Medtronic Valiant and T3bE was ascertainable by MAUDE data as early as 2013. Among 542 TEVARs for an aneurysm indication at Duke University Hospital since 2002, there were eight T3bEs - all in devices with sutured on graft material. CONCLUSION The Medtronic Valiant device met criteria for association with type IIIb endoleaks in the FDA's MAUDE database and met those criteria as early as 2013. A possible relationship between woven graft fabric and T3bEs is supported by the observation that all types of T3bE that occurred among a large number of TEVARs at the institution followed placement of grafts with sutured on woven fabric.
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Affiliation(s)
- E Hope Weissler
- Division of Vascular and Endovascular Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Bradley G Hammill
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Jenna L Armstrong
- Division of Cardiovascular and Thoracic Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Andrew M Vekstein
- Division of Cardiovascular and Thoracic Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Parth Chodavadia
- Division of Cardiovascular and Thoracic Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Chandler A Long
- Division of Vascular and Endovascular Surgery, Duke University School of Medicine, Durham, NC, USA
| | | | - G Chad Hughes
- Division of Cardiovascular and Thoracic Surgery, Duke University School of Medicine, Durham, NC, USA.
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Monard C, Tresson P, Lamblin A, Benatir F, Taverna XJ, Rimmelé T. Intraoperative extracorporeal blood purification therapy during major septic vascular surgery. Crit Care 2022; 26:404. [PMID: 36575522 PMCID: PMC9795654 DOI: 10.1186/s13054-022-04284-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 12/16/2022] [Indexed: 12/28/2022] Open
Affiliation(s)
- Céline Monard
- grid.413852.90000 0001 2163 3825Service d’Anesthésie-Réanimation, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France ,grid.7849.20000 0001 2150 7757EA 7426, PI3 (Pathophysiology of Injury-Induced Immunosuppression), Université Claude Bernard Lyon 1-Biomérieux-Hospices Civils de Lyon, Lyon, France
| | - Philippe Tresson
- grid.413852.90000 0001 2163 3825Service de Chirurgie Vasculaire et Endovasculaire, Hôpital Louis Pradel, Hospices Civils de Lyon, Bron, France ,grid.413852.90000 0001 2163 3825Centre de Référence des Infections Vasculaire Complexes (CRIVasc Network), Hospices Civils de Lyon, Lyon, France
| | - Antoine Lamblin
- grid.413852.90000 0001 2163 3825Service d’Anesthésie-Réanimation, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Farida Benatir
- grid.413852.90000 0001 2163 3825Service d’Anesthésie-Réanimation, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Xavier-Jean Taverna
- grid.413852.90000 0001 2163 3825Service d’Anesthésie-Réanimation, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Thomas Rimmelé
- grid.413852.90000 0001 2163 3825Service d’Anesthésie-Réanimation, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France ,grid.7849.20000 0001 2150 7757EA 7426, PI3 (Pathophysiology of Injury-Induced Immunosuppression), Université Claude Bernard Lyon 1-Biomérieux-Hospices Civils de Lyon, Lyon, France
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24
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Abstract
Patients that require major vascular surgery suffer from widespread atherosclerosis and have multiple comorbidities that place them at increased risk for postoperative complications and require admission to the intensive care unit (ICU). Postoperative critical care of these patients is focused on hemodynamic optimization, and early identification and management of complications to improve outcomes.
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Affiliation(s)
- Milad Sharifpour
- Department of Anesthesiology, Cedars Sinai Medical Center, 8700 Beverly Boulevard #8211, Los Angeles, CA 90048, USA.
| | - Edward A Bittner
- Critical Care-Anesthesiology Fellowship, Department of Anesthesia, Critical Care and Pain Medicine, Harvard Medical School, Massachusetts General Hospital, Boston MA 02114, USA
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25
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Idhrees M, Velayudhan B. Retroaortic left renal vein in open thoracoabdominal aneurysm repair: A modified approach. Eur J Cardiothorac Surg 2022; 62:6693625. [PMID: 36069635 DOI: 10.1093/ejcts/ezac452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 08/25/2022] [Accepted: 09/06/2022] [Indexed: 11/14/2022] Open
Abstract
The incidence of retro aortic left renal vein (raLRV) in less than 6%. This anatomical variation will hinder the exposure and anastomosis of visceral arteries during open thoraco-abdominal aneurysm repair. This may warrant a division and ligation of the raLRV with the conventional retroperitoneal approach. This report describes a modified approach, wherein the vein is not divided without compromising the exposure for surgery.
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Affiliation(s)
- Mohammed Idhrees
- Institute of Cardiac and Aortic Disorders (ICAD), SRM Institutes for Medical Science (SIMS Hospital), Chennai, India
| | - Bashi Velayudhan
- Institute of Cardiac and Aortic Disorders (ICAD), SRM Institutes for Medical Science (SIMS Hospital), Chennai, India
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26
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Nakahara Y, Tsukioka Y, Tateishi R, Ono S, Shioya M, Itoda Y, Kanemura T. Safety of retrograde cerebral perfusion under moderate hypothermia for hemiarch replacement. Gen Thorac Cardiovasc Surg 2022; 70:842-849. [PMID: 35416561 DOI: 10.1007/s11748-022-01814-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 03/23/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVES Aortic surgeries performed under moderate hypothermia require antegrade cerebral perfusion. The influence of retrograde cerebral perfusion under moderate hypothermic circulatory arrest remains unknown. To clarify this effect, this study aimed to compare the early outcomes of retrograde versus antegrade cerebral perfusion under moderate hypothermia for hemiarch replacement. METHODS Between March 2009 and April 2020, 391 hemiarch replacements under moderate hypothermic circulatory arrest via median sternotomy were performed at our institution. Of these, 70 involved retrograde perfusion and 162 involved antegrade perfusion. Propensity score matching was used to compare 61 pairs of retrograde and antegrade cases. RESULTS Retrograde and antegrade strategy under moderate hypothermia resulted in comparable operative mortality (3.3% vs. 1.6%, P > 0.99), permanent neurological deficits (8.5% vs. 6.6%, P > 0.99), and temporary neurological deficits (24.6% vs. 39.3%, P = 0.33). Retrograde surgery was associated with shorter circulatory arrest times (31.4 ± 8.2 min vs. 37.4 ± 12.2 min, P = 0.005) and fewer red blood cell transfusions (4.6 ± 3.9 units vs. 8.2 ± 5.1 units, P < 0.001) than those with antegrade surgery. CONCLUSIONS Retrograde cerebral perfusion under moderate hypothermia for hemiarch replacement yields excellent operative outcomes, equivalent to those achieved using an antegrade strategy.
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Affiliation(s)
- Yoshinori Nakahara
- Department of Cardiovascular Surgery, IMS Katsushika Heart Center, 3-30-1 Horikiri, Katsushika Ward, Tokyo, 124-0006, Japan.
| | - Yusuke Tsukioka
- Department of Cardiovascular Surgery, IMS Katsushika Heart Center, 3-30-1 Horikiri, Katsushika Ward, Tokyo, 124-0006, Japan
| | - Retsu Tateishi
- Department of Cardiovascular Surgery, IMS Katsushika Heart Center, 3-30-1 Horikiri, Katsushika Ward, Tokyo, 124-0006, Japan
| | - Shunya Ono
- Department of Cardiovascular Surgery, IMS Katsushika Heart Center, 3-30-1 Horikiri, Katsushika Ward, Tokyo, 124-0006, Japan
| | - Masato Shioya
- Department of Cardiovascular Surgery, IMS Katsushika Heart Center, 3-30-1 Horikiri, Katsushika Ward, Tokyo, 124-0006, Japan
| | - Yoshifumi Itoda
- Department of Cardiovascular Surgery, IMS Katsushika Heart Center, 3-30-1 Horikiri, Katsushika Ward, Tokyo, 124-0006, Japan
| | - Takeyuki Kanemura
- Department of Cardiovascular Surgery, IMS Katsushika Heart Center, 3-30-1 Horikiri, Katsushika Ward, Tokyo, 124-0006, Japan
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D'Oria M, Kondov S. The central role of cannulation in determining outcomes after surgery for acute type A aortic dissection: where do we stand? Eur J Cardiothorac Surg 2022; 62:6564661. [PMID: 35389475 DOI: 10.1093/ejcts/ezac250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 04/06/2022] [Indexed: 11/12/2022] Open
Affiliation(s)
- Mario D'Oria
- Division of Vascular and Endovascular Surgery, Cardiovascular Department, University Hospital of Trieste ASUGI, Trieste, Italy
| | - Stoyan Kondov
- Department of Cardiovascular Surgery, Faculty of Medicine, University Heart Centre, University Hospital Freiburg, Albert-Ludwigs-University of Freiburg, Freiburg, Germany
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28
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Buğra AK, Buğra A, Kadiroğulları E, Onan B. Incidentally detected aortitis during coronary bypass surgery: A case report. Turk Gogus Kalp Damar Cerrahisi Derg 2022; 30:267-271. [PMID: 36168564 PMCID: PMC9473598 DOI: 10.5606/tgkdc.dergisi.2022.22228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 07/19/2021] [Indexed: 06/16/2023]
Abstract
Aortitis is the inflammation of the aortic wall. In our case, in which we planned elective coronary bypass surgery, a firm and dilated ascending aorta with a pearlescent color was encountered intraoperatively. Histopathological examination revealed extensive lymphoplasmacytic infiltration and storiform fibrosis. Aortitis may be a component of a multisystemic or autoimmune disease. The time of diagnosis may coincide with the asymptomatic period of the systemic disease. This case was presented as it was incidentally detected during coronary bypass surgery and was histopathologically diagnosed as immunoglobulin G4-related aortitis, although it could not be diagnosed in clinical and laboratory evaluations.
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Affiliation(s)
- Abdul Kerim Buğra
- Department of Cardiovascular Surgery, Mehmet Akif Ersoy Thoracic Cardiovascular Surgery Training and Research Hospital, Istanbul, Türkiye
| | - Aytül Buğra
- Department of Histopathology, Council of Forensic Medicine, Istanbul, Türkiye
| | - Ersin Kadiroğulları
- Department of Cardiovascular Surgery, Mehmet Akif Ersoy Thoracic Cardiovascular Surgery Training and Research Hospital, Istanbul, Türkiye
| | - Burak Onan
- Department of Cardiovascular Surgery, Mehmet Akif Ersoy Thoracic Cardiovascular Surgery Training and Research Hospital, Istanbul, Türkiye
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29
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Rusch R, Hoffmann G, Rusch M, Cremer J, Berndt R. Robotic-assisted abdominal aortic surgery: evidence and techniques. J Robot Surg 2022. [PMID: 35244871 DOI: 10.1007/s11701-022-01390-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 02/14/2022] [Indexed: 12/04/2022]
Abstract
In various disciplines, robotic-assisted surgery is a well-proven routine procedure, but have never been established in vascular surgery so far. This review summarizes the results to date of robotic-assisted abdominal aortic surgery (RAAS) in the treatment of aorto-iliac occlusive disease (AIOD) and abdominal aortic aneurysm (AAA).
Web-based literature search of robotic-assisted surgical procedures on the abdominal aorta and iliac arteries between 1990 and 2020 including the Cochrane Library, OVID Medline, Embase, and PubMed medical databases.
All studies conducting Robotic-assisted surgery were included in the quantitative analysis regarding operative and cross-clamping times, conversion rates, mortality and morbidity within the first 30 days, and in-hospital stay. Case reports and case studies (< 5 patients) were not included. Twenty-four studies were deemed thematically eligible for inclusion; after exclusion of duplicate publications, nine met the inclusion criteria for further analysis. A total of 850 patients who had either abdominal aortic aneurysm or aorto-iliac occlusive disease underwent RAAS. One study of abdominal aortic aneurysm, three of aorto-iliac occlusive disease, and five studies of both disease entities were analyzed quantitatively. For AAA, conversion rates ranged from 13.1 to 20% and perioperative mortality ranged from 0 to 1.6% with in-hospital stay of 7 days. For aorto-iliac occlusive disease, conversion rates ranged from 0 to 20%, and perioperative mortality ranged from 0 to 3.6% with in-hospital stay of 5–8 days. RAAS has been shown to be technically feasible with acceptable short-term outcomes and questionable benefits in terms of in-hospital stay and complication rates. RAAS is currently considered only an outsider procedure. Randomized-controlled trials are indispensable for regular use in vascular surgery as well as a clear approval situation for the vascular sector.
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30
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Kronenfeld JP, Kang N, Kenel-Pierre S, Lopez A, Rey J, Fisher F, Karwowski J, Bornak A. Establishing and maintaining a remote vascular surgery aortic program: A single-center 5-year experience at the Veterans Affairs. J Vasc Surg 2022; 75:1063-72. [PMID: 34562570 DOI: 10.1016/j.jvs.2021.08.083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 08/24/2021] [Indexed: 11/20/2022]
Abstract
OBJECTIVE We sought to detail the process of establishing a surgical aortic telehealth program and report the outcomes of a 5-year experience. METHODS A telehealth program was established between two regional Veterans Affairs hospitals, one of which was without a comprehensive aortic surgical program, until such a program was established at the referring institution. A retrospective review was performed of all patients who underwent aortic surgery from 2014 to 2019. The operative data, demographics, perioperative complications, and follow-up data were reviewed. RESULTS From 2014 to 2019, 109 patients underwent aortic surgery for occlusive and aneurysmal disease. Preoperative evaluation and postoperative follow-up were done remotely via telehealth. The median age of the patients was 68 years, 107 were men (98.2%), 28 (25.7%) underwent open aortic repair, and 81 (74.3%) underwent endovascular repair. Of the 109 patients, 101 (92.7%) had a median follow-up of 24.3 months, 5 (4.6%) were lost to follow-up or were noncompliant, 2 (1.8%) were noncompliant with their follow-up imaging studies but responded to telephone interviews, and 1 (0.9%) moved to another state. At the 30-day follow-up, eight patients (7.3%) required readmission. Four complications were managed locally, and four patients (3.6%) required transfer back to the operative hospital for additional care. CONCLUSIONS Telehealth is a great tool to provide perioperative care and long-term follow-up for patients with aortic pathologies in remote locations. Most postoperative care and complications can be managed remotely, and patient compliance for long-term follow-up is high.
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Nakamura K, Ohbe H, Uda K, Matsui H, Yasunaga H. Effectiveness of early rehabilitation following aortic surgery: a nationwide inpatient database study. Gen Thorac Cardiovasc Surg 2022; 70:721-729. [PMID: 35182302 DOI: 10.1007/s11748-022-01786-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 02/03/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVE Exercise immediately after aortic surgery is controversial with limited evidence. The present study aimed to assess whether early rehabilitation commencing within 3 days of aortic surgery improves physical functions at discharge more than usual care in patients after aortic surgery. METHODS We used the Japanese Diagnosis Procedure Combination database, a nationwide inpatient database from more than 1600 acute care hospitals that covers approximately 75% of all intensive care unit (ICU) beds in Japan. We identified patients who underwent open or endovascular aortic surgery and were admitted to the ICU between July 2010 and March 2018. Patients beginning rehabilitation within 3 days of aortic surgery were defined as the early rehabilitation group and the remaining patients as the usual care group. We used inverse probability of treatment weighting analyses to compare outcomes between the two groups. RESULTS Among 121,024 eligible patients, there were 44,746 (37.0%) in the early rehabilitation group and 76,278 (63.0%) in the usual care group. In inverse probability of treatment weighting analyses, Barthel index scores at discharge were significantly higher in the early rehabilitation group than in the usual care group (difference, 4.0; 95% confidence interval, 2.8-5.2). The early rehabilitation group had significantly lower in-hospital mortality, lower total hospitalization costs, shorter ICU stay, and shorter hospital stay than the usual care group. CONCLUSION Early rehabilitation within 3 days of aortic surgery was associated with improved physical functions at discharge, shorter ICU and hospital stays, and lower hospitalization costs without increased mortality.
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Affiliation(s)
- Kensuke Nakamura
- Department of Emergency and Critical Care Medicine, Hitachi General Hospital, 2-1-1, Jonantyo, Hitachi, Ibaraki, 317-0077, Japan
| | - Hiroyuki Ohbe
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.
| | - Kazuaki Uda
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Hiroki Matsui
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
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Novotny T, Staffa R, Tomandl J, Krivka T, Slaby O, Kubicek L, Biros E, Tomandlova M, Vlachovsky R, Sponiar J, Radova L, Konieczna A. l-lactate kinetics after abdominal aortic surgery and intestinal ischemia - An observational cohort study. Int J Surg 2022; 98:106220. [PMID: 34999001 DOI: 10.1016/j.ijsu.2021.106220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 12/12/2021] [Accepted: 12/23/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Postoperative intestinal ischemia is a severe complication in abdominal aortic surgery. Early diagnosis is needed for adequate and timely treatment. We studied the postoperative kinetics of l-lactate in vascular patients to assess its value as a marker for early postoperative intestinal ischemia detection. MATERIAL AND METHODS We performed a prospective non-randomized single-center observational cohort study in eighty elective patients, fifty operated on for abdominal aortic aneurysm (AAA) and thirty for aortoiliac occlusive disease (AIOD). Serum l-lactate was measured preoperatively, intraoperatively, and postoperatively at defined timepoints up to postoperative day 7. Intestinal ischemia was detected using MRI enterocolography. We have used univariate logistic regression and receiver operating characteristics curves for the evaluation of marker accuracy. RESULTS We recorded 6 cases of postoperative intestinal ischemia (7.5%), five non-transmural and one transmural. Two patients died because of this complication (mortality 33%). The comparison of AAA and AIOD cohorts showed a significant difference in l-lactate levels at one intraoperative timepoint, which was attributable to procedure differences. The only preoperative factor associated with higher l-lactate levels at some timepoints was chronic kidney disease. Patients suffering postoperative intestinal ischemia had elevated serum l-lactate levels at multiple timepoints. The most accurate timepoint for diagnosis was 24 h after the declamping of the vascular reconstruction (DC24H), the second was 10 min after declamping. Sensitivity, specificity, positive and negative predictive values at timepoint DC24H were 100%, 82%, 32%, and 100%, respectively. CONCLUSION Serum l-lactate levels might help in the early detection of postoperative intestinal ischemia after aortic surgery if proper timepoints are used. Cutoff values need to be established in large-scale prospective studies.
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33
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Osaka M, Yamamoto R, Suzuki K, Nakajima T, Tsukada T, Mathis B, Sakamoto H, Hiramatsu Y. Total arch replacement with both frozen elephant trunk and transthoracic aorto-axillary extra-anatomical bypass through partial sternotomy for acute aortic dissection in a tracheostomy patient. Gen Thorac Cardiovasc Surg 2022. [PMID: 34993904 DOI: 10.1007/s11748-021-01755-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 11/28/2021] [Indexed: 11/04/2022]
Abstract
Median sternotomy near an existing tracheostoma risks deep sternal wound infection after cardiac surgery. We present herein a case of acute type A aortic dissection in a patient with a permanent tracheostoma after laryngectomy. Total arch replacement with both frozen elephant trunk and extra-anatomical bypass for supra-aortic trunks was performed through T-shaped partial sternotomy, resulting in recovery without deep sternal wound infection.
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34
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de Beaufort HWL, Roefs MM, Daeter EJ, Heijmen RH. Impact of the coronavirus disease 2019 pandemic on volume of thoracic aortic surgery on a national level. Eur J Cardiothorac Surg 2022; 61:854-859. [PMID: 34986237 PMCID: PMC8755400 DOI: 10.1093/ejcts/ezab550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 11/14/2022] [Accepted: 11/22/2021] [Indexed: 11/25/2022] Open
Affiliation(s)
| | | | - Edgar J Daeter
- Department of Cardiothoracic Surgery, St. Antonius Ziekenhuis, Nieuwegein, Netherlands.,Netherlands Heart Registration, Utrecht, Netherlands
| | - Robin H Heijmen
- Department of Cardiothoracic Surgery, St. Antonius Ziekenhuis, Nieuwegein, Netherlands
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35
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Stecker MM, Keselman I. Monitoring cardiac and ascending aortic procedures. Handb Clin Neurol 2022; 186:395-406. [PMID: 35772898 DOI: 10.1016/b978-0-12-819826-1.00009-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Although cardiac and aortic operations have been successfully performed for more than 60 years, the risk of neurologic complications remains high. In particular, the rate of stroke with cardiac operations continues to be significant in the 1%-5% range. Similarly, the risk of stroke with aortic operations remains in the range of 7%-10% despite many years of improving techniques. Because of this persistently high risk, the use of intra-operative neurophysiologic monitoring (IONM) has the potential of improving outcomes. This chapter provides an overview of cardiac/aortic arch procedures from the neurophysiologic standpoint and discusses the roles of different monitoring modalities in detecting injury.
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Affiliation(s)
- Mark M Stecker
- Fresno Institute of Neuroscience, Fresno, CA, United States.
| | - Inna Keselman
- Department of Neurology, University of California Los Angeles, Los Angeles, CA, United States
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Vornetti G, Spinardi L, Mariucci E, Graziano C, Baroni MC, Faccioli L, Donti A. Increased intracranial arterial tortuosity is associated with worse cardiovascular outcome in patients with Loeys-Dietz syndrome. J Clin Neurosci 2021; 96:38-42. [PMID: 34974246 DOI: 10.1016/j.jocn.2021.12.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 12/14/2021] [Accepted: 12/16/2021] [Indexed: 10/19/2022]
Abstract
The aim of our study was to evaluate the association between intracranial arterial tortuosity and cardiovascular outcome in patients with Loeys-Dietz syndrome (LDS). We performed a retrospective analysis of all patients with genetically confirmed LDS who underwent at least one brain MRA at our institution (n = 32); demographic and clinical features were evaluated in relation to the tortuosity of intracranial arteries as measured by tortuosity index (TI), which was calculated using the formula: [(centerline length) / (straight-line length)-1] × 100. Receiver operating characteristic curve analysis for intracranial TI and the binary end point of aortic surgery showed vertebrobasilar TI (VBTI) to be the best classifier among the examined arterial segments (AUC = 0.822). Patients with higher VBTI showed a greater incidence of aortic surgery (p < 0.001) and underwent more surgical and endovascular procedures (p = 0.006), with a higher rate of operations (p = 0.002). Kaplan-Meier analysis showed a significantly longer surgery-free survival in patients with lower arterial tortuosity (p < 0.001). At multivariate analysis, higher VBTI was associated with an increased risk of surgery (p < 0.001), which was independent of gene mutation and patient age. Increased VBTI is a marker of adverse cardiovascular outcome in patients with LDS, which can be easily measured on brain MRA, and may be useful in the management of this heterogeneous patient population.
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Affiliation(s)
- Gianfranco Vornetti
- Neuroradiology Unit, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.
| | - Luca Spinardi
- Neuroradiology Unit, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Elisabetta Mariucci
- Pediatric Cardiology and GUCH Unit, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Claudio Graziano
- Department of Medical Genetics, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Maria Chiara Baroni
- Department of Medical Genetics, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Luca Faccioli
- Neuroradiology Unit, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Andrea Donti
- Pediatric Cardiology and GUCH Unit, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
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Luehr M, Wahlers T. Predictive risk scores for patients with acute type A aortic dissection: Magic 8-Ball or inconvenient truth? Eur J Cardiothorac Surg 2021; 61:386-387. [PMID: 34788435 DOI: 10.1093/ejcts/ezab487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 09/23/2021] [Indexed: 11/14/2022] Open
Affiliation(s)
- Maximilian Luehr
- Department of Cardiothoracic Surgery, Heart Center, University of Cologne, Cologne, Germany
| | - Thorsten Wahlers
- Department of Cardiothoracic Surgery, Heart Center, University of Cologne, Cologne, Germany
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Balci E, Aykut A, Demir A, Vardar K, Karduz G, Aksu U. Retrograde autologous priming method reduces plasma free hemoglobin level in aortic surgery. Ann Card Anaesth 2021; 24:427-433. [PMID: 34747749 PMCID: PMC8617393 DOI: 10.4103/aca.aca_193_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Although conventional cardiopulmonary bypass (cCPB) is still the most widely used method in open heart surgery, methods such as retrograde autologous priming (RAP) are increasingly popular in terms of limiting hemodilution. Our hypothesis is that the use of the RAP method in aortic surgery may result in a limitation of hemodilution and a decrease in fHb levels. For this purpose, plasma free hemoglobin (fHb) levels were investigated in adult open aortic arch repair with axillary artery cannulation patients using cCPB and rRAP methods. Materials and Methods: In this study, a total of 36 patients undergoing aortic surgery using rRAP and standard cCPB were investigated. Measurements were performed at five time points: After induction of anesthesia, 5th minute of CPB, 10th minute of antegrade cerebral perfusion, 30th minute after declamping of aorta, and at sternum closure. Besides hemodynamic variables, arterial blood gas analysis and postoperative variables, patients were assessed for fHb levels. Results: The rRAP group had a significantly lower increase in fHb levels in T3, T4, and T5 time points, when compared to the cCPB group (p = 0.002, 0.047, 0.009, respectively). There was no significant difference between the rRAP and cCPB groups in other intraoperative, and postoperative variables. Also, it was observed that rRAP did not make a difference in terms of blood and blood product transfusion. Conclusion: In this study, in patients undergoing aortic surgery, a reduction in the increase of fHb was observed with the rRAP method which is a simple procedure that does not require high cost or advanced technology.
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Affiliation(s)
- Eda Balci
- Anesthesiology and Reanimation Department, Ankara City Hospital, Ankara, Turkey
| | - Aslihan Aykut
- Anesthesiology and Reanimation Department, Ankara City Hospital, Ankara, Turkey
| | - Asli Demir
- Anesthesiology and Reanimation Department, Ankara City Hospital, Ankara, Turkey
| | - Kübra Vardar
- Department of Biology, Faculty of Science, The University of Istanbul, Istanbul, Turkey
| | - Gülsüm Karduz
- Department of Biology, Faculty of Science, The University of Istanbul, Istanbul, Turkey
| | - Uğur Aksu
- Department of Biology, Faculty of Science, The University of Istanbul, Istanbul, Turkey
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Luo ZR, Tang MR, Li JH, Chen LW, Yan LL. Quality of life: modified triple-branched stent graft implantation versus frozen elephant trunk technique. J Cardiothorac Surg 2021; 16:297. [PMID: 34645494 PMCID: PMC8513261 DOI: 10.1186/s13019-021-01683-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 10/02/2021] [Indexed: 11/30/2022] Open
Abstract
Objective To compare the effects of modified triple-branched stent implantation and frozen elephant trunk technique on the quality of life (QoL) of acute Stanford Type A aortic dissection (AAAD) patients at different follow-up times. Methods Data from 175 AAAD survivors was collected which were divided into two groups according to different surgical techniques: (group A): modified triple-branched stent graft implantation; (group B): frozen elephant trunk. The SF-36 were used to assess the QoL at discharge (AD), the third postoperative month (POM3), and the twelfth postoperative month (POM12). Results (1) The total scores at each time of both groups showed lower than the normal level; Group A scored higher than group B at some time points in terms of some items (role physical, role emotion and mental health; all P = 0.000), and some items at POM3 or POM12 scored higher than at discharge (role physical, social function; both P = 0.000). (2) There were less patients with heavy self-perceived burden in group A than group B at discharge (P = 0.032) and patients with heavy self-perceived burden decreased over time. (3) Young postoperative AAD patients (P = 0.002) in group B (P = 0.005) with heavy self-perceived burden (P = 0.000), acute renal failure (P = 0.008), long LOS (P = 0.026) and blood loss (> 1000 mL/24 h) (P = 0.039) seemed to get a worse QoL. Conclusion The impact on QoL of the modified triple-branched stent graft implantation technique seemed to be better than those of frozen elephant trunk surgery in role physical, role emotion and mental health.
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Affiliation(s)
- Zeng-Rong Luo
- Department of Cardiovascular Surgery and Cardiac Disease Center, Union Hospital, Fujian Medical University, Fuzhou, 350001, People's Republic of China.,Key Laboratory of Cardio-Thoracic Surgery (Fujian Medical University), Fujian Province University, Fuzhou, People's Republic of China
| | - Mi-Rong Tang
- Department of Cardiovascular Surgery and Cardiac Disease Center, Union Hospital, Fujian Medical University, Fuzhou, 350001, People's Republic of China.,Key Laboratory of Cardio-Thoracic Surgery (Fujian Medical University), Fujian Province University, Fuzhou, People's Republic of China
| | - Jia-Hui Li
- Department of Cardiovascular Surgery and Cardiac Disease Center, Union Hospital, Fujian Medical University, Fuzhou, 350001, People's Republic of China.,Key Laboratory of Cardio-Thoracic Surgery (Fujian Medical University), Fujian Province University, Fuzhou, People's Republic of China
| | - Liang-Wan Chen
- Department of Cardiovascular Surgery and Cardiac Disease Center, Union Hospital, Fujian Medical University, Fuzhou, 350001, People's Republic of China.,Key Laboratory of Cardio-Thoracic Surgery (Fujian Medical University), Fujian Province University, Fuzhou, People's Republic of China
| | - Liang-Liang Yan
- Department of Cardiovascular Surgery and Cardiac Disease Center, Union Hospital, Fujian Medical University, Fuzhou, 350001, People's Republic of China. .,Key Laboratory of Cardio-Thoracic Surgery (Fujian Medical University), Fujian Province University, Fuzhou, People's Republic of China.
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Eris C, Engin M, Erdolu B, Kagan As A. Comparison of del Nido Cardioplegia vs blood cardioplegia in adult aortic surgery is the single-dose cardioplegia technique really advantageous? Asian J Surg 2021; 45:1122-1127. [PMID: 34649799 DOI: 10.1016/j.asjsur.2021.09.032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 08/14/2021] [Accepted: 09/20/2021] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND /objective: The aim of the present study was to compare the operative and early postoperative results of the use of del Nido Cardioplegia solution (dNCS) with traditional blood cardioplegia (BC) in adult aortic surgery. METHODS A retrospective single-center study was performed on 118 patients who underwent aortic surgery with cardiopulmonary bypass (CPB) between January 2016 and June 2020. Patients were divided in to two groups according to the type of cardioplegia solution used. Cardiac arrest was achieved in Group 1 (n = 65) with traditional BC and in Group 2 (n = 53) with dNCS. Operative and postoperative outcomes of the patients were compared between the two groups. RESULTS Patient demographic characteristics were similar between the two groups. dNCS group showed significantly lower aortic cross-clamp (ACC) time (73.3 vs. 87.5 min, P = 0.001), cardioplegia volume (1323.9 ± 368.5 vs. 2773.8 ± 453.8 ml, P< 0.001), defibrillation rate (44.4%vs. 69.2%, P = 0.006), drainage amount (412 ± 73.2 vs. 446.9 ± 95.1 ml, P = 0.026) and inotropic support need (37% vs. 55.3%, P = 0.046). Also dNCS group had significantly lower high sensitive troponin I (hsTnI) levels at 6th (203.5 ± 68.6 vs. 275.7 ± 76.2 ng/L, P< 0.001) and 24th (253.1 ± 101 vs. 293.4 ± 80.1 ng/L, P = 0.017) postoperative hours. And dNCS group showed significantly higher hematocrit levels at 6th (25.1 ± 3.2 vs. 22.5 ± 2.5%, P< 0.001) and 24th (25.8 ± 2.7 vs. 24.6 ± 2.8%, P = 0.024) postoperative hours. Times of intensive care unit stay, durations of intuabation and hospital stay times were similar in both groups. There was no significant difference in terms of postoperative ejection fraction values (P = 0.714). CONCLUSION Compared with conventional BC, dNCS provided significantly shorter ACC times, reduced the need for intraoperative defibrillation, lowered postoperative hsTnI levels with comparable early clinical outcomes for adult patients undergoing aortic surgery. dNCS is a safe and efficient alternative to the traditional BC solution in adult aortic cardiac surgery.
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Affiliation(s)
- Cuneyt Eris
- University of Health Sciences, Bursa Yuksek Ihtisas Training and Research Hospital, Department of Cardiovasculer Surgery, Mimar Sinan Town. Emniyet Street, Yıldırım, BURSA, Turkey.
| | - Mesut Engin
- University of Health Sciences, Bursa Yuksek Ihtisas Training and Research Hospital, Department of Cardiovasculer Surgery, Mimar Sinan Town. Emniyet Street, Yıldırım, BURSA, Turkey.
| | - Burak Erdolu
- University of Health Sciences, Bursa Yuksek Ihtisas Training and Research Hospital, Department of Cardiovasculer Surgery, Mimar Sinan Town. Emniyet Street, Yıldırım, BURSA, Turkey.
| | - Ahmet Kagan As
- University of Health Sciences, Bursa Yuksek Ihtisas Training and Research Hospital, Department of Cardiovasculer Surgery, Mimar Sinan Town. Emniyet Street, Yıldırım, BURSA, Turkey.
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Affiliation(s)
- Maximilian Luehr
- Department of Cardiothoracic Surgery, Heart Center, University of Cologne, Cologne, Germany
| | - Yupeng Li
- Department of Political Science & Economics, Rowan University, Glassboro, NJ, USA
| | - Thorsten Wahlers
- Department of Cardiothoracic Surgery, Heart Center, University of Cologne, Cologne, Germany
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Jungi S, Sangalli Z, Schmidli J, Makaloski V. Surgeon-modified fenestrated endovascular aortic repair for ruptured anastomotic aneurysm after open thoracoabdominal repair. J Vasc Surg Cases Innov Tech 2021; 7:484-487. [PMID: 34381932 PMCID: PMC8339120 DOI: 10.1016/j.jvscit.2021.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 06/11/2021] [Indexed: 11/25/2022] Open
Abstract
We report the case of a 60-year-old female patient with a contained rupture of a proximal anastomotic pseudoaneurysm after previous open repair of a type IV thoracoabdominal aneurysm. A repeat open repair was considered to be too risky. We performed an urgent endovascular repair with a thoracic stent-graft and a surgeon-modified fenestrated aortic cuff with two fenestrations. The final angiogram and postoperative imaging studies showed complete aneurysm exclusion without any endoleak. Surgeon-modified fenestrated endovascular aortic repair is a feasible treatment option for emergency cases for which repeat open repair or custom-made complex endovascular repair is not an option.
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Affiliation(s)
- Silvan Jungi
- Department of Cardiovascular Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Zoe Sangalli
- Department of Cardiovascular Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Jürg Schmidli
- Department of Cardiovascular Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Vladimir Makaloski
- Department of Cardiovascular Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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Crawford RS, Liu Y, Yuan D, Liu C, Sarkar R, Hu B. Transrectal intracolon cooling prevents paraplegia and mortality in a rat model of aortic occlusion-induced spinal cord ischemia. JVS Vasc Sci 2021; 2:181-193. [PMID: 34761238 PMCID: PMC8567003 DOI: 10.1016/j.jvssci.2021.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 07/27/2021] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE Spinal cord ischemia-reperfusion injury (SC-IRI) occurs in many medical conditions such as aneurysm surgical repair but no treatment of SC-IRI is available in clinical practice. The objective of the present study was to develop a novel medical device for the treatment of SC-IRI. METHODS A rat model of SC-IRI was used. A novel transrectal intracolon (TRIC) temperature management device was developed to maintain an intracolon wall temperature at either 37°C (TRIC37°C) or 12°C (TRIC12°C). The upper body temperature was maintained as close as possible to 37°C in both groups. A 2F Fogarty balloon catheter was inserted via the left common carotid artery to block the distal aortic blood flow to the spinal cord. The proximal blood pressure was controlled by the withdrawal and infusion of blood via the jugular vein catheter, such that the distal tail artery blood pressure was maintained at ∼10 mmHg for 13 and 20 minutes, respectively. Next, the balloon was deflated, and TRIC temperature management was continued for an additional 30 minutes to maintain the colon wall temperature at either 37°C or 12°C during the reperfusion period. RESULTS All the rats subjected to 13 minutes of spinal cord ischemia in the TRIC37°C group had developed paraplegia during the postischemic phase. In striking contrast, TRIC at 12°C completely prevented the paraplegia, dramatically improved the arterial blood gas parameters, and avoided the histopathologic injuries to the spinal cord in rats subjected to 13 minutes of spinal cord ischemia. Furthermore, TRIC12°C allowed for the extension of the ischemia duration from 13 minutes to 20 minutes, with significantly reduced functional deficits. CONCLUSIONS Directly cooling the intestine focally with the TRIC device offered an exceptional survival rate and functional improvement after aortic occlusion-induced spinal cord ischemia.
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Affiliation(s)
- Robert S. Crawford
- Departments of Anesthesiology and Surgery, University of Maryland School of Medicine, Baltimore, Md
| | - Yang Liu
- Departments of Anesthesiology and Surgery, University of Maryland School of Medicine, Baltimore, Md
| | - Dong Yuan
- Departments of Anesthesiology and Surgery, University of Maryland School of Medicine, Baltimore, Md
| | - Chunli Liu
- Veterans Affairs Maryland Health Center System, Baltimore, Md
| | - Rajabrata Sarkar
- Departments of Anesthesiology and Surgery, University of Maryland School of Medicine, Baltimore, Md
| | - Bingren Hu
- Departments of Anesthesiology and Surgery, University of Maryland School of Medicine, Baltimore, Md
- Veterans Affairs Maryland Health Center System, Baltimore, Md
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Kamla CE, Grigorescu-Vlass M, Wassilowsky D, Fischereder M, Hagl C, Schönermarck U, Pichlmaier MA, Peterss S, Jóskowiak D. Thrombotic microangiopathy following aortic surgery with hypothermic circulatory arrest: a single-centre experience of an underestimated cause of acute renal failure. Interact Cardiovasc Thorac Surg 2021; 34:258-266. [PMID: 34414411 DOI: 10.1093/icvts/ivab231] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 07/09/2021] [Accepted: 07/25/2021] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVES Acute kidney injury (AKI) following surgery involving the heart-lung-machine is associated with high mortality and morbidity. In addition to the known mechanisms, thrombotic microangiopathy (TMA) triggered by the dysregulation of complement activation was recently described as another pathophysiological pathway for AKI following aortic surgery. The aim of this retrospective study was to analyse incidence, predictors and outcome in these patients. METHODS Between January 2018 and September 2019, consecutive patients undergoing aortic surgery requiring hypothermic circulatory arrest were retrospectively reviewed. If suspected, diagnostic algorithm was initiated to identify a TMA and its risk factors, and postoperative outcome parameters were comparably investigated. RESULTS The incidence of TMA in the analysed cohort (n = 247) was 4.5%. Multivariable logistic regression indicated female gender {odds ratio (OR) 4.905 [95% confidence interval (CI) 1.234-19.495], P = 0.024} and aortic valve replacement [OR 8.886 (95% CI 1.030-76.660), P = 0.047] as independent predictors of TMA, while cardiopulmonary bypass, X-clamp and hypothermic circulatory arrest times showed no statistically significance. TMA resulted in postoperative AKI (82%), neurological disorders (73%) and thrombocytopaenia [31 (interquartile range 25-42) G/l], corresponding to the diagnostic criteria. Operative mortality and morbidity were equal to patients without postoperative TMA, despite a higher incidence of re-exploration for bleeding (27 vs 6%; P = 0.027). After 6 months, survival, laboratory parameters and need for dialysis were comparable between the groups. CONCLUSIONS TMA is a potential differential diagnosis for the cause of AKI following aortic surgery regardless of the hypothermic circulatory arrest time. Timely diagnosis and appropriate treatment resulted in a comparable outcome concerning mortality and renal function.
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Affiliation(s)
- Christine E Kamla
- Department of Cardiac Surgery, LMU University Hospital, Munich, Germany
| | - Melissa Grigorescu-Vlass
- Division Nephrology, Department of Internal Medicine IV, LMU University Hospital, Munich, Germany
| | | | - Michael Fischereder
- Division Nephrology, Department of Internal Medicine IV, LMU University Hospital, Munich, Germany
| | - Christian Hagl
- Department of Cardiac Surgery, LMU University Hospital, Munich, Germany
| | - Ulf Schönermarck
- Division Nephrology, Department of Internal Medicine IV, LMU University Hospital, Munich, Germany
| | | | - Sven Peterss
- Department of Cardiac Surgery, LMU University Hospital, Munich, Germany
| | - Dominik Jóskowiak
- Department of Cardiac Surgery, LMU University Hospital, Munich, Germany
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Oishi K, Mizuno T, Fujiwara T, Kuroki H, Yashima M, Takeshita M, Nagaoka E, Oi K, Arai H. Surgical strategy for inflammatory thoracic aortic aneurysms in the endovascular surgery era. J Vasc Surg 2021; 75:74-80.e2. [PMID: 34416323 DOI: 10.1016/j.jvs.2021.06.479] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 06/13/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Inflammatory thoracic aortic aneurysms (TAAs) are very rare aortic conditions. Resection and replacement of the inflammatory aorta is the first-line treatment, and thoracic endovascular aortic repair (TEVAR) has recently been reported as a less invasive alternative even for this aortic cohort. In the present study, we reviewed our experience with inflammatory TAAs and assessed the preoperative management, surgical procedures, and outcomes. METHODS From 2006 to 2019, 21 surgeries were performed for inflammatory TAAs in 17 of 2583 patients (0.7%) who had undergone cardiovascular surgery at our institution. The etiologies were Takayasu's arteritis in 13 patients, giant cell arteritis in 2, antineutrophil cytoplasmic antibody-associated vasculitis in 1, and unknown in 1. The mean follow-up period was 66.2 ± 50.2 months (range, 19-186 months). RESULTS Three patients had undergone multiple surgeries. The aorta was replaced in 14 patients (ascending aorta in 9, aortic arch in 4, and thoracoabdominal aorta in 1). Three isolated TEVARs were performed in two patients and single-stage hybrid aortic repair (ascending aorta and partial arch replacement combined with zone 0 TEVAR) in four patients for extended arch and descending thoracic aortic aneurysms. Stent grafts were deployed on the native aorta in five of the seven TEVARs. The perioperative inflammation was well-controlled with prednisolone (mean dose, 7.4 ± 9.4 mg) in all patients except for one who had required two surgeries under inflammation-uncontrolled situations. No aorta-related complications, including anastomotic aneurysms and TEVAR-related aortic dissection, developed during the follow-up period, and the 5-year freedom from all-cause death was 92.9%. CONCLUSIONS The mid-term outcomes of surgery for inflammatory TAAs were acceptable. Although replacement remains the standard procedure for inflammatory TAAs, TEVAR is a less invasive acceptable alternative when the inflammation is properly managed.
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Affiliation(s)
- Kiyotoshi Oishi
- Department of Cardiovascular Surgery, Graduate School of Medical and Dental Science, Tokyo Medical and Dental University, Tokyo, Japan
| | - Tomohiro Mizuno
- Department of Cardiovascular Surgery, Graduate School of Medical and Dental Science, Tokyo Medical and Dental University, Tokyo, Japan.
| | - Tatsuki Fujiwara
- Department of Cardiovascular Surgery, Graduate School of Medical and Dental Science, Tokyo Medical and Dental University, Tokyo, Japan
| | - Hidehito Kuroki
- Department of Cardiovascular Surgery, Graduate School of Medical and Dental Science, Tokyo Medical and Dental University, Tokyo, Japan
| | - Masafumi Yashima
- Department of Cardiovascular Surgery, Graduate School of Medical and Dental Science, Tokyo Medical and Dental University, Tokyo, Japan
| | - Masashi Takeshita
- Department of Cardiovascular Surgery, Graduate School of Medical and Dental Science, Tokyo Medical and Dental University, Tokyo, Japan
| | - Eiki Nagaoka
- Department of Cardiovascular Surgery, Graduate School of Medical and Dental Science, Tokyo Medical and Dental University, Tokyo, Japan
| | - Keiji Oi
- Department of Cardiovascular Surgery, Graduate School of Medical and Dental Science, Tokyo Medical and Dental University, Tokyo, Japan
| | - Hirokuni Arai
- Department of Cardiovascular Surgery, Graduate School of Medical and Dental Science, Tokyo Medical and Dental University, Tokyo, Japan
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Tsagakis K, Osswald A, Weymann A, Demircioglu A, Schmack B, Wendt D, Jakob H, Ruhparwar A. The frozen elephant trunk technique: impact of proximalization and the four-sites perfusion technique. Eur J Cardiothorac Surg 2021; 61:195-203. [PMID: 34378023 PMCID: PMC8759516 DOI: 10.1093/ejcts/ezab295] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 02/01/2021] [Accepted: 05/11/2021] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES To improve organ protection with the frozen elephant trunk (FET) procedure, a so-called four-sites perfusion in combination with proximalization for the distal aortic anastomosis was performed. The impact of these techniques on patient outcome is reported. METHODS Between February 2005 and April 2020, a total of 357 patients underwent the FET procedure for acute (54%) or chronic (22%) aortic dissection or aneurysmal disease (24%). The level of the distal FET anastomosis was defined according to aortic arch zones 0–3. Patients were divided into 3 groups according to the intraoperative perfusion strategy: (i) selective antegrade cerebral perfusion (SACP) alone (N = 96, 2 sites); (ii) SACP plus left subclavian artery or distal aorta (N = 84, 3 sites) and (iii) SACP plus left subclavian artery plus distal aorta (N = 177, 4 sites). Early outcome was addressed by a composite end point: occurrence of either a disabling stroke, a disabling spinal cord injury, extracorporeal circulatory support, kidney dialysis or death within 90 days. RESULTS Preoperative characteristics were similar among the groups. Surgery in group C was characterized by FET proximalization in arch zone ≤2, moderate hypothermia at 28°C and shorter periods of extracorporeal circulation, SACP, hypothermic circulatory arrest and cardioplegic arrest (P < 0.001, respectively). Occurrence of the composite end point was reduced in group C (P = 0.008). The combination of FET proximalization and four-sites perfusion was a protective factor for the composite outcome in multivariable analysis (P = 0.009). The 5-year survival was improved in patients who underwent FET proximalization in zone ≤2 (hazard ratio 0.7, 95% confidence interval 0.4–1.0; P = 0.036). CONCLUSIONS FET proximalization in combination with four-sites perfusion has the potential to improve patient outcomes in terms of survival and major events. Subject collection 120; 161.
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Affiliation(s)
- Konstantinos Tsagakis
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital Essen, Essen, Germany
| | - Anja Osswald
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital Essen, Essen, Germany
| | - Alexander Weymann
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital Essen, Essen, Germany
| | - Aydin Demircioglu
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Bastian Schmack
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital Essen, Essen, Germany
| | - Daniel Wendt
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital Essen, Essen, Germany
| | - Heinz Jakob
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital Essen, Essen, Germany
| | - Arjang Ruhparwar
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital Essen, Essen, Germany
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Tozzi P. Reply to Peterss et al. Eur J Cardiothorac Surg 2021; 61:731-732. [PMID: 34347051 DOI: 10.1093/ejcts/ezab354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 07/12/2021] [Indexed: 11/12/2022] Open
Affiliation(s)
- Piergiorgio Tozzi
- Department of Cardiac Surgery, Lausanne University Hospital, Lausanne, Switzerland
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Tozzi P. Reply to Greco and Demertzis. Eur J Cardiothorac Surg 2021; 60:202-203. [PMID: 33280044 DOI: 10.1093/ejcts/ezaa449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 11/16/2020] [Indexed: 11/13/2022] Open
Affiliation(s)
- Piergiorgio Tozzi
- Cardiac Surgery, Lausanne University Hospital, Lausanne, Switzerland
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Saha S, Fabry TG, Buech J, Ali A, Joskowiak D, Tsilimparis N, Hagl C, Pichlmaier M, Peterss S. Time is of the essence: where can we improve care in acute aortic dissection? Interact Cardiovasc Thorac Surg 2021; 33:941-948. [PMID: 34255060 DOI: 10.1093/icvts/ivab190] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Revised: 04/10/2021] [Accepted: 06/03/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES In acute aortic dissection type A various components of the diagnostic and logistic pathways may affect the time to definitive treatment. This study aimed to characterize these components and to identify factors delaying the optimal management within our institutional referral network. METHODS Between January 2017 and January 2020, 96 consecutive patients with classical aortic dissection type A were admitted (28%) or referred (72%) to our tertiary care centre and analysed retrospectively. Data are presented as medians (25th-75th quartile). RESULTS Median age was 66 years (56-74), 63% were male. Most of the patients were primarily admitted to a cardiology department (40%), whereas about a fourth were admitted to departments for internal medicine (26%) and general surgery (27%). The median interval from the onset of symptoms to hospital admission was 2.1 (1-4.4) h. From admission to confirmed diagnosis it took 2.1 (0.6-9.5) h and the median interval from confirmed diagnosis to admission at our specialized tertiary care aortic centre was 1.5 (0.9-2.4) h. Following admission to our centre, 1.1 (0.5-1.9) h passed until the induction of anaesthesia and 0.8 (0.0-1.1) h until the start of surgery. The total interval from the onset of symptoms to the start of surgery was 7.6 h (5.1-12.3). CONCLUSIONS The marked variability of the time from symptoms to diagnosis at any medical facility demonstrates the importance of awareness in the optimization of the treatment of acute aortic dissection type A.
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Affiliation(s)
- Shekhar Saha
- Department of Cardiac Surgery, LMU University Hospital, Munich, Germany
| | - Thomas G Fabry
- Department of Cardiac Surgery, LMU University Hospital, Munich, Germany
| | - Joscha Buech
- Department of Cardiac Surgery, LMU University Hospital, Munich, Germany
| | - Ahmad Ali
- Department of Cardiac Surgery, LMU University Hospital, Munich, Germany
| | - Dominik Joskowiak
- Department of Cardiac Surgery, LMU University Hospital, Munich, Germany
| | | | - Christian Hagl
- Department of Cardiac Surgery, LMU University Hospital, Munich, Germany
| | | | - Sven Peterss
- Department of Cardiac Surgery, LMU University Hospital, Munich, Germany
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50
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Luehr M, Merkle-Storms J, Gerfer S, Li Y, Krasivskyi I, Vehrenberg J, Rahmanian P, Kuhn-Régnier F, Mader N, Wahlers T. Evaluation of the GERAADA score for prediction of 30-day mortality in patients with acute type A aortic dissection. Eur J Cardiothorac Surg 2021; 59:1109-1114. [PMID: 33374014 DOI: 10.1093/ejcts/ezaa455] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 11/01/2020] [Accepted: 11/15/2020] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVES The German Registry of Acute Aortic Dissection Type A (GERAADA) score to predict 30-day mortality in patients suffering from acute aortic dissection type A (AADA) was recently introduced. The aim of this study was to evaluate if the GERAADA score's prediction corresponds with the authors' institutional results. METHODS All consecutive AADA patients between 2010 and 2020 were included. Retrospective data collection comprised 11 preoperative parameters: age, sex, previous cardiac surgery, inotropic support at referral, resuscitation before surgery, aortic regurgitation, preoperative hemiparesis, intubation/ventilation at referral, preoperative organ malperfusion, extension of aortic dissection and location of primary entry site. Calculations of the GERAADA score were individually performed by a cardiac surgeon blinded to the study for all patients via a web-based application (https://www.dgthg.de/de/GERAADA_Score). RESULTS A total of 371 AADA patients were operated at the authors' institution. The mean age was 62.7 ± 13.5 years and 233 (63%) were males. Prediction of 30-day mortality was accurate for the entire study cohort (actual vs predicted 30-day mortality: 15.1% vs 15.7%; P = 0.776) as well as for all 26 subgroups. In addition, preoperative resuscitation (P < 0.001), advanced age (P = 0.042) and other/unknown malperfusion (P = 0.032) were identified as independent risk factors. CONCLUSIONS The GERAADA score prediction of 30-day mortality after surgery is accurate, easily accessible due to its web-based platform and can be calculated with very basic preoperative clinical parameters. A prospective clinical trial is required to further evaluate the new GERAADA score as a useful tool to allow for improved decision-making in the emergency setting of AADA.
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Affiliation(s)
- Maximilian Luehr
- Department of Cardiothoracic Surgery, Heart Center, University of Cologne, Cologne, Germany
| | - Julia Merkle-Storms
- Department of Cardiothoracic Surgery, Heart Center, University of Cologne, Cologne, Germany
| | - Stephen Gerfer
- Department of Cardiothoracic Surgery, Heart Center, University of Cologne, Cologne, Germany
| | - Yupeng Li
- Department of Political Science & Economics, Rowan University, Glassboro, NJ, USA
| | - Ihor Krasivskyi
- Department of Cardiothoracic Surgery, Heart Center, University of Cologne, Cologne, Germany
| | - Johannes Vehrenberg
- Department of Cardiothoracic Surgery, Heart Center, University of Cologne, Cologne, Germany
| | - Parwis Rahmanian
- Department of Cardiothoracic Surgery, Heart Center, University of Cologne, Cologne, Germany
| | - Ferdinand Kuhn-Régnier
- Department of Cardiothoracic Surgery, Heart Center, University of Cologne, Cologne, Germany
| | - Navid Mader
- Department of Cardiothoracic Surgery, Heart Center, University of Cologne, Cologne, Germany
| | - Thorsten Wahlers
- Department of Cardiothoracic Surgery, Heart Center, University of Cologne, Cologne, Germany
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