201
|
Abstract
PURPOSE OF REVIEW Bicuspid aortic valve (BAV) disease is observed in 1-2% of the general population. In addition to valve-related complications (such as aortic stenosis and aortic regurgitation), individuals with BAV often develop dilatation of the proximal aorta (aortic root and ascending aorta), a condition termed BAV aortopathy. The development of BAV aortopathy can occur independent of valvular alterations and can lead to aneurysm formation, aortic dissection or aortic rupture. This review aims to update the clinician with an approach to BAV aortopathy decision making in keeping with the 2022 American College of Cardiology (ACC)/American Heart Association (AHA) Guideline recommendations. RECENT FINDINGS The ACC/AHA 2022 guidelines provide a contemporary and comprehensive approach to the diagnosis and treatment of aortic pathologies. We review the thresholds for replacement of the aortic root and/or ascending aorta along with the strength and level of evidence recommendations. We also review the various Class 2A and 2B recommendations for earlier intervention, which emphasize the importance of experienced surgeons, and multidisciplinary aortic teams (MATs). SUMMARY BAV aortopathy is a common and heterogenous clinical problem. The decision making around timing of intervention requires a personalized approach that is based on the aortic dimensions, valve function, rate of growth, family history, patient factors, and surgical experience within MATs.
Collapse
Affiliation(s)
- Raj Verma
- Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Gideon Cohen
- Division of Cardiac Surgery, Sunnybrook Hospital, Toronto, Canada
| | - Jillian Colbert
- Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Libin Cardiovascular Institute, Calgary, Alberta, Canada
| | - Paul W M Fedak
- Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Libin Cardiovascular Institute, Calgary, Alberta, Canada
| |
Collapse
|
202
|
Jutidamrongphan W, Kritpracha B, Sörelius K, Chichareon P, Chongsuvivatwong V, Sungsiri J, Rookkapan S, Premprabha D, Juntarapatin P, Tantarattanapong W, Suwannanon R. Predicting Infection Related Complications After Endovascular Repair of Infective Native Aortic Aneurysms. Eur J Vasc Endovasc Surg 2023; 65:425-432. [PMID: 36336285 DOI: 10.1016/j.ejvs.2022.11.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 01/10/2022] [Revised: 09/26/2022] [Accepted: 11/01/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Endovascular aortic repair (EVAR) as surgical treatment for infective native aortic aneurysm (INAA) is associated with superior survival compared with open surgery, but with the risk of infection related complications (IRCs). This study aimed to assess the association between baseline clinical and computed tomography (CT) features and the risk of post-operative IRCs in patients treated with EVAR for INAA. It also sought to develop a model to predict long term IRCs in patients with abdominal INAA treated with EVAR. METHODS All initial clinical details and CT examinations of INAAs between 2005 and 2020 at a major referral hospital were reviewed retrospectively. The images were scrutinised according to aneurysm features, as well as peri-aortic and surrounding organ involvement. Data on post-operative IRCs were found in the patient records. Cox regression analysis was used to derive predictors for IRCs and develop a model to predict five year IRCs after EVAR in abdominal INAA. RESULTS Of 3 780 patients with the diagnosis of aortic aneurysm or aortitis, 98 (3%) patients were treated with EVAR for abdominal INAAs and were thus included. The mean follow up time was 52 months (range 0 ‒ 163). The mean transaxial diameter was 6.5 ± 2.4 cm (range 2.1 ‒14.7). In the enrolled patients, 38 (39%) presented with rupture. The five year IRC rate in abdominal INAAs was 26%. Female sex, renal insufficiency, positive blood culture, aneurysm diameter, and psoas muscle involvement were predictive of five year IRC in abdominal INAA after EVAR. The model had a C-index of 0.76 (95% CI 0.66 - 0.87). CONCLUSION Pre-operative clinical and CT features have the potential to predict IRC after endovascular aortic repair in INAA patients. These findings stress the importance of rigorous clinical, laboratory, and radiological follow up in these patients.
Collapse
Affiliation(s)
| | - Boonprasit Kritpracha
- Department of Surgery, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Karl Sörelius
- Department of Vascular Surgery, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Ply Chichareon
- Cardiology Unit, Division of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | | | - Jitpreedee Sungsiri
- Department of Radiology, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Sorracha Rookkapan
- Department of Radiology, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Dhanakom Premprabha
- Department of Surgery, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Pong Juntarapatin
- Department of Surgery, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | | | - Ruedeekorn Suwannanon
- Department of Radiology, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand.
| |
Collapse
|
203
|
Berger T, Chikvatia S, Siepe M, Kondov S, Meissl D, Gottardi R, Rylski B, Czerny M, Kreibich M. Concomitant aortic root replacement during frozen elephant trunk implantation does not increase perioperative risk. Eur J Cardiothorac Surg 2023; 63:7048665. [PMID: 36808408 DOI: 10.1093/ejcts/ezad053] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 12/16/2022] [Accepted: 02/17/2023] [Indexed: 02/22/2023] Open
Abstract
OBJECTIVES Our aim was to evaluate the risk of concomitant aortic root replacement during frozen elephant trunk (FET) total arch replacement. METHODS Between 03/2013 and 02/2021, 303 patients underwent aortic arch replacement using the FET technique. Patient characteristics, intra- and postoperative data were compared between patients with (n = 50) and without (n = 253) concomitant aortic root replacement (implantation of a valved conduit or using the reimplantation valve sparing technique) after propensity score matching. RESULTS After propensity score matching there were no statistically significant differences in preoperative characteristics including the underlying pathology. There was no statistically significant difference regarding arterial inflow-cannulation or concomitant cardiac procedures, while cardiopulmonary bypass (p < 0.001) and aortic cross-clamp (p < 0.001) times were significantly longer in the root replacement group. Postoperative outcome was similar between the groups and there were no proximal reoperations in the root replacement group during follow-up. Root replacement was not predictive for mortality (p = 0.133, odds ratio: 0.291) in our Cox regression model. There was no statistically significant difference in overall survival (log rank: p = 0.062). CONCLUSIONS Concomitant FET implantation and aortic root replacement prolongs operative times, but does not influence postoperative outcomes or increase operative risk in an experienced high-volume centre. The FET procedure did not appear to be a contraindication for concomitant aortic root replacement even in patients with borderline indications for aortic root replacement.
Collapse
Affiliation(s)
- Tim Berger
- Department of Cardiovascular Surgery, Heart Centre Freiburg University, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Salome Chikvatia
- Department of Cardiovascular Surgery, Heart Centre Freiburg University, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Matthias Siepe
- Department of Cardiac Surgery, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Stoyan Kondov
- Department of Cardiovascular Surgery, Heart Centre Freiburg University, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Dominic Meissl
- Department of Cardiovascular Surgery, Heart Centre Freiburg University, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Roman Gottardi
- Department of Cardiovascular Surgery, Heart Centre Freiburg University, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Bartosz Rylski
- Department of Cardiovascular Surgery, Heart Centre Freiburg University, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Martin Czerny
- Department of Cardiovascular Surgery, Heart Centre Freiburg University, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Maximilian Kreibich
- Department of Cardiovascular Surgery, Heart Centre Freiburg University, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| |
Collapse
|
204
|
Rodriguez-Patarroyo FA, Yalcin EK, Campana MM, Almonacid-Cardenas F, Sale S, Bauer A, Duncan AE. Management of a Parturient with an Aortic Pseudoaneurysm. J Cardiothorac Vasc Anesth 2023; 37:86-89. [PMID: 36347729 DOI: 10.1053/j.jvca.2022.10.011] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 09/23/2022] [Accepted: 10/07/2022] [Indexed: 11/06/2022]
Affiliation(s)
| | | | | | | | - Shiva Sale
- Department of Cardiothoracic Anesthesiology, Cleveland Clinic, Cleveland, OH
| | - Andrew Bauer
- Department of Cardiothoracic Anesthesiology, Cleveland Clinic, Cleveland, OH
| | - Andra E Duncan
- Department of Outcomes Research, Cleveland Clinic, Cleveland, OH; Department of Cardiothoracic Anesthesiology, Cleveland Clinic, Cleveland, OH
| |
Collapse
|
205
|
Boldyrev SY, Erastova AV, Butaev SR, Bezdenezhnykh OS, Barbukhatti KO. [Total replacement of both carotid arteries combined with ascending aorta and aortic arch replacement for acute DeBakey type I aortic dissection]. Khirurgiia (Mosk) 2023:134-139. [PMID: 38088851 DOI: 10.17116/hirurgia2023121134] [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] [Indexed: 12/18/2023]
Abstract
Involvement of supra-aortic vessels into acute DeBakey type I aortic dissection is a significant predictor of adverse postoperative neurological outcomes and mortality. The choice of surgical tactics remains open in such patients. We present total replacement of both common carotid arteries and proximal part of the right subclavian artery with reconstruction of ascending aorta and aortic arch for acute DeBakey type I dissection.
Collapse
Affiliation(s)
- S Yu Boldyrev
- Research Institute - Ochapovskiy Regional Clinical Hospital No. 1, Krasnodar, Russia
- Kuban State Medical University, Krasnodar, Russia
| | - A V Erastova
- Kuban State Medical University, Krasnodar, Russia
| | - S R Butaev
- Research Institute - Ochapovskiy Regional Clinical Hospital No. 1, Krasnodar, Russia
| | | | - K O Barbukhatti
- Research Institute - Ochapovskiy Regional Clinical Hospital No. 1, Krasnodar, Russia
- Kuban State Medical University, Krasnodar, Russia
| |
Collapse
|
206
|
David TE, Seidman MA, David CM, Lafreniere-Roula M. Outcomes of Reimplantation of the Aortic Valve in Patients With Aortic Cusp Fenestration. Ann Thorac Surg 2023; 115:106-111. [PMID: 35122724 DOI: 10.1016/j.athoracsur.2021.12.070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 12/12/2021] [Accepted: 12/20/2021] [Indexed: 12/31/2022]
Abstract
BACKGROUND Aortic cusp fenestrations are common in patients with aortic root aneurysm, and their management during aortic valve repair remains controversial. We believe that fenestrations in the area of the commissures may rupture after reimplantation of the aortic valve because this operation increases the mechanical stress on the cusps. For this reason we have reinforced the free margin of the aortic cusp with fenestration with fine Gore-Tex sutures (WL Gore). This study examines the outcomes of reimplantation of the aortic valve in patients who had cusp fenestration reinforced with Gore-Tex sutures. METHODS A review of all patients who had reimplantation of the aortic valve for aortic root aneurysm disclosed 111 patients who had at least 1 cusp fenestration reinforced with a double layer of a fine Gore-Tex suture. The outcomes of these patients were examined and compared with a group of patients without fenestration using propensity score analysis. All patients were followed prospectively with images of the heart. RESULTS The median follow-up was 8.3 years. Overall the cumulative incidence of aortic valve reintervention at 15 years was 4.8% and the cumulative incidence of aortic insufficiency of moderate or severe degree was 9.2%. Comparison of outcomes of patients with and without fenestrations showed similar results up to 15 years of follow-up. CONCLUSIONS Reinforcement of the free margins of cusps with fenestrations using Gore-Tex sutures is safe and does not seem to adversely affect the durability of reimplantation of the aortic valve.
Collapse
Affiliation(s)
- Tirone E David
- Division of Cardiac Surgery, University Health Network and Peter Munk Cardiac Centre, Toronto, Ontario, Canada.
| | - Michael A Seidman
- Division of Cardiac Surgery, University Health Network and Peter Munk Cardiac Centre, Toronto, Ontario, Canada
| | - Carolyn M David
- Division of Cardiac Surgery, University Health Network and Peter Munk Cardiac Centre, Toronto, Ontario, Canada
| | - Myriam Lafreniere-Roula
- Division of Cardiac Surgery, University Health Network and Peter Munk Cardiac Centre, Toronto, Ontario, Canada
| |
Collapse
|
207
|
Ohshima T, Ioku T, Yokota M, Kawaguchi R, Matsuo N, Miyachi S. A Novel Approach to Neuroendovascular Treatment Looking Up from the Ascending Aorta Using an Alpha Shape Guiding Catheter. World Neurosurg 2023; 169:32-35. [PMID: 36328168 DOI: 10.1016/j.wneu.2022.10.095] [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: 10/16/2022] [Revised: 10/24/2022] [Accepted: 10/25/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND A method of guiding an intermediate catheter from a new alpha-type guiding catheter placed in the ascending aorta to the carotid artery is evaluated in neuroendovascular treatment in challenging anatomic directions of the guiding catheter, such as the bovine aortic arch and type III aortic arch. METHODS The existing 8-Fr guiding catheter was given a strong bending shape at the tip to make it an alpha type. The total length of the catheter was 85 cm. This guiding catheter was inserted into the ascending aorta to verify whether a 6-Fr intermediate or aspiration catheter could be coaxially guided into the right and left internal carotid arteries. A silicone vascular model was used for evaluation and in actual clinical cases. RESULTS Creating an alpha shape of the catheter at the aortic arch was very easy. The inner catheter could be easily guided from the brachiocephalic artery to the right common carotid artery by pushing the alpha shape guiding catheter toward the aortic valve. The catheter was easily guided into the left common carotid artery when the α-guide was pulled a little bit backward. The 0.071-inch lumen aspiration catheter reached the bilateral middle cerebral arteries. CONCLUSIONS The 8-Fr alpha shape guiding catheter quickly guides the inner catheter into the bovine and the type III aortic arch by looking up from the ascending aorta.
Collapse
Affiliation(s)
- Tomotaka Ohshima
- Neuroendovascular Therapy Center, Aichi Medical University, Nagakute, Aichi, Japan.
| | - Tetsuya Ioku
- Neuroendovascular Therapy Center, Aichi Medical University, Nagakute, Aichi, Japan
| | - Mao Yokota
- Department of Neurosurgery, Aichi Medical University, Nagakute, Aichi, Japan
| | - Reo Kawaguchi
- Department of Neurosurgery, Aichi Medical University, Nagakute, Aichi, Japan
| | - Naoki Matsuo
- Department of Neurosurgery, Aichi Medical University, Nagakute, Aichi, Japan
| | - Shigeru Miyachi
- Neuroendovascular Therapy Center, Aichi Medical University, Nagakute, Aichi, Japan; Department of Neurosurgery, Aichi Medical University, Nagakute, Aichi, Japan
| |
Collapse
|
208
|
Bai L, Ge L, Zhang Y, Li M, Jiang B, Song Y. Experience of the Postoperative Intensive Care Treatment of Stanford Type A Aortic Dissection. Int J Clin Pract 2023; 2023:4191277. [PMID: 36713953 PMCID: PMC9845037 DOI: 10.1155/2023/4191277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 11/30/2022] [Accepted: 11/30/2022] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVE To summarize the experience of the postoperative intensive care treatment of Stanford type A aortic dissection (STAAD) following Sun's procedure. METHODS A total of 124 patients with STAAD who underwent Sun's procedure from January 2014 to December 2021 at the General Hospital of Ningxia Medical University were retrospectively analyzed. All patients were admitted to the cardiac surgery intensive care unit (ICU) after surgery. According to the perioperative characteristics of the patients with STAAD, intensive care treatment was given to actively prevent the occurrence of postoperative complications. RESULTS In all the cases enrolled in this study, the causes of aortic dissection comprised hypertension (105 cases), trauma (six cases), Marfan's syndrome (six cases), and aorto-arteritis (seven cases). The history of past illnesses comprised hypertension (105 cases), coronary disease (25 cases), diabetes mellitus (16 cases), and chronic obstructive pulmonary disease (six cases). There were some preoperative complications, such as cardiac insufficiency, acute liver insufficiency, acute renal insufficiency, pleural effusion, pericardial effusion, pulmonary infection, lower limb ischemia, mesenteric arterial embolism, and digestive tract hemorrhage. The average cardiopulmonary bypass time was 186 ± 32.1 min, the aortic clamp time was 74 ± 12.8 min, the deep hypothermic circulatory arrest time was 21 ± 2.6 min, and the mechanical ventilation time was 34 ± 2.8 h. The average ICU and hospital residence times were 7 ± 1.6 days and 12 ± 3.6 days, respectively. Postoperative complications comprised hypoxemia (34 cases), pulmonary infections (22 cases), tracheostomy (four cases), cerebral hemorrhage (four cases), cerebral infarction (four cases), transient delirium (eight cases), secondary thoracotomies due to bleeding (two cases), alimentary tract hemorrhage (eight cases), and acute renal insufficiency (38 cases). There was no occurrence of hoarseness or chylothorax. There were 15 cases of death, and the total mortality rate was 12.1%. In four cases, the cause of death was one postoperative complication (3.2%), and in 11 cases, the cause of death was multiple postoperative complications (8.9%). The other patients were discharged from the hospital with a good prognosis for full recovery. CONCLUSION Postoperative intensive care treatment was an important part of the successful surgical treatment of STAAD.
Collapse
Affiliation(s)
- Lei Bai
- Department of Cardiovascular Surgery, General Hospital of Ningxia Medical University, Yinchuan 750004, China
| | - Lijuan Ge
- Department of Pediatrics, General Hospital of Ningxia Medical University, Yinchuan 750004, China
| | - Yujing Zhang
- Department of Cardiovascular Surgery, General Hospital of Ningxia Medical University, Yinchuan 750004, China
| | - Mingliang Li
- Department of Cardiovascular Surgery, General Hospital of Ningxia Medical University, Yinchuan 750004, China
| | - Bo Jiang
- Department of Cardiovascular Surgery, General Hospital of Ningxia Medical University, Yinchuan 750004, China
| | - Yanyan Song
- Department of Cardiovascular Surgery, General Hospital of Ningxia Medical University, Yinchuan 750004, China
| |
Collapse
|
209
|
Patlolla SH, Stephens EH, Schaff HV, Anavekar NS, Miranda WR, Julsrud PR, Dearani JA. Outcomes of a protocolized approach for surgical unroofing of intramural anomalous aortic origin of coronary artery in children and adults. J Thorac Cardiovasc Surg 2022; 165:1641-1650. [PMID: 36690526 DOI: 10.1016/j.jtcvs.2022.11.037] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 10/09/2022] [Accepted: 11/19/2022] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Management of anomalous aortic origin of coronary arteries has been variable, and limited data are available on early and late outcomes. METHODS We report a single institution's experience with a protocolized approach to 148 consecutive patients who underwent surgical unroofing of intramural anomalous aortic origin of coronary arteries (June 2003 to December 2020). The management algorithm included preoperative and postoperative cross-sectional and echocardiographic imaging, exercise testing, and a standardized operative technique. RESULTS The median age of the cohort was 44.4 years (range, 4 months to 83 years); 130 patients had an anomalous right coronary artery, and 19 patients had an anomalous left coronary artery. Surgical unroofing was an isolated procedure in 118 patients (80%) and a concomitant procedure in 30 patients (20.3%). There were 2 (1%) early deaths; both were reoperations for aortic root or valve replacement. Over a median follow-up of 9.5 (interquartile range, 5-12.3) years, there were 5 late deaths, 3 due to noncardiac causes and 2 due to unknown cause. Late survival after anomalous aortic origin of coronary arteries repair at 10 and 15 years was 94.5% and 94.5%, respectively. There were no early or late deaths in the pediatric cohort with a median follow-up of 10.9 years (interquartile range, 6.9-12.1). At a median clinical follow-up of 3.9 years (interquartile range, 1.1-9.5), 36 patients had chest pain but none with evidence of ischemia related to the unroofing. CONCLUSIONS Surgical unroofing of anomalous aortic origin of coronary arteries can be performed safely with low early mortality, even in the setting of concomitant procedures. Late survival is excellent, with the vast majority being symptom free.
Collapse
Affiliation(s)
- Sri Harsha Patlolla
- Department of Cardiovascular Surgery, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minn
| | - Elizabeth H Stephens
- Department of Cardiovascular Surgery, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minn
| | - Hartzell V Schaff
- Department of Cardiovascular Surgery, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minn
| | | | | | | | - Joseph A Dearani
- Department of Cardiovascular Surgery, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minn.
| |
Collapse
|
210
|
Kumar J, Kumar S, Khatri M. Acute aortic dissection type A: Impact of aortic specialists on short and long term. J Card Surg 2022; 37:5682. [PMID: 36183399 DOI: 10.1111/jocs.16971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 09/13/2022] [Indexed: 01/06/2023]
Affiliation(s)
- Jugdesh Kumar
- Shaheed Mohtarma Benazir Bhutto Medical College Liyari, Karachi, Pakistan
| | - Satesh Kumar
- Shaheed Mohtarma Benazir Bhutto Medical College Liyari, Karachi, Pakistan
| | - Mahima Khatri
- Dow University of Health Sciences, Karachi, Pakistan
| |
Collapse
|
211
|
Rômullo Medeiros S, Ribeiro Dias R, Leyton Pozzo V, Duncan Santiago J, Madrini Junior V, Biscegli Jatene F. Surgical correction of the ascending aorta and an aortic root aneurysm associated with coarctation of the descending aorta. Multimed Man Cardiothorac Surg 2022; 2022. [PMID: 36314438 DOI: 10.1510/mmcts.2022.052] [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] [Indexed: 06/16/2023]
Abstract
This case report shows how to perform simultaneously an open surgical correction of an aortic root aneurysm and aortic stenosis by interposition of an aortic composite graft and the transdiaphragmatic extra-anatomical correction of an aortic coarctation.
Collapse
Affiliation(s)
| | - Ricardo Ribeiro Dias
- Cardiovascular surgery, Heart institute from the University of Sao Paulo, Brazil
| | - Vanina Leyton Pozzo
- Heart Institute (InCor), University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Jose Duncan Santiago
- Cardiovascular surgery, Heart institute from the University of Sao Paulo, Brazil
| | | | | |
Collapse
|
212
|
Lorenz V, Muzzi L, Neri E. How to perform a direct axillary artery cannulation. Multimed Man Cardiothorac Surg 2022; 2022. [PMID: 36239585 DOI: 10.1510/mmcts.2022.075] [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] [Indexed: 06/16/2023]
Abstract
The choice of the arterial cannulation site has been a matter of debate over the years. The femoral artery has been used for a long time due to its ease of isolation and the possibility of percutaneous cannulation. However, it is associated with the risk of embolization because of the retrograde flow, and it is more dangerous in the case of aortic dissection because perfusion is unpredictable and retrograde flow exposes the patient to the risk of malperfusion. Cannulation of the axillary artery has recently gained popularity because of its advantages, in particular for antegrade aortic perfusion during cardiopulmonary bypass and for its ability to facilitate cerebral perfusion during hypothermic circulatory arrest. We show tips and tricks to facilitate the isolation and direct cannulation of the axillary artery because we think that this procedure should be practiced by all cardiac surgeons, even those who are just beginning their practices.
Collapse
Affiliation(s)
- Veronica Lorenz
- Department of Cardiovascular and Thoracic Surgery, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Luigi Muzzi
- (a) Division of Cardio-Thoracic Surgery, Department of Medical Biotechnologies, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Eugenio Neri
- Division of Cardio-Thoracic Surgery, Department of Medical Biotechnologies, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| |
Collapse
|
213
|
Belitsis G, Aynetdinova R, Dent C, Kostolny M. Ductal arch decoded: the use of its spatial fingerprint to design a Norwood type of patch. Multimed Man Cardiothorac Surg 2022; 2022. [PMID: 36239124 DOI: 10.1510/mmcts.2022.074] [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] [Indexed: 11/07/2022]
Abstract
Reconstruction of the aortic arch for the Norwood procedure remains a focus of attention in terms of the management of the distal anastomosis [1,2], patch design and material [3,4], and fashioning the Damus-Kaye-Stansel itself [5]. The reconstructed aorta supplies the coronaries and the head and neck vessels and directs flow to the descending aorta. As the fetus develops, the right ventricle shunts to the aorta through the ductal arch, supporting a great percentage of the systemic and the placental circulation. We have developed a method of designing a Norwood patch by decoding the 3-dimensional geometry of the arterial duct and its arch.
Collapse
Affiliation(s)
- Georgios Belitsis
- University College London and Great Ormond Street Hospital, London, UK
| | | | | | | |
Collapse
|
214
|
Thet MST, Balmforth D, Lopez-Marco A, Ye Oo A. Resternotomy aortic root and arch replacement following previous complex type A aortic dissection requiring endovascular repair for malperfusion. Multimed Man Cardiothorac Surg 2022; 2022. [PMID: 36239233 DOI: 10.1510/mmcts.2022.042] [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] [Indexed: 06/16/2023]
Abstract
A redo sternotomy, aortic root, and arch replacement in a patient following previous complex surgical and endovascular type A aortic dissection repair is presented in this video case report. Shortly after having the initial type A aortic dissection repair with replacement of the ascending aorta, the patient developed severe visceral malperfusion due to a compressed distal true lumen and underwent emergency endovascular repair with ascending arch and descending thoracic aorta stents and chimney grafts for the aortic arch vessels as well as fenestration of the intimal flap of the abdominal aorta. Unfortunately, the patient developed permanent paraplegia and progressive symptomatic severe aortic regurgitation. The patient underwent a redo sternotomy, aortic root, and arch replacement with explantation of the ascending stent graft and chimney stent grafts. Antegrade cerebral perfusion was maintained throughout the procedure. The aortic arch was replaced using a Terumo Aortic Plexus multibranched graft distally anastomosed to the endovascular stent graft, and the innominate and left common carotid arteries were reimplanted onto the graft. The aortic root was replaced with a Bioconduit graft, using a modified Cabrol technique to reimplant the left coronary artery. A satisfactory postoperative course and computed tomography imaging highlight the feasibility of this highly complex aortic arch repair with careful preoperative planning.
Collapse
Affiliation(s)
- Myat Soe Thet Thet
- Department of Cardiothoracic Surgery, St Bartholomew's Hospital, London, UK
| | - Damian Balmforth
- Department of Cardiothoracic Surgery, St Bartholomew's Hospital, London, UK
| | - Ana Lopez-Marco
- Department of Cardiothoracic Surgery, St Bartholomew's Hospital, London, UK
| | - Aung Ye Oo
- Department of Cardiothoracic Surgery, St Bartholomew's Hospital, London, UK
| |
Collapse
|
215
|
Avnioglu S, Dikici R, Etli M. 3D modeling and comparative analysis of the double arcus aorta case. Int J Cardiovasc Imaging 2022; 38:2263-2268. [PMID: 37726466 DOI: 10.1007/s10554-022-02675-z] [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] [Received: 06/08/2022] [Accepted: 06/13/2022] [Indexed: 11/05/2022]
Abstract
We analyzed the double arch of a 51-year-old male patient who applied to the outpatient clinic with chest pain and shortness of breath and compared this rare case with the studies in the literature. Double aortic arch (DAA) is defined as a type of vascular ring malformation. The incidence of congenital heart diseases is less than 1%. DAA makes up 46-76% of all rings. We aimed to contribute to cardiac surgery by examining and modeling the diameters in the 2D and 3D images of the patient. For 3D modeling, an open-source software program ITK-SNAP 3.8 was used, which converts 2D images from MRI, CT, and ultrasound to 3D medical image volumes. CT images of the case taken from the SECTRA system of our hospital were uploaded to ITK-SNAP and segmentation was performed. With 3D modeling, a better understanding of the stenosis in the trachea and the double arch was achieved. The ascending aorta diameter was 30 mm. There were atherosclerotic changes in the aorta and its branches. The diameter of the right aortic arch was 22.2 mm, and the diameter of the left aortic arch was 14.5 mm. Trachea diameter was found to be 17 mm/13.2 mm. Esophageal diameter was 9.8 mm. The patient had no specific complaints and no medical or surgical treatment was recommended because his physical examination was normal. We think that a better understanding of such cases in 3D may contribute to cardiovascular surgery.
Collapse
Affiliation(s)
- Seda Avnioglu
- Department of Anatomy, Faculty of Medicine, Alanya Alaaddin Keykubat University, Antalya, Turkey
| | - Rumeysa Dikici
- Department of Anatomy, Faculty of Medicine, Alanya Alaaddin Keykubat University, Antalya, Turkey.
| | - Mustafa Etli
- Department of Cardiovascular Surgery, Faculty of Medicine, Alanya Alaaddin Keykubat University, Antalya, Turkey
| |
Collapse
|
216
|
Nah J, Shirakabe A, Mukai R, Zhai P, Sung EA, Ivessa A, Mizushima W, Nakada Y, Saito T, Hu C, Jung YK, Sadoshima J. Ulk1-dependent alternative mitophagy plays a protective role during pressure overload in the heart. Cardiovasc Res 2022; 118:2638-2651. [PMID: 35018428 PMCID: PMC10144728 DOI: 10.1093/cvr/cvac003] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 01/06/2022] [Indexed: 11/13/2022] Open
Abstract
AIMS Well-controlled mitochondrial homeostasis, including a mitochondria-specific form of autophagy (hereafter referred to as mitophagy), is essential for maintaining cardiac function. The molecular mechanism mediating mitophagy during pressure overload (PO) is poorly understood. We have shown previously that mitophagy in the heart is mediated primarily by Atg5/Atg7-independent mechanisms, including Unc-51-like kinase 1 (Ulk1)-dependent alternative mitophagy, during myocardial ischaemia. Here, we investigated the role of alternative mitophagy in the heart during PO-induced hypertrophy. METHODS AND RESULTS Mitophagy was observed in the heart in response to transverse aortic constriction (TAC), peaking at 3-5 days. Whereas mitophagy is transiently up-regulated by TAC through an Atg7-dependent mechanism in the heart, peaking at 1 day, it is also activated more strongly and with a delayed time course through an Ulk1-dependent mechanism. TAC induced more severe cardiac dysfunction, hypertrophy, and fibrosis in ulk1 cardiac-specific knock-out (cKO) mice than in wild-type mice. Delayed activation of mitophagy was characterized by the co-localization of Rab9 dots and mitochondria and phosphorylation of Rab9 at Ser179, major features of alternative mitophagy. Furthermore, TAC-induced decreases in the mitochondrial aspect ratio were abolished and the irregularity of mitochondrial cristae was exacerbated, suggesting that mitochondrial quality control mechanisms are impaired in ulk1 cKO mice in response to TAC. TAT-Beclin 1 activates mitophagy even in Ulk1-deficient conditions. TAT-Beclin 1 treatment rescued mitochondrial dysfunction and cardiac dysfunction in ulk1 cKO mice during PO. CONCLUSION Ulk1-mediated alternative mitophagy is a major mechanism mediating mitophagy in response to PO and plays an important role in mediating mitochondrial quality control mechanisms and protecting the heart against cardiac dysfunction.
Collapse
Affiliation(s)
- Jihoon Nah
- Department of Cell Biology and Molecular Medicine, Rutgers New Jersey Medical School, Newark, NJ, USA
- School of Biological Sciences, Seoul National University, Seoul, Korea
| | - Akihiro Shirakabe
- Department of Cell Biology and Molecular Medicine, Rutgers New Jersey Medical School, Newark, NJ, USA
- Nippon Medical School, Chiba Hokusoh Hospital, Chiba, Japan
| | - Risa Mukai
- Department of Cell Biology and Molecular Medicine, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Peiyong Zhai
- Department of Cell Biology and Molecular Medicine, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Eun Ah Sung
- Department of Cell Biology and Molecular Medicine, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Andreas Ivessa
- Department of Cell Biology and Molecular Medicine, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Wataru Mizushima
- Department of Cell Biology and Molecular Medicine, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Yasuki Nakada
- Department of Cell Biology and Molecular Medicine, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Toshiro Saito
- Department of Cell Biology and Molecular Medicine, Rutgers New Jersey Medical School, Newark, NJ, USA
- Department of Surgery and Clinical Science, Graduate School of Medicine, Yamaguchi University, Ube, Yamaguchi, Japan
| | - Chengchen Hu
- Department of Cell Biology and Molecular Medicine, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Yong Keun Jung
- School of Biological Sciences, Seoul National University, Seoul, Korea
| | - Junichi Sadoshima
- Department of Cell Biology and Molecular Medicine, Rutgers New Jersey Medical School, Newark, NJ, USA
| |
Collapse
|
217
|
Vekstein AM, Chen EP. Thinking below the surface in valve-sparing aortic root repair: iceberg or smooth waters? Eur J Cardiothorac Surg 2022; 62:ezac450. [PMID: 36099019 PMCID: PMC9507022 DOI: 10.1093/ejcts/ezac450] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 09/12/2022] [Indexed: 11/12/2022] Open
Affiliation(s)
- Andrew M Vekstein
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, NC, USA
| | - Edward P Chen
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, NC, USA
| |
Collapse
|
218
|
Shimizu T, Sato K, Kakiuchi T, Kobinata T. [Successful Thoracic Endovascular Aortic Repair in a Patient with Mid-aortic Syndrome:Report of a Case]. Kyobu Geka 2022; 75:679-682. [PMID: 36156516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
We report a case of thoracic endovascular aortic repair (TEVAR) for mid-aortic syndrome, which is characterized by a segmental narrowing of the aorta, in a 71-year-old man who presented with intermittent claudication. Contrast-enhanced computed tomography (CT) showed segmental stenosis of the descending aorta, for which TEVAR was performed. The ankle-branchial index increased after surgery, and the dorsalis pedis arterial pulses became palpable bilaterally. The patient was discharged on postoperative day 14 without any complication. At present, four years after surgery, he is in good condition with improved renal function, requiring no hospitalization for the treatment of heart failure.
Collapse
Affiliation(s)
- Toshikazu Shimizu
- Department of Cardiovascular Surgery, Kasukabe Central General Hospital, Kasukabe, Japan
| | | | | | | |
Collapse
|
219
|
Inoue T, Okada K. [Up to Date for Treatment of Stanford Type A Acute Aortic Dissection]. Kyobu Geka 2022; 75:741-747. [PMID: 36155562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Surgical outcomes for acute type A aortic dissection (ATAAD) have been improving, but mortality rate remains about 10% in the last decade. Based on the current literatures including American Association for Thoracic Surgery (AATS) expert consensus, we presented the latest treatments and our surgical strategies for ATAAD. This section states about cannulation strategies for cardio-pulmonary bypass, aortic root managements, aggressive arch strategies, distal anastomosis strategies and the managements of malperfusion syndrome. We recommended the ascending aorta using the Seldinger technique as the cannulation site. As the aortic root management, valve resuspension is effective, but valve-sparing aortic root repair may be an option for young patients with annulo-aortic ectasia, intimal tear located in Valsalva sinus or Valsalva sinus rupture. The tear-oriented surgery is the standard for the range of the graft replacement, however, aggressive arch repair is also good indication for young patients. Distal anastomoses are felt sandwich technique for hemi-arch replacement or partial arch replacement and frozen elephant trunk is useful to total arch replacement. Early reperfusion strategies were important to the malperfusion syndrome of coronary arteries, supra-aortic vessels and superior mesenteric artery. To the dissected common carotid arteries (CCAs), early reperfusion and direct reconstruction of CCAs were effective.
Collapse
Affiliation(s)
- Taishi Inoue
- Division of Cardiovascular Surgery, Kobe University, Kobe, Japan
| | | |
Collapse
|
220
|
Kayali F, Jubouri M, Tan SZ, Mohammed I, Bashir M. Aortic remodeling in aortic dissection after frozen elephant trunk: overcoming the challenges. J Cardiovasc Surg (Torino) 2022; 63:434-438. [PMID: 35621062 DOI: 10.23736/s0021-9509.22.12385-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The introduction of the single-step hybrid frozen elephant trunk (FET) procedure expanded the surgeon's armamentarium in managing aortic dissection (AD). This is evident by the reduction in mortality and complication rates associated with conventional techniques used to repair ADs. Although FET still carries a risk of certain complications, it has been associated with excellent aortic remodeling following the procedure. The main scope of this review is to evaluate aortic remodeling in aortic dissection after FET as well as to highlight the challenges that may arise and ways to overcome them. A comprehensive literature search was conducted on multiple electronic databases including PubMed, Ovid, Scopus and Embase to highlight the evidence in the literature on aortic remodeling in aortic dissection after FET. The FET procedure promotes excellent long-term remodeling, this is seen in the substantial increase in the size of the true lumen along with the decrease in that of the false lumen (FL), in addition to significant FL thrombosis. However, this occurs to a lesser extent more distally at the level of the abdominal aorta. Negative remodeling may present a major challenge to the process of aortic remodeling, nevertheless, this can be overcome with endovascular reintervention which has demonstrated highly favorable results. Additionally, the choice of FET graft, in terms of type and length, seems to influence outcomes. Namely, the Thoraflex™ Hybrid graft can be considered the superior graft on the global market. On the other hand, there seems to be a debate in the literature on the optimal FET graft length. The FET procedure has revolutionized the field of aortovascular surgery and promotes excellent long-term aortic remodeling. Negative remodeling can occur but can also be favorably overcome with endovascular reintervention. Finally, the choice of FET graft may also influence results, thus, should be taken with great care.
Collapse
Affiliation(s)
- Fatima Kayali
- School of Medicine, University of Central Lancashire, Preston, UK
| | - Matti Jubouri
- Hull York Medical School, University of York, York, UK
| | - Sven Z Tan
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Idhrees Mohammed
- Institute of Cardiac and Aortic Disorders (ICAD), SRM Institutes for Medical Science (SIMS Hospital), Chennai, India
| | - Mohamad Bashir
- Department of Vascular and Endovascular Surgery, Velindre University NHS Trust, Health Education and Improvement Wales (HEIW), Cardiff, UK -
| |
Collapse
|
221
|
Dossabhoy SS, Forbes TL. Providing high-quality open aortic surgical care in the endovascular era. J Vasc Surg 2022; 76:409-410. [PMID: 35870848 DOI: 10.1016/j.jvs.2022.02.059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 02/28/2022] [Indexed: 11/16/2022]
Affiliation(s)
- Shernaz S Dossabhoy
- Division of Vascular and Endovascular Surgery, Stanford University School of Medicine, Stanford, CA
| | - Thomas L Forbes
- Division of Vascular Surgery, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
222
|
Amin A, Etheridge GM, Amarasekara HS, Green SY, Orozco-Sevilla V, Coselli JS. Aortic arch repair: lessons learned over three decades at Baylor College of Medicine. J Cardiovasc Surg (Torino) 2022; 63:393-405. [PMID: 35621061 DOI: 10.23736/s0021-9509.22.12376-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The treatment of complex aortic arch disease continues to be among the most demanding cardiovascular operations, with a considerable risk of death and stroke. Since January 1990, our single-practice service has performed over 3000 repairs of the aortic arch. Our aim was to describe the progression of our technical approach to open aortic arch repair. Our center's surgical technique has evolved considerably over the last three decades. When it comes to initial arterial cannulation, we have shifted away from femoral artery cannulation to innominate and axillary artery cannulation. During difficult repairs, this transition has made it easier to use antegrade cerebral perfusion rather than retrograde cerebral perfusion, which was commonly used in the early days. Brain protection tactics during open aortic arch procedures have evolved from profound (≤14 °C) hypothermia during circulatory arrest to moderate (22-24 °C) hypothermia. Aortic arch repair is performed through a median sternotomy and may treat acute aortic dissection, chronic aortic dissection, or degenerative aneurysm. Reoperative repair - that necessitating redo sternotomy - is common in patients undergoing aortic arch repair. The majority of repairs will include varying portions of the ascending aorta and may involve the aortic valve or the aortic root. In some patients, repair may extend into the proximal descending thoracic aorta; this includes elephant trunk, frozen elephant trunk, and antegrade hybrid approaches.
Collapse
Affiliation(s)
- Arsalan Amin
- Baylor College of Medicine, Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Houston, TX, USA
| | - Ginger M Etheridge
- Baylor College of Medicine, Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Houston, TX, USA
| | - Hiruni S Amarasekara
- Baylor College of Medicine, Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Houston, TX, USA
| | - Susan Y Green
- Baylor College of Medicine, Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Houston, TX, USA
| | - Vicente Orozco-Sevilla
- Baylor College of Medicine, Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Houston, TX, USA
- Texas Heart Institute, Houston, TX, USA
- Department of Cardiovascular Surgery, CHI St Luke's Health - Baylor St Luke's Medical Center, Houston, TX, USA
| | - Joseph S Coselli
- Baylor College of Medicine, Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Houston, TX, USA -
- Texas Heart Institute, Houston, TX, USA
- Department of Cardiovascular Surgery, CHI St Luke's Health - Baylor St Luke's Medical Center, Houston, TX, USA
| |
Collapse
|
223
|
Spanjersberg AJ, Ottervanger JP, Nierich AP, Hoogendoorn M, Bruinsma GJBB. Mortality Reduction After a Preincision Safety Check Before Cardiac Surgery: Is It the Aorta? J Cardiothorac Vasc Anesth 2022; 36:2954-2960. [PMID: 35288024 DOI: 10.1053/j.jvca.2022.01.047] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 01/13/2022] [Accepted: 01/29/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVES The introduction and use of a preincision safety check were associated with lower mortality after mixed adult cardiac surgery; however, an explanatory mechanism is lacking. Stroke, one of the most severe complications after cardiac surgery, with high mortality, may be reduced by adapting the surgical handling of the ascending aorta. This study assessed the prevalence and predictors of this adaptation after a preincision safety check and the subsequent effect on outcome. DESIGN A prospective, single-center, observational study comparing adaptation with no-adaptation. The primary outcome measure was 30-day mortality. Multivariate analyses were performed to determine independent predictors of adaptation. To study the effect of adaptation on outcome, a propensity score-matched cohort was constructed in a 1:3 intervention:control ratio. SETTING At Isala Zwolle (NL), a large, nonacademic teaching hospital. PARTICIPANTS All consecutive cardiac surgery procedures from 2012 until 2015, including 4,752 surgeries. INTERVENTIONS The adaptation of surgical handling of the ascending aorta. MEASUREMENTS AND MAIN RESULTS In 283 cardiac surgeries (5.9%), adaptation was indicated. The most important independent predictors for adaptation were extracardiac atherosclerosis, current smoking, and increasing age. In the propensity score-matched cohort consisting of 1,069 procedures, there were no significant differences in outcome. After correction for propensity score, the hazard ratio of adaptation for 30-day mortality was 1.8 (0.85-3.79). CONCLUSIONS The adaptation of aortic surgical handling after a preincision safety check was necessary for 5.9% of cardiac surgeries, with extracardiac atherosclerosis as the strongest predictor. Outcome was not significantly different between patients with and without adaptation. Although promising, it remains unclear whether adaptation may fully explain mortality reduction after the use of a preincision safety check.
Collapse
Affiliation(s)
- Alexander J Spanjersberg
- Division Cardiothoracic Anesthesiology, Department of Anesthesiology and Intensive Care, Isala Heart Centre, Isala Zwolle, The Netherlands.
| | | | - Arno P Nierich
- Division Cardiothoracic Anesthesiology, Department of Anesthesiology and Intensive Care, Isala Heart Centre, Isala Zwolle, The Netherlands
| | - Marga Hoogendoorn
- Division Cardiothoracic Anesthesiology, Department of Anesthesiology and Intensive Care, Isala Heart Centre, Isala Zwolle, The Netherlands
| | | |
Collapse
|
224
|
Helmberger T. [Aorta-Current treatment options]. Radiologie (Heidelb) 2022; 62:549-550. [PMID: 35768585 DOI: 10.1007/s00117-022-01031-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/31/2022] [Indexed: 06/15/2023]
Affiliation(s)
- Thomas Helmberger
- Institut für Radiologie, Neuroradiologie und minimal-invasive Therapie, München Klinik Bogenhausen, Englschalkinger Str. 77, 81925, München, Deutschland.
| |
Collapse
|
225
|
Affiliation(s)
- Tirone David
- Surgery, Toronto General Hospital, Toronto, Ontario, Canada
| |
Collapse
|
226
|
Darigny S, Astarci P, Elens M. Complete Aortic Replacement in a Patient With Loeys-Dietz Syndrome. Vasc Endovascular Surg 2022; 56:767-771. [PMID: 35705511 DOI: 10.1177/15385744221109037] [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] [Indexed: 11/15/2022]
Abstract
Background: LDS is an autosomal dominant connective tissue disease. It is a rare multi-systemic disorder with serious vascular impact. Case report: We report a case of a 38-year-old male with Loeys-Dietz syndrome (LDS) suffering from major aortic complications. The disease initially manifested itself as a type A aortic dissection, successfully treated by open ascending aorta replacement. Ten days later, the patient developed an uncomplicated type B dissection. During follow up, the patient became symptomatic in both legs (rest pain) due to major true lumen compression. A thoracic endovascular aortic repair was performed with immediate improvement of the symptoms. During follow up, a computer tomography angiogram, showed a persistence false lumen perfusion and an aortic diameter increase. Multiple additional endovascular procedures and a final open thoracoabdominal aortic replacement were needed to exclude completely the false lumen. Conclusion: Open surgical repair is still the gold standard therapy for patients with connective tissue disease. However, with the nowadays progress, hybrid procedures could be a better option.
Collapse
Affiliation(s)
- Sandrine Darigny
- Department of Cardiovascular and Thoracic Surgery, St Luc Hospital, Catholic University of Louvain, Brussels, Belgium
| | - Parla Astarci
- Department of Cardiovascular and Thoracic Surgery, St Luc Hospital, Catholic University of Louvain, Brussels, Belgium
| | - Maxime Elens
- Department of Cardiovascular and Thoracic Surgery, St Luc Hospital, Catholic University of Louvain, Brussels, Belgium
| |
Collapse
|
227
|
Dong H, Liu M, Qin T, Liang L, Ziganshin B, Ellauzi H, Zafar M, Jang S, Elefteriades J, Sun W. Engineering analysis of aortic wall stress and root dilatation in the V-shape surgery for treatment of ascending aortic aneurysms. Interact Cardiovasc Thorac Surg 2022; 34:1124-1131. [PMID: 35134955 PMCID: PMC9159430 DOI: 10.1093/icvts/ivac004] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 12/11/2021] [Accepted: 12/17/2021] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES The study objective was to evaluate the aortic wall stress and root dilatation before and after the novel V-shape surgery for the treatment of ascending aortic aneurysms and root ectasia. METHODS Clinical cardiac computed tomography images were obtained for 14 patients [median age, 65 years (range, 33-78); 10 (71%) males] who underwent the V-shape surgery. For 10 of the 14 patients, the computed tomography images of the whole aorta pre- and post-surgery were available, and finite element simulations were performed to obtain the stress distributions of the aortic wall at pre- and post-surgery states. For 6 of the 14 patients, the computed tomography images of the aortic root were available at 2 follow-up time points post-surgery (Post 1, within 4 months after surgery and Post 2, about 20-52 months from Post 1). We analysed the root dilatation post-surgery using change of the effective diameter of the root at the two time points and investigated the relationship between root wall stress and root dilatation. RESULTS The mean and peak max-principal stresses of the aortic root exhibit a significant reduction, P=0.002 between pre- and post-surgery for both root mean stress (median among the 10 patients presurgery, 285.46 kPa; post-surgery, 199.46 kPa) and root peak stress (median presurgery, 466.66 kPa; post-surgery, 342.40 kPa). The mean and peak max-principal stresses of the ascending aorta also decrease significantly from pre- to post-surgery, with P=0.004 for the mean value (median presurgery, 296.48 kPa; post-surgery, 183.87 kPa), and P=0.002 for the peak value (median presurgery, 449.73 kPa; post-surgery, 282.89 kPa), respectively. The aortic root diameter after the surgery has an average dilatation of 5.01% in total and 2.15%/year. Larger root stress results in larger root dilatation. CONCLUSIONS This study marks the first biomechanical analysis of the novel V-shape surgery. The study has demonstrated significant reduction in wall stress of the aortic root repaired by the surgery. The root was able to dilate mildly post-surgery. Wall stress could be a critical factor for the dilatation since larger root stress results in larger root dilatation. The dilated aortic root within 4 years after surgery is still much smaller than that of presurgery.
Collapse
Affiliation(s)
- Hai Dong
- Tissue Mechanics Laboratory, The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, USA
| | - Minliang Liu
- Tissue Mechanics Laboratory, The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, USA
| | - Tongran Qin
- Tissue Mechanics Laboratory, The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, USA
| | - Liang Liang
- Department of Computer Science, University of Miami, Coral Gables, FL, USA
| | - Bulat Ziganshin
- Aortic Institute at Yale New Haven Hospital, Yale University School of Medicine, New Haven, CT, USA
| | - Hesham Ellauzi
- Aortic Institute at Yale New Haven Hospital, Yale University School of Medicine, New Haven, CT, USA
| | - Mohammad Zafar
- Aortic Institute at Yale New Haven Hospital, Yale University School of Medicine, New Haven, CT, USA
| | - Sophie Jang
- Aortic Institute at Yale New Haven Hospital, Yale University School of Medicine, New Haven, CT, USA
| | - John Elefteriades
- Aortic Institute at Yale New Haven Hospital, Yale University School of Medicine, New Haven, CT, USA
| | - Wei Sun
- Tissue Mechanics Laboratory, The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, USA
- Corresponding author. Tissue Mechanics Laboratory, The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Technology Enterprise Park, Room 206 387 Technology Circle, Atlanta, GA 30313-2412, USA. Tel: (404)-385-1245; e-mail: (W. Sun)
| |
Collapse
|
228
|
Orelaru F, Longi F, Ahmad RA, Naeem A, Wu X, Kim KM, Fukuhara S, Patel H, Michael Deeb G, Yang B. Progression of aortic root based on long-term imaging studies after acute type A dissection repair. J Card Surg 2022; 37:1674-1681. [PMID: 35262974 DOI: 10.1111/jocs.16392] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 02/08/2022] [Accepted: 02/13/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND To determine the progression of aortic root in acute type A aortic dissection (ATAAD) patients after aortic root repair (ARr) or replacement (ARR) based on long-term follow-up imaging studies. METHODS From 1996 to 2019, 732 patients had ATAAD repair at our institution. Six hundred and seven of these patients had either ARr, (n = 383) or ARR (n = 224). Eighty-one patients were excluded due to a lack of postoperative imaging. Three hundred and thirty-two patients were included in the repair group and 194 patients in the replacement group for long-term follow-up imaging study. RESULTS Compared to the ARR group, the ARr group was significantly older (60 years vs. 55 years) and had more patients with hypertension (79% vs. 63%) but less male patients (63% vs. 79%) and connective tissue disorder (1.8% vs 8%). The ARr group had more zone two arch replacement (22% vs. 11%), similar HCA time (35 min vs. 31 min), shorter cardiopulmonary bypass time (203 min vs. 266 min), aortic cross-clamp time (128 min vs. 214 min), and fewer concomitant coronary artery bypass (3.9% vs. 8.9%). The root growth rate over 12 years was similar between the repair and replacement group (0.20 mm/year vs. 0.18 mm/year, p = .75). Both the repair and replacement group had similar 15-year cumulative incidence of reoperation (6.9% vs. 5.9%; p = .67), operative mortality (7.8% vs. 8.5%; p = .78), and 15-year survival (51% vs. 52%; p = .40). CONCLUSIONS There was minimal growth of the aortic root after root repair or replacement for ATAAD patients. Both aortic root repair and replacement were acceptable techniques for ATAAD surgery in select patients.
Collapse
Affiliation(s)
- Felix Orelaru
- Department of General Surgery, St. Joseph Mercy Hospital, Ann Arbor, Michigan, USA
| | - Faraz Longi
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | | | - Aroma Naeem
- Department of Cardiac Surgery, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Xiaoting Wu
- Department of Cardiac Surgery, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Karen M Kim
- Department of Cardiac Surgery, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Shinichi Fukuhara
- Department of Cardiac Surgery, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Himanshu Patel
- Department of Cardiac Surgery, Michigan Medicine, Ann Arbor, Michigan, USA
| | - G Michael Deeb
- Department of Cardiac Surgery, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Bo Yang
- Department of Cardiac Surgery, Michigan Medicine, Ann Arbor, Michigan, USA
| |
Collapse
|
229
|
Saiki M, Yunoki K, Takao K, Yokoyama S, Inoue T, Tateishi A, Tamura K, Ohshima Y, Hisamochi K. [Bentall Operation for Pregnant Women with Marfan's Syndrome]. Kyobu Geka 2022; 75:423-427. [PMID: 35618687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
A 35-years-old pregnant woman with Marfan's syndrome visited the emergent department. She had sudden severe back pain. She was at the 20th week of gestation. An emergent chest computed tomo-graphy scan showed Stanford type B acute aortic dissection. After admission, strict blood pressure control was started. According to aortic valve insufficiency and fluid retention with pregnancy, acute heart and respiratory failure was getting worse. It seemed risky for both mother and the fetus to continue pregnancy. After sincere and detailed discussion between the patient and our multidisciplinary medical team, the patient decided to continue pregnancy. An urgent Bentall operation was performed. A careful attention was paid for the fetus during and after the surgery. Strict blood pressure control was also continued. The mother and the 30-week-gestation newborn recovered uneventfully. During four years of follow-up, thoracic and thoraco-abdominal aortic replacement was performed. The patient survived all of these procedures without any complication.
Collapse
Affiliation(s)
- Munehiro Saiki
- Department of Cardiovascular Surgery, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
| | | | | | | | | | | | | | | | | |
Collapse
|
230
|
Ganapathi AM, Ranney DN, Peterson MD, Lindsay ME, Patel HJ, Pyeritz RE, Trimarchi S, Hutchison S, Harris KM, Greason KL, Ota T, Montgomery DG, Nienaber CA, Eagle KA, Isselbacher EM, Hughes GC. Location of Aortic Enlargement and Risk of Type A Dissection at Smaller Diameters. J Am Coll Cardiol 2022; 79:1890-1897. [PMID: 35550685 DOI: 10.1016/j.jacc.2022.02.053] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 02/16/2022] [Accepted: 02/28/2022] [Indexed: 12/17/2022]
Abstract
BACKGROUND Previous work has demonstrated that more than one-half of acute type A aortic dissections (ATADs) occur at a maximal aortic diameter (MAD) of <5.5 cm. However, no analysis has investigated whether ATAD risk at smaller MADs is more common with modest dilation of the aortic root (AR) or supracoronary ascending aorta (AA) in patients without genetically triggered aortopathy. OBJECTIVES This study sought to determine if the segment of modest aortic dilation affects risk of ATAD. METHODS Using the International Registry of Acute Aortic Dissection (IRAD) database from May 1996 to October 2016, we identified 667 ATAD patients with MAD <5.5 cm. Patients were stratified by location of the largest proximal aortic segment (AR or AA). Patients with known genetically triggered aortopathy were excluded. MADs at time of dissection were compared between AR and AA groups. Secondary outcomes included operation, postoperative outcomes, and long-term survival. RESULTS Of patients with ATAD at an MAD <5.5 cm, 79.5% (n = 530) were in the AA group and 20.5% (n = 137) in the AR group. Modestly dilated ARs (median MAD 4.6 cm [IQR: 4.1-5.0 cm]) dissected at a significantly smaller diameter than modestly dilated AAs (median MAD 4.8 cm [IQR: 4.4-5.1 cm]) (P < 0.01). AR patients were significantly younger than AA patients (58.5 ± 13.0 years vs 63.2 ± 13.3 years; P < 0.01) and more commonly male (78% vs 65%; P < 0.01). Postoperative and long-term outcomes did not differ between groups. CONCLUSIONS ATAD appears to occur at smaller diameters in patients with modest dilation in the AR vs the AA (4.6 vs 4.8 cm). These findings may have implications for future consensus guidelines regarding the management of patients with aortic disease.
Collapse
Affiliation(s)
- Asvin M Ganapathi
- Department of Surgery, Division of Cardiac Surgery, Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - David N Ranney
- Department of Surgery, Division of Cardiovascular and Thoracic Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Mark D Peterson
- Division of Cardiac Surgery, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Mark E Lindsay
- Thoracic Aortic Center, Massachusetts General Hospital, Boson, Massachusetts, USA
| | - Himanshu J Patel
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Reed E Pyeritz
- Departments of Medicine and Genetics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
| | - Santi Trimarchi
- Department of Scienze Cliniche e di Comunita, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico-University of Milan, Milan, Italy
| | - Stuart Hutchison
- Departments of Cardiac Sciences, Medicine, and Radiology, University of Calgary Medical Centre, Calgary, Alberta, Canada
| | - Kevin M Harris
- Cardiovascular Division, Minneapolis Heart Institute, Minneapolis, Minnesota, USA
| | - Kevin L Greason
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Takeyoshi Ota
- Department of Surgery, University of Chicago Medical Center, Chicago, Illinois, USA
| | | | - Christoph A Nienaber
- Cardiology and Aortic Centre, The Royal Brompton & Harefield NHS Trust, London, United Kingdom
| | - Kim A Eagle
- Cardiovascular Center, University of Michigan, Ann Arbor, Michigan, USA
| | - Eric M Isselbacher
- Thoracic Aortic Center, Massachusetts General Hospital, Boson, Massachusetts, USA
| | - G Chad Hughes
- Department of Surgery, Division of Cardiovascular and Thoracic Surgery, Duke University Medical Center, Durham, North Carolina, USA.
| |
Collapse
|
231
|
Berger T, Zimmer E, Kondov S, Siepe M. The David procedure for quadricuspid aortic valve repair. Multimed Man Cardiothorac Surg 2022; 2022. [PMID: 35671233 DOI: 10.1510/mmcts.2022.022] [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] [Indexed: 06/15/2023]
Abstract
Quadricuspid aortic valves are rare but may result in significant aortic regurgitation requiring surgery. To date, valve-sparing root replacement is frequently done in patients with bi- and tricuspid aortic valve pathologies with preserved cusp tissue. Nevertheless, little is known about quadricuspid repair, especially in regard to the optimal surgical technique for long-term durability. We hereby provide a surgical guide to valve-sparing aortic root replacement using the David technique in a young patient with severe aortic regurgitation.
Collapse
Affiliation(s)
- Tim Berger
- Department of Cardiovascular Surgery, University Hospital Freiburg, Heart Centre Freiburg, Freiburg, Germany, University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - Emmanuel Zimmer
- Department of Cardiovascular Surgery, University Hospital Freiburg, Heart Centre Freiburg, Freiburg, Germany, University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - Stoyan Kondov
- Department of Cardiovascular Surgery University Heart Center Freiburg Faculty of Medicine, University of Freiburg Hugstetterstr. 55 79106, Freiburg Germany
| | | |
Collapse
|
232
|
Affronti A, Hernandez-Meneses M, Sandoval Martínez E, Pruna-Guillen R, Castellà M, Quintana E. Comprehensive management of late mediastinitis involving an aortic Dacron graft. Multimed Man Cardiothorac Surg 2022; 2022. [PMID: 35822641 DOI: 10.1510/mmcts.2022.023] [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] [Indexed: 06/15/2023]
Abstract
We present a case of late mediastinitis following surgery for type A aortic dissection. After a thorough preoperative workup, the patient underwent a redo sternotomy, removal of all prosthetic material, and replacement of the aortic root with a homograft. The patient required venoarterial extracorporeal membrane oxygenation and delayed sternal closure for post-postoperative biventricular failure as well as prolonged antibiotic treatment. We present our institutional multidisciplinary approach for the management of such complex cases.
Collapse
Affiliation(s)
- Alessandro Affronti
- Cardiovascular Surgery Department, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | | | - Elena Sandoval Martínez
- Cardiovascular Surgery Department, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Robert Pruna-Guillen
- Infectious Diseases Department, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Manuel Castellà
- Cardiovascular Surgery Department, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Eduard Quintana
- Cardiovascular Surgery Department, Hospital Clínic, University of Barcelona, Barcelona, Spain
| |
Collapse
|
233
|
Jansen JO, Cochran C, Boyers D, Gillies K, Lendrum R, Sadek S, Lecky F, MacLennan G, Campbell MK. The effectiveness and cost-effectiveness of resuscitative endovascular balloon occlusion of the aorta (REBOA) for trauma patients with uncontrolled torso haemorrhage: study protocol for a randomised clinical trial (the UK-REBOA trial). Trials 2022; 23:384. [PMID: 35550642 PMCID: PMC9097076 DOI: 10.1186/s13063-022-06346-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 04/23/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Haemorrhage is the most common cause of preventable death after injury. REBOA is a novel technique whereby a percutaneously inserted balloon is deployed in the aorta, providing a relatively quick means of temporarily controlling haemorrhage and augmenting cerebral and coronary perfusion, until definitive control of haemorrhage can be attained. The aim of the UK-REBOA trial is to establish the clinical and cost-effectiveness of a policy of standard major trauma centre treatment plus REBOA, as compared with standard major trauma centre treatment alone, for the management of uncontrolled torso haemorrhage caused by injury. METHODS Pragmatic, Bayesian, group-sequential, randomised controlled trial, performed in 16 major trauma centres in England. We aim to randomise 120 injured patients with suspected exsanguinating haemorrhage to either standard major trauma centre care plus REBOA or standard major trauma centre care alone. The primary clinical outcome is 90-day mortality. Secondary clinical outcomes include 3-h, 6-h, and 24-h mortality; in-hospital mortality; 6-month mortality; length of stay (in hospital and intensive care unit); 24-h blood product use; need for haemorrhage control procedure (operation or angioembolisation); and time to commencement of haemorrhage control procedure (REBOA, operation, or angioembolisation). The primary economic outcome is lifetime incremental cost per QALY gained, from a health and personal social services perspective. DISCUSSION This study, which is the first to randomly allocate patients to treatment with REBOA or standard care, will contribute high-level evidence on the clinical and cost-effectiveness of REBOA in the management of trauma patients with exsanguinating haemorrhage and will provide important data on the feasibility of implementation of REBOA into mainstream clinical practice. TRIAL REGISTRATION ISRCTN16184981.
Collapse
Affiliation(s)
- Jan O Jansen
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK.
- Department of Surgery, Center for Injury Science, University of Alabama at Birmingham, 1808 7th Ave S, Birmingham, AL, 35294, USA.
| | - Claire Cochran
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Dwayne Boyers
- Health Economics Research Unit, University of Aberdeen, Aberdeen, UK
| | - Katie Gillies
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Robbie Lendrum
- Barts Health NHS Trust, Royal London Hospital, St. Bartholomew's Hospital, London, UK
| | - Sam Sadek
- Barts Health NHS Trust, Royal London Hospital, St. Bartholomew's Hospital, London, UK
| | - Fiona Lecky
- Centre for Urgent and Emergency Care Research, Health Services Research Section, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Graeme MacLennan
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | | |
Collapse
|
234
|
Granath C, Freiholtz D, Bredin F, Olsson C, Franco‐Cereceda A, Björck HM. Acetylsalicylic Acid Is Associated With a Lower Prevalence of Ascending Aortic Aneurysm and a Decreased Aortic Expression of Cyclooxygenase 2. J Am Heart Assoc 2022; 11:e024346. [PMID: 35470674 PMCID: PMC9238591 DOI: 10.1161/jaha.121.024346] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 03/18/2022] [Indexed: 11/20/2022]
Abstract
Background Acetylsalicylic acid (ASA) therapy has been associated with a reduced prevalence and growth rate of abdominal as well as intracranial aneurysms, but the relationship between ASA and ascending aortic aneurysm formation remains largely unknown. The aim of the present study was to investigate whether ASA therapy is associated with a lower prevalence of ascending aortic aneurysm in a surgical cohort. Methods and Results One thousand seven hundred patients undergoing open-heart surgery for ascending aortic aneurysm and/or aortic valve disease were studied in this retrospective cross-sectional study. Aortic dilatation was defined as an aortic root or ascending aortic diameter ≥45 mm. Medications were self-reported by the patients in a systematic questionnaire. Cyclooxygenase gene expression was measured in the intima-media portion of the ascending aorta (n=117). In a multivariable analysis, ASA was associated with a reduced prevalence of ascending aortic aneurysm (relative risk, 0.68 [95% CI, 0.48-0.95], P=0.026) in patients with tricuspid aortic valves, but not in patients with bicuspid aortic valves (relative risk, 0.93 [95% CI, 0.64-1.34], P=0.687). Intima-media cyclooxygenase expression was positively correlated with ascending aortic dimensions (P<0.001 for cyclooxygenase-1 and P=0.05 for cyclooxygenase-2). In dilated, but not nondilated tricuspid aortic valve aortic specimens, ASA was associated with significantly lower cyclooxygenase-2 levels (P=0.034). Conclusions Our findings are consistent with the hypothesis that ASA treatment may attenuate ascending aortic aneurysmal growth, possibly via cyclooxygenase-2 inhibition in the ascending aortic wall and subsequent anti-inflammatory actions.
Collapse
Affiliation(s)
- Carl Granath
- Section of Cardiothoracic SurgeryDepartment of Molecular Medicine and SurgeryKarolinska InstitutetStockholmSweden
| | - David Freiholtz
- Section of Cardiothoracic SurgeryDepartment of Molecular Medicine and SurgeryKarolinska InstitutetStockholmSweden
| | - Fredrik Bredin
- Section of Cardiothoracic SurgeryDepartment of Molecular Medicine and SurgeryKarolinska InstitutetStockholmSweden
| | - Christian Olsson
- Section of Cardiothoracic SurgeryDepartment of Molecular Medicine and SurgeryKarolinska InstitutetStockholmSweden
| | - Anders Franco‐Cereceda
- Section of Cardiothoracic SurgeryDepartment of Molecular Medicine and SurgeryKarolinska InstitutetStockholmSweden
| | - Hanna M. Björck
- Cardiovascular Medicine UnitCenter for Molecular MedicineDepartment of MedicineKarolinska Institutet, StockholmKarolinska University HospitalSolnaSweden
| |
Collapse
|
235
|
Milnerowicz A, Jędrzejczak T, Rynio P, Kazimierczak A. Modified implantation of a Bolton Relay branch arch device into the ascending aorta close to a mechanical aortic valve. Interact Cardiovasc Thorac Surg 2022; 34:936-938. [PMID: 35142358 PMCID: PMC9070509 DOI: 10.1093/icvts/ivac017] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 01/10/2022] [Accepted: 01/18/2022] [Indexed: 11/13/2022] Open
Abstract
An aortic arch stent graft is usually contraindicated with a mechanical aortic valve. However, a modified stent graft plus the use of an externalized transapical guidewire technique allowed a safe implantation close to a mechanical aortic valve.
Collapse
Affiliation(s)
- Artur Milnerowicz
- Kliniczny Oddział Chirurgii Naczyniowej 4WSK z Polikliniką Wrocław ul, . Weigla 5, Poland
| | - Tomasz Jędrzejczak
- Klinika Chirurgii Naczyniowej, Ogólnej i Angiologii PUM w Szczecinie. Ul, . Powstańców Wielkopolskich 72, Poland
| | - Paweł Rynio
- Klinika Chirurgii Naczyniowej, Ogólnej i Angiologii PUM w Szczecinie. Ul, . Powstańców Wielkopolskich 72, Poland
| | - Arkadiusz Kazimierczak
- Klinika Chirurgii Naczyniowej, Ogólnej i Angiologii PUM w Szczecinie. Ul, . Powstańców Wielkopolskich 72, Poland
| |
Collapse
|
236
|
Okada S, Ezure M, Hasegawa Y, Yamada Y, Hoshino J, Morishita H, Seki M, Kaga T, Oi A. [Localized Stenosis in a Non-anastomotic Site of the Ascending Aorta to Bifemoral Bypass Graft:Report of a Case]. Kyobu Geka 2022; 75:387-391. [PMID: 35474205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
An 85-year-old man received simultaneous coronary artery bypass grafting (CABG) and the ascending aorta to bifemoral bypass with a Dacron graft 11 years ago. He suffered from intermittent claudication. Angiography demonstrated a localized stenosis in a non-anastomotic site, straight portion of the graft. He received percutaneous transluminal angioplasty. The right ankle-brachial pressure index (ABI) improved from 0.58 to 0.74 and left ABI improved from 0.52 to 0.71. One year later, intermittent claudication appeared again, right ABI decreased to 0.53 and left ABI decreased to 0.52. Computed tomography( CT) demonstrated restenosis at the same portion of the graft. A re-do operation was performed, stenotic portion was removed and replaced by a new ePTFE graft. No restenosis was seen three years after the second operation. We thought that repeated temporary compression of the graft might have led to a clot formation in the non-anastomotic site.
Collapse
Affiliation(s)
- Shuichi Okada
- Division of Cardiovascular Surgery, Gunma Prefectural Cardiovascular Center, Maebashi, Japan
| | | | | | | | | | | | | | | | | |
Collapse
|
237
|
Masaki S, Murayama H, Okada N, Kozakai M, Osawa T. Surgical Management of Group A β-Hemolytic Streptococcal Aortic Root Abscess. Ann Thorac Surg 2022; 115:e113-e115. [PMID: 35609649 DOI: 10.1016/j.athoracsur.2022.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 04/13/2022] [Accepted: 05/08/2022] [Indexed: 11/29/2022]
Abstract
This case report presents a pediatric patient with an aortic root abscess caused by group A β-hemolytic Streptococcus. After aggressive debridement of infected tissue, the continuity between the left ventricular outflow tract and aorta was reconstructed with autologous pericardium, and the aortic valve was replaced with a mechanical prosthesis using the Konno procedure with concomitant mitral valve plasty. We believe that radical resection of the abscess is an effective way to eradicate such a life-threatening infection.
Collapse
Affiliation(s)
- Shota Masaki
- Department of Cardiovascular Surgery, Aichi Children's Health and Medical Center, Aichi, Japan.
| | - Hiroomi Murayama
- Department of Cardiovascular Surgery, Aichi Children's Health and Medical Center, Aichi, Japan
| | - Noritaka Okada
- Department of Cardiovascular Surgery, Aichi Children's Health and Medical Center, Aichi, Japan
| | - Motoshi Kozakai
- Department of Cardiovascular Surgery, Aichi Children's Health and Medical Center, Aichi, Japan
| | - Takuya Osawa
- Department of Cardiovascular Surgery, Aichi Children's Health and Medical Center, Aichi, Japan
| |
Collapse
|
238
|
Hiraoka Y, Ishiwari K, Niitsu H, Hama G, Toyoda Y, Shiratori K, Kunihara T. [True Ascending Aortic Aneurysm Late after Total Arch Replacement]. Kyobu Geka 2022; 75:340-343. [PMID: 35474196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
An aortic aneurysm was incidentally diagnosed in a 75-year-old woman during a thorough examination for other diseases. She had a history of total arch replacement( TAR) for aortic arch aneurysm 17 years previously. Contrast-enhanced computed tomography( CT) revealed a proximal aortic aneurysm with a maximum diameter of 67 mm protruding to the lateral side. She was treated by elective ascending aortic replacement. The resected aneurysm was not a pseudoaneurysm, but a true aneurysm. The etiology of this aneurysm might be long-term hemodynamic stress from the left ventricle and inadequate blood pressure control in addition to the anatomical position of the proximal residual aorta after first surgery. Therefore, to prevent aneurysm formation, it is important to replace the ascending aorta as proximally as possible at first surgery and to continue strict postoperative blood pressure control.
Collapse
Affiliation(s)
- Yuki Hiraoka
- Department of Cardiovascular Surgery, Saku Central Hospital Advanced Care Center, Saku, Japan
| | | | | | | | | | | | | |
Collapse
|
239
|
Inaba K, Alam HB, Brasel KJ, Brenner M, Brown CVR, Ciesla DJ, de Moya MA, DuBose JJ, Moore EE, Moore LJ, Sava JA, Vercruysse GA, Martin MJ. A Western Trauma Association critical decisions algorithm: Resuscitative endovascular balloon occlusion of the aorta. J Trauma Acute Care Surg 2022; 92:748-753. [PMID: 34686636 DOI: 10.1097/ta.0000000000003438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Kenji Inaba
- From the Division of Trauma and Surgical Critical Care (K.I., M.J.M.), Department of Surgery, University of Southern California, Los Angeles, California; Department of Surgery (H.B.A.), Northwestern University, Chicago, Illinois; Department of Surgery (K.J.B.), Oregon Health and Science University, Portland, Oregon; Department of Surgery (M.B.), University of California Riverside, Riverside, California; Department of Surgery (C.V.R.B., J.J.D.), University of Texas at Austin, Austin, Texas; Department of Surgery (D.J.C.), University of South Florida, Tampa, Florida; Department of Surgery (M.A.d.M.), Medical College of Wisconsin, Milwaukee, Wisconsin; Department of Surgery (E.E.M.), Ernest E Moore Shock Trauma Center at Denver Health, Denver, Colorado; Department of Surgery (L.J.M.), University of Texas, McGovern Medical School, Houston, Houston, Texas; Department of Surgery (J.A.S.), MedStar Washington Hospital, Washington, DC; and Department of Surgery (G.A.V.), University of Michigan, Ann Arbor, Michigan
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
240
|
Matsumura Y, Shiraishi A, Kushimoto S. Minimising the biases in the observational study of resuscitative endovascular balloon occlusion of the aorta: a research protocol for a prospective study analysed with propensity score matching with time-varying covariates. BMJ Open 2022; 12:e053743. [PMID: 35365521 PMCID: PMC8977817 DOI: 10.1136/bmjopen-2021-053743] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Resuscitative endovascular balloon occlusion of the aorta (REBOA) has been used as a bridge to definitive bleeding control of subdiaphragmatic injury. Since previous observational studies have poorly adjusted for confounding factors, it is necessary to incorporate REBOA-specific and time-varying covariates in the model. We hypothesised that REBOA improves the survival of haemodynamically unstable torso trauma patients after comparing the REBOA group with a matched control group (non-REBOA group). METHODS AND ANALYSIS The Japanese Association for the Surgery of Trauma-REBOA Study is a prospective, multicentre, matched cohort study organised by the Clinical Trial Committee of the Japanese Association for the Surgery of Trauma. To minimise observational study biases, this study will prospectively register traumatic shock patients who require bleeding control within 60 min upon arrival at the emergency department, with in-hospital mortality as the primary outcome. After the data set is fixed, the missing values for all variables will be imputed using the multiple imputation technique. In the primary analysis, propensity scores for the probability of REBOA decision (regardless of the actual REBOA deployment) will be calculated from the baseline information using a logistic regression generalised linear mixed-effects model, which will be performed for both the REBOA use and non-REBOA use groups. ETHICS AND DISSEMINATION This study was approved by the ethics committee of each participating hospital. The results will be disseminated to the participating hospitals, submitted to peer-reviewed journals for publication and presented at congresses. TRIAL REGISTRATION NUMBER UMIN Clinical Trials Registry (UMIN000035458).
Collapse
Affiliation(s)
- Yosuke Matsumura
- Department of Emergency and Critical Care Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
- Department of Intensive Care, Chiba Emergency Medical Center, Chiba, Japan
| | - Atsushi Shiraishi
- Emergency and Trauma Department, Kameda Medical Center, Kamogawa, Japan
| | - Shigeki Kushimoto
- Division of Emergency and Critical Care Medicine, Tohoku University, Sendai, Miyagi, Japan
| |
Collapse
|
241
|
Abstract
The occurrence of acute aortic dissection with the initiating tear in the ascending aorta superimposed on cardiovascular syphilis is an exceedingly rare occurrence. Such was the case, however, in a recently seen patient who presented with typical features of acute dissection (type A). Operative repair yielded the entire ascending aorta to examine both grossly and histologically and classic features of both conditions were observed.
Collapse
Affiliation(s)
- William C Roberts
- Baylor Scott & White Heart and Vascular Institute, the Departments of; Internal Medicine,; Pathology,.
| | - Charles S Roberts
- Baylor Scott & White Heart and Vascular Institute, the Departments of; Cardiac and Thoracic Surgery, Baylor University Medical Center, Baylor Scott & White Health, Dallas, Texas
| |
Collapse
|
242
|
Franko JJ, Vu MM, Parsons ME, Conner JR, Lammers DT, Ieronimakis N, Reynolds GD, Eckert MJ, Bingham JR. Adenosine, lidocaine, and magnesium for attenuating ischemia reperfusion injury from resuscitative endovascular balloon occlusion of the aorta in a porcine model. J Trauma Acute Care Surg 2022; 92:631-639. [PMID: 34840271 DOI: 10.1097/ta.0000000000003482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Minimally invasive resuscitative endovascular balloon occlusion of the aorta (REBOA) following noncompressible hemorrhage results in significant ischemia reperfusion injury (IRI). Adverse outcomes from IRI include organ dysfunction and can result in profound hemodynamic and molecular compromise. We hypothesized that adenosine, lidocaine, and magnesium (ALM) attenuates organ injury and inflammation responses following REBOA IRI in a porcine model of hemorrhage. METHODS Animals underwent a 20% controlled hemorrhage followed by 45 minutes of supraceliac balloon occlusion. They were randomized into two groups: control (n = 9) and ALM intervention (n = 9) to include a posthemorrhage, pre-REBOA bolus (200 mL of 3% NaCl ALM) followed by a continuous drip (2 mL/kg per hour of 0.9% NaCl ALM) during the 4-hour resuscitative period. Primary outcomes included hemodynamic parameters, gene expression of inflammatory signaling molecules, and plasma concentrations of select cytokines and chemokines. RESULTS The ALM cohort demonstrated a significant reduction in cardiac output and cardiac index. Plasma concentrations of interleukin 2 and interleukin 10 were significantly lower 3 hours post-REBOA in animals treated with ALM versus vehicle. Interleukin 4 levels in plasma were also lower with ALM at 3 and 4 hours post-REBOA (p < 0.05). Liver expression of IL1RN, MTOR, and LAMP3 messenger RNA was significantly lower with ALM as compared with the vehicle. No significant difference in large bowel gene expression was observed between treatments. CONCLUSION In a porcine model of hemorrhage, ALM treatment mitigated inflammatory responses early during post-REBOA resuscitation. Our findings suggest that ALM use with trauma may reduce inflammatory injury and improve outcomes related to REBOA utilization.
Collapse
Affiliation(s)
- Jace J Franko
- From the Department of Surgery (J.J.F., M.M.V., M.E.P., J.R.C., D.T.L., N.I., G.D.R., J.R.B.), Madigan Army Medical Center, Tacoma, Washington; and Department of Surgery (M.J.E.), University of North Carolina Medical Center, Chapel Hill, North Carolina
| | | | | | | | | | | | | | | | | |
Collapse
|
243
|
Buech J, Radner C, Fabry TG, Horke KM, Ali A, Saha S, Hagl C, Pichlmaier MA, Peterss S. Visceral and renal malperfusion syndromes in acute aortic dissection type A: the fate of the branch vessel. J Cardiovasc Surg (Torino) 2022; 63:117-123. [PMID: 35238524 DOI: 10.23736/s0021-9509.22.12276-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND Malperfusion in acute aortic dissection is not uncommonly observed and associated with a highly significant increase in mortality and morbidity. Of the various malperfusion syndromes, visceral and renal involvement is the most challenging in terms of correct and timely diagnosis as well as the choice of management strategy. The aim of this study was to identify the pathology and associated fate of each visceral and renal vessel in acute type A dissections. METHODS Over a 12-year period, 167 consecutive patients with acute dissection type A extending into the thoracoabdominal aorta were included and radiographic images analyzed with a focus on individual branch vessel pathology and dependent organ perfusion. RESULTS Sixty-five patients (39%) were diagnosed with radiological signs of malperfusion on the CT Images. Of those, 20% expired during the hospital stay, compared to 8% without malperfusion. The left renal artery was the most frequently affected by dissection (31%) or false lumen supply (28%). False lumen perfusion was more often associated with manifest malperfusion than an extension of the dissection flap into the branch vessel. During the study period, there was no preference of surgical procedure treating the malperfusion. CONCLUSIONS Malperfusion of the visceral/renal branches of a dissected aorta represents a manifest indicator for postoperative mortality and morbidity. Neither clinical outcome, nor the fate of individual vessels can reliably be predicted prior to proximal reconstruction and thus, surgical strategy cannot generally be defined alone by radiological findings.
Collapse
Affiliation(s)
- Joscha Buech
- Department of Cardiac Surgery, LMU University Hospital, Munich, Germany
| | - Caroline Radner
- Department of Cardiac Surgery, LMU University Hospital, Munich, Germany
| | - Thomas G Fabry
- Department of Cardiac Surgery, LMU University Hospital, Munich, Germany
| | - Konstanze M Horke
- Department of Cardiac Surgery, LMU University Hospital, Munich, Germany
| | - Ahmad Ali
- Department of Cardiac Surgery, LMU University Hospital, Munich, Germany
| | - Shekhar Saha
- Department of Cardiac Surgery, LMU University Hospital, Munich, Germany
| | - Christian Hagl
- Department of Cardiac Surgery, LMU University Hospital, Munich, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site of Munich Heart Alliance, Munich, Germany
| | | | - Sven Peterss
- Department of Cardiac Surgery, LMU University Hospital, Munich, Germany -
| |
Collapse
|
244
|
Moore LJ, Rasmussen TE. A contemporary assessment of resuscitative endovascular balloon occlusion of the aorta. J Trauma Acute Care Surg 2022; 92:762-764. [PMID: 35121706 DOI: 10.1097/ta.0000000000003556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Laura J Moore
- From the Department of Surgery, University of Texas McGovern Medical School (L.J.M.), Houston, Texas; and Department of Surgery (T.E.R.), Mayo Clinic, Rochester, Minnesota
| | | |
Collapse
|
245
|
Palumbo MC, Redaelli A, Wingo M, Tak KA, Leonard JR, Kim J, Rong LQ, Park C, Mitlak HW, Devereux RB, Roman MJ, RoyChoudury A, Lau C, Gaudino MFL, Girardi LN, Weinsaft JW. Impact of ascending aortic prosthetic grafts on early postoperative descending aortic biomechanics on cardiac magnetic resonance imaging. Eur J Cardiothorac Surg 2022; 61:860-868. [PMID: 34849679 PMCID: PMC8947796 DOI: 10.1093/ejcts/ezab501] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 10/07/2021] [Accepted: 10/23/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Among patients with ascending thoracic aortic aneurysms, prosthetic graft replacement yields major benefits but risk for recurrent aortic events persists for which mechanism is poorly understood. This pilot study employed cardiac magnetic resonance to test the impact of proximal prosthetic grafts on downstream aortic flow and vascular biomechanics. METHODS Cardiac magnetic resonance imaging was prospectively performed in patients with thoracic aortic aneurysms undergoing surgical (Dacron) prosthetic graft implantation. Imaging included time resolved (4-dimensional) phase velocity encoded cardiac magnetic resonance for flow quantification and cine-cardiac magnetic resonance for aortic wall distensibility/strain. RESULTS Twenty-nine patients with thoracic aortic aneurysms undergoing proximal aortic graft replacement were studied; cardiac magnetic resonance was performed pre- [12 (4, 21) days] and postoperatively [6.4 (6.2, 7.2) months]. Postoperatively, flow velocity and wall shear stress increased in the arch and descending aorta (P < 0.05); increases were greatest in hereditary aneurysm patients. Global circumferential strain correlated with wall shear stress (r = 0.60-0.72, P < 0.001); strain increased postoperatively in the native descending and thoraco-abdominal aorta (P < 0.001). Graft-induced changes in biomechanical properties of the distal native ascending aorta were associated with post-surgical changes in descending aortic wall shear stress, as evidenced by correlations (r = -0.39-0.52; P ≤ 0.05) between graft-induced reduction of ascending aortic distensibility and increased distal native aortic wall shear stress following grafting. CONCLUSIONS Prosthetic graft replacement of the ascending aorta increases downstream aortic wall shear stress and strain. Postoperative increments in descending aortic wall shear stress correlate with reduced ascending aortic distensibility, suggesting that grafts provide a nidus for high energy flow and adverse distal aortic remodelling.
Collapse
Affiliation(s)
- Maria C Palumbo
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, USA
- Department of Bioengineering, Polytecnico University, Milan, Italy
| | - Alberto Redaelli
- Department of Bioengineering, Polytecnico University, Milan, Italy
| | - Matthew Wingo
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, USA
| | - Katherine A Tak
- Department of Medicine (Cardiology), Weill Cornell Medicine, New York, NY, USA
| | - Jeremy R Leonard
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, USA
| | - Jiwon Kim
- Department of Medicine (Cardiology), Weill Cornell Medicine, New York, NY, USA
| | - Lisa Q Rong
- Department of Anesthesiology, Weill Cornell Medicine, New York, NY, USA
| | - Christine Park
- Department of Medicine (Cardiology), Weill Cornell Medicine, New York, NY, USA
| | - Hannah W Mitlak
- Department of Medicine (Cardiology), Weill Cornell Medicine, New York, NY, USA
| | - Richard B Devereux
- Department of Medicine (Cardiology), Weill Cornell Medicine, New York, NY, USA
| | - Mary J Roman
- Department of Medicine (Cardiology), Weill Cornell Medicine, New York, NY, USA
| | - Arindam RoyChoudury
- Division of Biostatistics, Population Health Sciences, Weill Cornell Medicine, New York, NY, USA
| | - Christopher Lau
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, USA
| | - Mario F L Gaudino
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, USA
| | - Leonard N Girardi
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, USA
| | - Jonathan W Weinsaft
- Department of Medicine (Cardiology), Weill Cornell Medicine, New York, NY, USA
| |
Collapse
|
246
|
Knapp J, Jakob DA, Haltmeier T, Lehmann B, Hautz WE. [Resuscitative endovascular balloon occlusion of the aorta in severely injured patients in the emergency trauma room: a case series]. Anaesthesist 2022; 71:599-607. [PMID: 35254464 PMCID: PMC9352627 DOI: 10.1007/s00101-022-01100-3] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 01/01/2022] [Accepted: 02/13/2022] [Indexed: 11/27/2022]
Abstract
Hemorrhage is the cause of death in 30-40% of severely injured patients due to trauma and the most frequent avoidable cause of death. In civilian emergency medical services, the majority of life-threatening hemorrhages are found in incompressible body regions (e.g. abdomen and pelvis). Resuscitative endovascular balloon occlusion of the aorta (REBOA) has therefore been discussed in recent years as a lifesaving procedure for temporary bleeding control in multiple trauma patients. Since August 2020 REBOA is implented in the treatment of seriously injured patients in the emergency department of the University Hospital of Bern. In this case series we report on our experiences in all seven patients in whom we performed this procedure during the first year.
Collapse
Affiliation(s)
- Jürgen Knapp
- Klinik für Anästhesiologie und Schmerztherapie, Inselspital, Universitätsspital Bern, Universität Bern, Bern, Schweiz.
- Klinik für Anästhesie, Intensivmedizin und Schmerztherapie, Spital Schwyz, Schwyz, Schweiz.
- Klinik für Anästhesiologie und Schmerztherapie, Universitätsspital Bern, Universität Bern, Freiburgstraße, 3010, Bern, Schweiz.
| | - Dominik A Jakob
- Universitäres Notfallzentrum, Inselspital, Universitätsspital Bern, Universität Bern, Bern, Schweiz
| | - Tobias Haltmeier
- Klinik für Viszerale Chirurgie und Medizin, Inselspital, Universitätsspital Bern, Universität Bern, Bern, Schweiz
| | - Beat Lehmann
- Universitäres Notfallzentrum, Inselspital, Universitätsspital Bern, Universität Bern, Bern, Schweiz
| | - Wolf E Hautz
- Universitäres Notfallzentrum, Inselspital, Universitätsspital Bern, Universität Bern, Bern, Schweiz
| |
Collapse
|
247
|
Inaba Y, Minegishi S, Endo H, Kubota H. Removal of a frozen elephant trunk using a polyvinyl tube. Gen Thorac Cardiovasc Surg 2022; 70:506-508. [PMID: 35246777 PMCID: PMC9016002 DOI: 10.1007/s11748-022-01790-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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 02/14/2022] [Indexed: 11/27/2022]
Abstract
The increasing use of total arch replacement and frozen elephant trunk (FET) is expected to lead to an increase in the prevalence of graft infections requiring replacement involving an FET, which is generally a more invasive procedure than the initial surgery. Herein, we describe a novel method for FET removal using a polyvinyl tube as the storage device. The procedure is completed using the same median sternotomy approach as the initial surgery. We report on the outcomes for six patients. Our procedure is simple to perform and safe and caused no injury to the aorta in our case series.
Collapse
Affiliation(s)
- Yusuke Inaba
- Department of Cardiovascular Surgery, Kyorin University, 6-20-2 Shinkawa, Mitaka City, Tokyo, Japan.
| | - Sachito Minegishi
- Department of Cardiovascular Surgery, Kyorin University, 6-20-2 Shinkawa, Mitaka City, Tokyo, Japan
| | - Hidehito Endo
- Department of Cardiovascular Surgery, Kyorin University, 6-20-2 Shinkawa, Mitaka City, Tokyo, Japan
| | - Hiroshi Kubota
- Department of Cardiovascular Surgery, Kyorin University, 6-20-2 Shinkawa, Mitaka City, Tokyo, Japan
| |
Collapse
|
248
|
Mazine A, Chu MWA, El-Hamamsy I, Peterson MD. Valve-sparing aortic root replacement: a primer for cardiologists. Curr Opin Cardiol 2022; 37:156-164. [PMID: 35058413 DOI: 10.1097/hco.0000000000000951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW The purpose of this article is to review the contemporary evidence supporting valve-sparing aortic root replacement as the best option for patients with aortic root aneurysms and preservable aortic valves as well as to review the technical variations and modern adjuncts of these operations that impact both short and long-term durability. RECENT FINDINGS In patients with an aortic root aneurysm, with or without aortic valve regurgitation, valve-sparing aortic root replacement provide excellent clinical outcomes and stable valve function over several decades. Successful execution of this operation depends on careful patient selection and a thorough understanding of the anatomical and physiological relationships between the various components of the aortic root. Echocardiography remains the mainstay of imaging to determine the feasibility of valve-sparing root replacement. SUMMARY Valve-sparing aortic root replacement is an excellent alternative to composite valve graft replacement in nonelderly patients with aortic root aneurysms. Dedicated aortic root surgeons perform several technical variations of valve-sparing procedures aimed at matching the specific aortic root disorder with the optimal operation.
Collapse
Affiliation(s)
- Amine Mazine
- Division of Cardiac Surgery, Department of Surgery, University of Toronto, Toronto
| | - Michael W A Chu
- Division of Cardiac Surgery, Department of Surgery, Western University, London Health Sciences Centre, London, Ontario, Canada
| | - Ismail El-Hamamsy
- Department of Cardiovascular Surgery, Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Mark D Peterson
- Division of Cardiac Surgery, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
249
|
Shimizu K, Kurumisawa S, Aizawa K, Kawahito K. [Stanford Type A Acute Aortic Dissection Complicated by Takotsubo Cardiomyopathy:Report of a Case]. Kyobu Geka 2022; 75:203-207. [PMID: 35249954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
No case report about takotsubo cardiomyopathy with Stanford type A acute dissection is present in the literature. Here we report a case of takotsubo cardiomyopathy that was diagnosed following Stanford type A acute aortic dissection. A 65-year-old man was admitted with dyspnea. He had experienced acute chest pain 10 days prior. Computed tomography (CT) confirmed Stanford type A aortic dissection and primary entry tear in the proximal aortic arch with a thrombosed false lumen in the ascending aorta. Echocardiography revealed takotsubo-like wall motion, with an ejection fraction (EF) of 20%. Electrocardiography (ECG) showed ST-segment elevation in V2-V3. Subsequently, coronary artery disease was excluded by coronary CT. After 1 month, ECG findings and EF appeared normal. Thirty-five days after admission, aortic arch replacement was performed with the frozen elephant trunk technique. The patient's postoperative course was uneventful. Takotsubo cardiomyopathy should be considered as a possible complication of acute aortic dissection with ST-segment elevation.
Collapse
Affiliation(s)
- Keisuke Shimizu
- Department of Cardiovascular Surgery, Jichi Medical University, Shimotuske, Japan
| | | | | | | |
Collapse
|
250
|
Zhu Y, Imbrie-Moore AM, Paulsen MJ, Park MH, Tran NA, Woo YJ. A Novel Device for Intraoperative Direct Visualization of a Pressurized Root in Aortic Valve Repair. Ann Thorac Surg 2022; 114:567-571. [PMID: 35216987 PMCID: PMC9393902 DOI: 10.1016/j.athoracsur.2022.02.013] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 01/25/2022] [Accepted: 02/05/2022] [Indexed: 11/19/2022]
Abstract
PURPOSE One major challenge in generating reproducible aortic valve (AV) repair results is the inability to assess AV morphology under physiologic pressure. A transparent intraoperative aortic valve visualization device was designed and manufactured. DESCRIPTION This device is comprised of an open proximal end, a cantilevered edge to allow attachment of the device to the aorta or graft, a distal viewing surface, and two side ports for fluid delivery and air removal. EVALUATION The performance of the device was evaluated ex vivo using normal porcine AV in situ (n=3), AV after valve-sparing aortic root replacement (VSARR, n=3), and porcine pulmonary valve in Ross procedure (n=3), and in 3 patients who underwent VSARR. AV morphology was clearly visualized using the device in all experiments. In human, the use of this device successfully illustrated cusp prolapse after the initial VSARR and effectively guided additional cusp repair. CONCLUSIONS This device successfully allows for direct visual assessment of the AV apparatus under physiologic pressure. The use of this device can potentially increase the adoptability of AV repair in clinical practice.
Collapse
Affiliation(s)
- Yuanjia Zhu
- Department of Cardiothoracic Surgery, Stanford University, Stanford, California; Department of Bioengineering, Stanford University, Stanford, California
| | - Annabel M Imbrie-Moore
- Department of Cardiothoracic Surgery, Stanford University, Stanford, California; Department of Mechanical Engineering, Stanford University, Stanford, California
| | - Michael J Paulsen
- Department of Cardiothoracic Surgery, Stanford University, Stanford, California
| | - Matthew H Park
- Department of Cardiothoracic Surgery, Stanford University, Stanford, California; Department of Mechanical Engineering, Stanford University, Stanford, California
| | - Nicholas A Tran
- Department of Cardiothoracic Surgery, Stanford University, Stanford, California
| | - Y Joseph Woo
- Department of Cardiothoracic Surgery, Stanford University, Stanford, California; Department of Bioengineering, Stanford University, Stanford, California.
| |
Collapse
|