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Berger T, Miriam G, Rylski B, Fagu A, Roman G, Kondov S, Czerny M, Kreibich M. Incidence and Risk for Distal Aortic Failure after the Frozen Elephant Trunk Procedure. Thorac Cardiovasc Surg 2023. [DOI: 10.1055/s-0043-1761649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2023]
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Kreibich M, Berger T, Rylski B, Siepe M, Czerny M. Frozen Elephant Trunk Procedure and Risk for Distal Stent-Graft-Induced New Entries. AORTA (STAMFORD, CONN.) 2022; 10:178-181. [PMID: 36521810 PMCID: PMC9754859 DOI: 10.1055/s-0042-1756666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The frozen elephant trunk (FET) procedure is known as an effective treatment option for patients with any aortic pathology involving the aortic arch. However, there is growing evidence that many patients often require secondary intended, expected, or unexpected aortic reinterventions during follow-up. In those with underlying aortic dissection pathology, a substantial risk for developing distal stent-graft-induced new entries (dSINEs) has been identified as one cause for secondary aortic reinterventions. dSINE can develop at any time after the FET procedure. Endovascular treatment is generally feasible and safe to close the newly formed entry with low procedural risk. Nevertheless, all patients need continuous follow-up after FET treatment, ideally in a specialized aortic outpatient clinic.
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Fagu A, Siepe M, Uzdenov M, Dees D, Kondov S, Beyersdorf F, Rylski B, Czerny M, Neumann FJ, Kreibich M, Berger T. Subsequent cardiac surgery after transcatheter aortic valve implantation: Indications and outcomes. J Card Surg 2022; 37:5187-5194. [PMID: 36378828 DOI: 10.1111/jocs.17219] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Revised: 10/30/2022] [Accepted: 11/01/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Aim of this study was to report on indications and clinical outcomes of patients who underwent subsequent open-cardiac surgery after transcatheter aortic valve implantation TAVI. METHODS Between 01/2011 and 12/2020 our centre performed 4043 TAVI procedures. Twenty-seven patients (including patients in whom TAVI was performed in other centres) underwent subsequent open-heart surgery via cardiopulmonary bypass. Demographic, intraprocedural data, indications for, and outcomes after surgery were evaluated. RESULTS Indications for cardiac surgery (aged 79 [IQR 76-84]; 59.3% male) were endocarditis (n = 11; 40.7%), annular rupture, severe paravalvular leak and severe stenosis in three (11.1%) patients, respectively as well as in one patient each (3.7%) severe tricuspid valve regurgitation, valve thrombosis, valve malposition, valve migration, ostial right coronary artery obstruction, left ventricular rupture and type A aortic dissection. The interval between the index TAVI procedure to open surgery was 3 months (IQR 0-26 months). Eight patients underwent emergent surgical conversions. Immediate procedural and procedural mortality was 25.9% and 40.7%, respectively and all-cause mortality was 51.9% (11/12 died for cardiovascular reasons). No disabling stroke was observed postoperatively. New permanent pacemaker implantation was required in three patients (11.1%). CONCLUSIONS Subsequent open-cardiac surgery after TAVI is rare, but may urgently become necessary due to TAVI related complications or progressing other cardiac pathologies. Despite a substantial early attrition rate clinical outcome is acceptable and a relevant number of these high-risk patients can be discharged even after emergency conversions. The option of subsequent surgical conversion remains.
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Discher P, Kreibich M, Berger T, Kondov S, Walter T, Benk J, Beyersdorf F, Gottardi R, Siepe M, Rylski B, Czerny M. Similarities, differences and unmet needs regarding prosthetic materials in aortic arch replacement using the frozen elephant trunk technique: a review. Cardiovasc Diagn Ther 2022; 12:722-726. [PMCID: PMC9622398 DOI: 10.21037/cdt-22-176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 08/23/2022] [Indexed: 11/06/2022]
Abstract
The constant improvement of operative techniques offers the possibility of treating an increasing number of patients with complex acute and chronic thoracic aortic pathologies involving the aortic arch. Reliable and durable prosthetic material forms the platform for these approaches. Besides the most important properties like impermeability for blood, infection and thrombotic resistance, there are also properties which are not seen at first glance but can nevertheless play a key role in the healing process and long-term results, such as endothelialization and immunostimulation. To ensure the best possible properties of the graft, different variables of the grafts are continuously developed. Beside the choice of material and the weaving technique, Dacron sealing with gelatin is in clinical use for many years but is still being discussed. Collecting clinical experiences with sealed and unsealed grafts in aortic arch replacement led to the conclusion that blood loss through the prosthesis, especially in the early phase after the implantation of the graft, is lowered by gelatin sealing. Furthermore, binding of antimicrobiotic and antithrombotic agents to the collagen are promising approaches to a better prevention of these dreaded complications. More research examining the healing process of the prosthesis is needed in order to find out more about the influence of the prosthesis sealing.
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Kimura N, Nakamura M, Takagi R, Mieno MN, Yamaguchi A, Czerny M, Beyersdorf F, Kari FA, Rylski B. False lumen/true lumen wall pressure ratio is increased in acute non-A non-B aortic dissection. Interact Cardiovasc Thorac Surg 2022; 35:6585342. [PMID: 35552699 PMCID: PMC9486891 DOI: 10.1093/icvts/ivac138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 05/06/2022] [Accepted: 05/09/2022] [Indexed: 11/13/2022] Open
Abstract
Abstract
OBJECTIVES
We aimed to determine whether non-A non-B aortic dissection (AD) differs in morphologic and haemodynamic properties from type B AD.
METHODS
We simulated and compared haemodynamics of patients with acute type B or acute non-A non-B AD by means of computational fluid dynamics. Wall pressure and wall shear stress (WSS) in both the true lumen (TL) and false lumen (FL) at early, mid- and late systole were evaluated. Morphology, WSS and the FL/TL wall pressure ratio were compared between groups.
RESULTS
Nineteen patients (type B, n = 7; non-A non-B, n = 12) were included. The median age (51 [46, 67] vs 53 [50, 63] years; P = 0.71) and a complicated course (14% vs 33%; P = 0.6) did not differ between the type B group and the non-A non-B group. However, the median entry tear width was increased in the non-A non-B group (9.7 [7.3, 12.7] vs 16.3 [11.9, 24.9] mm; P = 0.010). Streamlines showed, in patients with non-A non-B AD, blood from the TL flowed into the FL via the entry tear. Prevalence of a FL/TL wall pressure ratio >1.0 (type B versus non-A non-B) at early, mid- and late systole was 57% vs 83% (P = 0.31), 43% vs 83% (P = 0.13) and 57% vs 75% (P = 0.62), respectively. WSS did not differ between the groups.
CONCLUSIONS
The increased FL/TL wall pressure ratio observed during systole in non-A non-B AD may beget a complicated presentation.
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Kreibich M, Berger T, Siepe M, Czerny M, Rylski B. „Distal stent graft-induced new entries“ nach Frozen-Elephant-Trunk-Operation. ZEITSCHRIFT FUR HERZ THORAX UND GEFASSCHIRURGIE 2022. [DOI: 10.1007/s00398-022-00515-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Walter T, Berger T, Kondov S, Gottardi R, Benk J, Rylski B, Czerny M, Kreibich M. Postoperative In-Stent Thrombus Formation Following Frozen Elephant Trunk Total Arch Repair. Front Cardiovasc Med 2022; 9:921479. [PMID: 35845055 PMCID: PMC9279669 DOI: 10.3389/fcvm.2022.921479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 05/31/2022] [Indexed: 12/02/2022] Open
Abstract
Objectives Our aim was to investigate the occurrence and clinical consequence of postoperative in-stent thrombus formation following the frozen elephant trunk (FET) procedure. Methods Postoperative computed tomography angiography (CTA) scans of all 304 patients following the FET procedure between 04/2014 and 11/2021 were analysed retrospectively. Thrombus size and location were assessed in multiplanar reconstruction using IMPAX EE (Agfa HealthCare N.V., Morstel, Belgium) software. Patients’ characteristics and clinical outcomes were evaluated between patients with and without thrombus formation. Results During the study period, we detected a new postoperative in-stent thrombus in 19 patients (6%). These patients were significantly older (p = 0.009), predominantly female (p = 0.002) and were more commonly treated for aortic aneurysms (p = 0.001). In 15 patients (79%), the thrombi were located in the distal half of the FET stent-graft. Thrombus size was 18.9 mm (first quartile: 12.1; third quartile: 33.2). Distal embolisation occurred in 4 patients (21%) causing one in-hospital death caused by severe visceral ischaemia. Therapeutic anticoagulation was initiated in all patients. Overstenting with a conventional stent-graft placed within the FET stent-graft was the treatment in 2 patients (11%). Outcomes were comparable both groups. Female sex (p = 0.005; OR: 4.289) and an aortic aneurysm (p = 0.023; OR: 5.198) were identified as significant predictors for thrombus development. Conclusion Postoperative new thrombus formation within the FET stent-graft is a new, rare, but clinically highly relevant event. The embolisation of these thrombi can result in dismal postoperative outcomes. More research is therefore required to better identify patients at risk and improve perioperative treatment.
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Benk J, Siepe M, Berger T, Beyersdorf F, Kondov S, Rylski B, Czerny M, Kreibich M. Early and mid-term outcomes of thoracic endovascular aortic repair to treat aortic rupture in patients with aneurysms, dissections and trauma. Interact Cardiovasc Thorac Surg 2022; 35:ivac042. [PMID: 35167665 PMCID: PMC9714596 DOI: 10.1093/icvts/ivac042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 01/27/2022] [Accepted: 01/31/2022] [Indexed: 09/10/2023] Open
Abstract
OBJECTIVES The aim of this study was to analyse outcomes of thoracic endovascular aortic repair to treat aortic rupture. METHODS Patient and outcome characteristics of all emergent endovascular treatments for thoracic aortic rupture between January 2009 and December 2019 were analysed. RESULTS Thoracic aortic rupture occurred in patients with aortic aneurysms (n = 42, 49%), aortic dissection (n = 13, 16%) or after trauma (n = 30, 35%). Preoperative cerebrospinal fluid drainage was placed in 9 patients (11%) and 18 patients (21%) underwent perioperative supra-aortic transposition. The proximal landing zones were: zone 1 (n = 1, 1%), zone 2 (n = 23, 27%), zone 3 (n = 52, 61%) and zone 4 (n = 9, 11%). Temporary spinal cord injury occurred in 1 patient (1%), permanent spinal cord injury in 7 patients (8%). Two patients (2%) experienced a postoperative stroke. Seventeen patients (20%) expired in-hospital. Aortic dissection (odds ratio: 16.246, p = 0.001), aneurysm (odds ratio: 9.090, P = 0.003) and preoperative shock (odds ratio: 4.646, P < 0.001) were predictive for mortality. Eighteen patients (21%) required a stent-graft-related aortic reintervention for symptomatic supra-aortic malperfusion (n = 3, 4%), endoleaks (n = 6, 7%), a second aortic rupture (n = 4, 5%), retrograde type A aortic dissection (n = 2, 2%), aortic-oesophageal fistulation (n = 2, 2%) and stent-graft kinking (n = 1, 1%). CONCLUSIONS Thoracic endovascular aortic repair in patients with aortic rupture has become a valuable treatment modality to stabilize patients. However, a significant risk of postoperative morbidity and mortality remains, particularly in patients with aortic dissections, aneurysms or shock. Patients require thorough follow-up ideally in an aortic clinic with a staff having the entire spectrum of cardiovascular and thoracic surgical expertise.
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Berger T, Graap M, Rylski B, Fagu A, Gottardi R, Walter T, Discher P, Hagar MT, Kondov S, Czerny M, Kreibich M. Distal Aortic Failure Following the Frozen Elephant Trunk Procedure for Aortic Dissection. Front Cardiovasc Med 2022; 9:911548. [PMID: 35734273 PMCID: PMC9207307 DOI: 10.3389/fcvm.2022.911548] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Accepted: 05/10/2022] [Indexed: 11/16/2022] Open
Abstract
Background Aim of this study was to report and to identify risk factors for distal aortic failure following aortic arch replacement via the frozen elephant trunk (FET) procedure. Methods One hundred eighty-six consecutive patients underwent the FET procedure for acute and chronic aortic dissection. Our cohort was divided into patients with and without distal aortic failure. Distal aortic failure was defined as: (I) distal aortic reintervention, (II) aortic diameter dilatation to ≥ 6 cm or > 5 mm growth within 6 months, (III) development of a distal stent-graft-induced new entry (dSINE) and/or (IV) aortic-related death. Preoperative, intraoperative, postoperative and aortic morphological data were analyzed. Results Distal aortic failure occurred in 88 (47.3%) patients. Forty-six (24.7%) required a distal reintervention, aortic diameter dilatation was observed in 9 (4.8%) patients, a dSINE occurred in 22 (11.8%) patients and 11 (6.4%) suffered an aortic-related death. We found no difference in the number of communications between true and false lumen (p = 0.25) but there were significantly more communications between Ishimaru zone 6–8 in the distal aortic failure group (p = 0.01). The volume of the thoracic descending aorta measured preoperatively and postoperatively within 36 months afterward was significantly larger in patients suffering distal aortic failure (p < 0.001; p = 0.011). Acute aortic dissection (SHR 2.111; p = 0.007), preoperative maximum descending aortic diameter (SHR 1.029; p = 0.018) and preoperative maximum aortic diameter at the level of the diaphragm (SHR 1.041; p = 0.012) were identified as risk factors for distal aortic failure. Conclusion The incidence and risk of distal aortic failure following the FET procedure is high. Especially those patients with more acute and more extensive aortic dissections or larger preoperative descending aortic diameters carry a substantially higher risk of developing distal aortic failure. The prospective of the FET technique as a single-step treatment for aortic dissection seems low and follow-up in dedicated aortic centers is therefore paramount.
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Kreibich M, Berger T, Walter T, Potratz P, Discher P, Kondov S, Beyersdorf F, Siepe M, Gottardi R, Czerny M, Rylski B. Downstream thoracic endovascular aortic repair following the frozen elephant trunk procedure. Cardiovasc Diagn Ther 2022; 12:272-277. [PMID: 35800359 PMCID: PMC9253175 DOI: 10.21037/cdt-22-99] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 05/09/2022] [Indexed: 09/10/2023]
Abstract
The frozen elephant trunk technique has become a well-established treatment option for patients presenting all thoracic aortic pathologies including acute and chronic dissection, aortic aneurysms and even penetrating aortic ulcers involving the aortic arch and descending aorta. Nevertheless, there is a significant incidence of and risk for distal aortic reinterventions after the frozen elephant trunk. Indications mainly include a planned staged approach, diameter progression of downstream aortic segments and the development of distal stent-graft induced new entries (dSINEs). Endovascular stent-graft extension through conventional thoracic endovascular aortic repair (TEVAR) is a relatively simple and safe method to address any pathologies in the remaining descending thoracic aorta up to the level of the coeliac trunk. In fact, the frozen elephant trunk stent-graft provides an ideal proximal landing zone for any endovascular stent-graft extension. Postoperative outcomes are very promising with very low reported in-hospital mortality and morbidity. In case this 2-staged-approach fails to stabilize the remaining aorta, a 3-step procedure, namely open thoracoabdominal aortic replacement, is simplified because the anastomosis site has moved distally. Follow-up of all patients, following frozen elephant trunk implantation or distal stent-graft extension, is mandatory, ideally in an outpatient clinic dedicated to the aorta in order to identify disease progression or to detect any complications as soon as possible.
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Heuts S, Adriaans B, Kawczynski M, Daemen J, Natour E, Lorusso R, Schalla S, Maessen J, Wildberger J, Jacobs M, Rylski B, Bidar E. Extending Aortic Replacement Beyond the Proximal Arch in Acute Type A Aortic Dissection: A Meta-Analysis of Short Term Outcomes and Long Term Actuarial Survival. J Vasc Surg 2022. [DOI: 10.1016/j.jvs.2022.04.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Kallenbach K, Büsch C, Rylski B, Dohle DS, Krüger T, Holubec T, Brickwedel J, Pöling J, Noack T, Hagl C, Jawny P, Böning A, Chalabi K, Karck M, Arif R. Treatment of the aortic root in acute aortic dissection type A: insights from the German Registry for Acute Aortic Dissection Type A. Eur J Cardiothorac Surg 2022; 62:ezac261. [PMID: 35511255 DOI: 10.1093/ejcts/ezac261] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 04/04/2022] [Accepted: 04/16/2022] [Indexed: 02/21/2024] Open
Abstract
OBJECTIVES Surgery of the aortic root in acute aortic dissection type A (AADA) remains a topic of vague evidence since the extend of dissection and surgeons' capability and interpretation of the disease vary remarkably. We aimed to interpret root operation strategies in the German Registry for Acute Aortic Dissection cohort. METHODS German Registry for Acute Aortic Dissection collected the data of 56 centres between July 2006 and June 2015. A total of 3382 patients undergoing operations for AADA were included and divided into 3 groups according to aortic root procedure types: supracommissural replacement (SCR), conduit replacement (CR) and valve sparing root replacement (VSRR). RESULTS Patients in SCR (2425, 71.7%) were significantly older than CR (681, 20.1%) and VSRR (276, 8.2%) (63.4 vs 57.5 vs 54.2 years; P < 0.001), more female (38.9% vs 32.0% vs 26.1%; P < 0.001) and presented with less aortic regurgitation (26.3% vs 57.1% vs 56.5%; P < 0.001). VSRR presented with slightly less multiple organ malperfusion (11.6% vs 12.0% vs 10.9%; P = 0.045) and were more often diagnosed for Marfan syndrome (2.4% vs 5.1% vs 9.1%; P < 0.001). Thirty-day mortality was lower for VSRR (11.6%) compared to SCR (16.1%) and CR (19.8%; P = 0.010). Despite longer procedural times, multivariable regression showed no influence of total arch replacement for VSRR on mortality compared to CR (odds ratio 0.264; 95% confidence interval, 0.033-2.117; P = 0.21). CONCLUSIONS SCR remains the procedure of choice in elderly and compromised patients. Extended root preservation techniques may be applied even in combination with extended aortic arch surgery for selected patients for AADA with promising early outcomes.
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Schibilsky D, Kondov S, Gottardi R, Kreibich M, Lehane C, Berger T, Beyersdorf F, Siepe M, Czerny M, Rylski B. Endovascular treatment of traumatic aortic rupture using iliac extension stent-grafts in patients with small aortic diameters. Interact Cardiovasc Thorac Surg 2022; 34:885-891. [PMID: 35037937 PMCID: PMC9153381 DOI: 10.1093/icvts/ivab377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 10/03/2021] [Accepted: 11/20/2021] [Indexed: 11/26/2022] Open
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Berger T, Kreibich M, Mueller F, Breurer-Kellner L, Rylski B, Kondov S, Schröfel H, Pingpoh C, Beyersdorf F, Siepe M, Czerny M. Risk factors for stroke after total aortic arch replacement using the frozen elephant trunk technique. Interact Cardiovasc Thorac Surg 2022; 34:865-871. [PMID: 35092274 PMCID: PMC9070457 DOI: 10.1093/icvts/ivac013] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2021] [Accepted: 01/13/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES This study aimed to analyse risk factors for postoperative stroke, evaluate the underlying mechanisms and report on outcomes of patients suffering a postoperative stroke after total aortic arch replacement using the frozen elephant trunk technique. METHODS Two-hundred and fifty patients underwent total aortic arch replacement via the frozen elephant trunk technique between March 2013 and November 2020 for acute and chronic aortic pathologies. Postoperative strokes were evaluated interdisciplinarily by a cardiac surgeon, neurologist and radiologist, and subclassified to each's cerebral territory. We conducted a logistic regression analysis to identify any predictors for postoperative stroke. RESULTS Overall in-hospital was mortality 10% (25 patients, 11 with a stroke). A symptomatic postoperative stroke occurred in 42 (16.8%) of our cohort. Eight thereof were non-disabling (3.3%), whereas 34 (13.6%) were disabling strokes. The most frequently affected region was the arteria cerebri media. Embolism was the primary underlying mechanism (n = 31; 73.8%). Mortality in patients with postoperative stroke was 26.2%. Logistic regression analysis revealed age over 75 (odds ratio = 3.25; 95% confidence interval 1.20-8.82; P = 0.021), a bovine arch (odds ratio = 4.96; 95% confidence interval 1.28-19.28; P = 0.021) and an acute preoperative neurological deficit (odds ratio = 19.82; 95% confidence interval 1.09-360.84; P = 0.044) as predictors for postoperative stroke. CONCLUSIONS Stroke after total aortic arch replacement using the frozen elephant trunk technique remains problematic, and most lesions are of embolic origin. Refined organ protection strategies, and sophisticated monitoring are mandatory to reduce the incidence of postoperative stroke, particularly in older patients presenting an acute preoperative neurological deficit or bovine arch.
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Berezowski M, Scheumann J, Beyersdorf F, Jasinski M, Plonek T, Siepe M, Czerny M, Rylski B. Early aortic growth in acute descending aortic dissection. Interact Cardiovasc Thorac Surg 2022; 34:857-864. [PMID: 35043199 PMCID: PMC9070521 DOI: 10.1093/icvts/ivab351] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 04/20/2021] [Accepted: 11/24/2021] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVES Acute aortic dissection leads to the destabilization of the aortic wall, followed by an immediate increase in aortic diameter. It remains unclear how the aortic diameter changes during the dissection's acute and subacute phases. The aim of this study was to evaluate the change in aortic geometry within 30 days after the onset of a descending aortic dissection. METHODS Patients with acute type B and non-A non-B dissection who had at least 2 computed tomography angiography scans obtained within 30 days after the onset of dissection were evaluated. Exclusion criteria were a thrombosed false lumen, connective tissue disorders and endovascular or open aortic repair performed prior to the second computed tomography angiography. RESULTS Among 190 patients with acute aortic dissection, 42 patients met our inclusion criteria. Their aortic geometry was analysed according to the computed tomography angiography scans obtained between 0-3 (N = 35), 4-7 (N = 9) and 8-30 (N = 12) days after the dissection onset. The highest aortic diameter growth rate was observed in the first quartile of the thoracic aorta and measured 0.66 (0.06; 1.03), 0.29 (-0.01; 0.41) and 0.06 (-0.13; 0.26) mm/day at 0-3, 4-7 and 8-30 days after the dissection, respectively. Proximal entry location (P = 0.037) and entry located at the arch concavity (P = 0.008) were associated with a higher aortic diameter increase. CONCLUSIONS Early rapid growth occurs during the first week after the descending aortic dissection-most intensely over the first 3 days, and this is associated with the location of the dissection's entry.
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Juraszek A, Czerny M, Rylski B. Thoracic endovascular aortic repair: Current evidence and challenges. Kardiol Pol 2022:VM/OJS/J/89449. [PMID: 35380010 DOI: 10.33963/kp.a2022.0093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 04/04/2022] [Indexed: 11/23/2022]
Abstract
In 1987 Nikolay Volodos performed the world's first endovascular treatment of aortic aneurysms. Endovascular technology has progressed significantly since then. There are now many thoracic endovascular aortic repair (TEVAR) systems commercially available. Applying them, we can treat many pathologies: aneurysms, dissections, aortic ruptures, and penetrating aortic ulcers. However, TEVAR technology still has its limitations, namely the risk of a retrograde type A dissection, the issue of precise landing in the distal landing zone, and the risk of air embolism and paraplegia. Furthermore, there are no appropriate stentgrafts widely available to treat acute dissections. Those being used are designed for aneurysms, not for dissections. As a result, there are currently several challenges facing the future TEVAR surgical community, such as the need to develop new and more precise systems with retrograde deployment for the distal landing zone, as well as to introduce flexible stentgrafts to treat dissections. The endo-Bentall is being developed as an alternative treatment method for acute type-A aortic dissection.
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Berger T, Siepe M, Simon B, Beyersdorf F, Bamberg F, Schlett CL, Kondov S, Czerny M, Rylski B, Kreibich M. Pulmonary Artery Diameter: Means and Normal Limits: Assessment by Computed Tomography Angiography. Thorac Cardiovasc Surg 2022. [DOI: 10.1055/s-0042-1742826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Kondov S, Beyersdorf F, Braun N, Höhn R, Schlett C, Rylski B, Siepe M, Kreibich M, Gottardi R, Czerny M. Corrigendum to: 'Morphology of the left subclavian artery: implications for single-branched endovascular aortic arch repair'. Eur J Cardiothorac Surg 2022; 61:965. [PMID: 35024818 DOI: 10.1093/ejcts/ezab573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Kondov S, Frankenberger L, Siepe M, Keyl C, Staier K, Humburger F, Rylski B, Kreibich M, Berger T, Beyersdorf F, Czerny M. OUP accepted manuscript. Interact Cardiovasc Thorac Surg 2022; 35:6570176. [PMID: 35437605 PMCID: PMC9419677 DOI: 10.1093/icvts/ivac076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 10/02/2021] [Accepted: 03/15/2022] [Indexed: 11/17/2022] Open
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Kosiorowska M, Berezowski M, Widenka K, Kreibich M, Beyersdorf F, Czerny M, Rylski B. OUP accepted manuscript. Interact Cardiovasc Thorac Surg 2022; 34:878-884. [PMID: 35137081 PMCID: PMC9070470 DOI: 10.1093/icvts/ivab375] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 12/08/2021] [Indexed: 11/30/2022] Open
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Kondov S, Dimov A, Beyersdorf F, Maruschke L, Pooth JS, Kreibich M, Kaier K, Siepe M, Czerny M, Rylski B. OUP accepted manuscript. Interact Cardiovasc Thorac Surg 2022; 35:6568948. [PMID: 35425973 PMCID: PMC9252125 DOI: 10.1093/icvts/ivac016] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 01/10/2022] [Accepted: 01/27/2022] [Indexed: 12/02/2022] Open
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Kreibich M, Siepe M, Berger T, Kondov S, Morlock J, Pingpoh C, Beyersdorf F, Rylski B, Czerny M. Downstream thoracic endovascular aortic repair following zone 2, 100-mm stent graft frozen elephant trunk implantation. Interact Cardiovasc Thorac Surg 2021; 34:1141-1146. [PMID: 34849947 PMCID: PMC9159434 DOI: 10.1093/icvts/ivab338] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 10/21/2021] [Accepted: 10/29/2021] [Indexed: 12/03/2022] Open
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Kondov S, Beyersdorf F, Braun N, Höhn R, Schlett C, Rylski B, Siepe M, Kreibich M, Gottardi R, Czerny M. Morphology of the left subclavian artery: implications for single-branched endovascular aortic arch repair. Eur J Cardiothorac Surg 2021; 61:348-354. [PMID: 34792129 DOI: 10.1093/ejcts/ezab482] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 09/17/2021] [Accepted: 09/23/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Our goal was to evaluate the morphology of the aortic arch, focusing on the left subclavian artery (LSA), and to anticipate implications for single-branched endovascular aortic arch repair. METHODS We performed a morphological analysis of computed tomography angiography scans of 322 patients between January 2002 and December 2018. Arch type and distance between arch vessels on the convexity were evaluated. We defined 3 morphological types: U-type distance between the left common carotid artery (LCCA) and LSA offspring >10 mm; V-type distance between the LCCA and LSA offspring <10 mm and W-type isolated left vertebral artery offspring from the aortic arch. RESULTS Most patients presented a type III arch [50% (n = 161)]. The median distance from the brachiocephalic trunk offspring to the LCCA offspring measured 2.5 mm (2.0-3.0 mm) and that between the LCCA offspring and the LSA offspring was 6.5 mm (4.0-11.0 mm). We observed no significant difference based on the morphological type (V versus U versus W) in the brachiocephalic trunk-LCCA distance, but there were significant differences in the LCCA-LSA distance between types V and U (P < 0.001) and between types V and W (P < 0.001). Interestingly, we found no significant difference in the LCCA-LSA distance between types U and W. We noted a significant difference in the median diameter of the LSA according to U, V and W types: V type versus U type, 12.5 vs 13.5 mm (P = 0.033) as well as U type versus W type, 13.5 vs 10.5 mm (P < 0.001) and V type versus W type, 12.5 vs 10.5 mm (P < 0.002). The distances between the LSA offspring and left vertebral artery offspring between types U and V did not differ significantly. CONCLUSIONS Our categorization of the U, V and W types of the LSA can help us anticipate shapes and distances and thereby function as an initial evaluation tool for predicting single branched endovascular aortic arch repair involving the LSA.
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Berger T, Siepe M, Simon B, Beyersdorf F, Chen Z, Kondov S, Schlett CL, Bamberg F, Tarkhnishvili A, Chikvatia S, Czerny M, Rylski B, Kreibich M. Pulmonary artery diameter: means and normal limits-assessment by computed tomography angiography. Interact Cardiovasc Thorac Surg 2021; 34:637-644. [PMID: 34791257 PMCID: PMC9026207 DOI: 10.1093/icvts/ivab308] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 09/30/2021] [Accepted: 10/07/2021] [Indexed: 11/14/2022] Open
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Gottardi R, Wyss TR, van den Berg JC, Rylski B, Berger T, Schmidli J, Czerny M. Corrigendum to: 'Current trends in reduction or elimination of the aortic impulse during stent-graft deployment and balloon moulding during thoracic endovascular aortic repair' [Eur J Cardiothorac Surg 2021; doi:10.1093/ejcts/ezab275]. Eur J Cardiothorac Surg 2021; 60:1482. [PMID: 34718496 DOI: 10.1093/ejcts/ezab419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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