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Marrocco-Trischitta MM, Rylski B, Schofer F, Secchi F, Piffaretti G, de Beaufort H, Belvroy V, Bismuth J, Czerny M, Trimarchi S. Prevalence of type III arch configuration in patients with type B aortic dissection. Eur J Cardiothorac Surg 2019; 56:1075-1080. [DOI: 10.1093/ejcts/ezz137] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 03/26/2019] [Accepted: 04/01/2019] [Indexed: 12/23/2022] Open
Abstract
Abstract
OBJECTIVES
Type III aortic arch configuration consistently presents anatomical and biomechanical characteristics which have been associated with an increased risk of type B aortic dissection (TBD). Our aim was to investigate the prevalence of type III arch in patients with TBD and type B intramural haematoma (IMH-B).
METHODS
A multicentre retrospective analysis was performed on patients with TBD and IMH-B observed between 2002 and 2017. The computed tomographic images were reviewed to identify the type of aortic arch. Exclusion criteria included previous arch surgery, presence of aortic dissection or aneurysm proximal to the left subclavian artery and bovine arches. An ad hoc systematic literature review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines to assess the prevalence of type III arch in non-TBD and non-aneurysmal patients.
RESULTS
Two hundred and sixty-one patients with TBD/IMH-B were found to be suitable for the study and were stratified according to aortic arch classification. The ad hoc literature search provided 10 relevant articles, from which a total of 7983 control cases were retrieved. TBD/IMH-B patients were significantly younger than controls [64.3, standard error: 0.74 (62.84–65.76) vs mean pooled age 70.5, standard error: 0.40 (69.71–71.28)]. Patients with TBD/IMH-B presented with a significantly higher prevalence of type III arch [41.0% (107/261) (35.2–47.1)] than controls [16% (1241/7983) (10–22)].
CONCLUSIONS
Our data indicate an association between type III arch configuration and the occurrence of TBD/IMH-B. These findings warrant further studies to disclose the potential role of type III arch configuration as an anatomical risk factor for TBD/IMH-B.
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Berger T, Weiss G, Voetsch A, Arnold Z, Kreibich M, Rylski B, Krombholz-Reindl P, Winkler A, Mach M, Geisler D, Seitelberger R, Siepe M, Beyersdorf F, Grabenwoeger M, Czerny M, Gottardi R. Multicentre experience with two frozen elephant trunk prostheses in the treatment of acute aortic dissection†. Eur J Cardiothorac Surg 2019; 56:572-578. [DOI: 10.1093/ejcts/ezz037] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 01/23/2019] [Accepted: 01/24/2019] [Indexed: 11/13/2022] Open
Abstract
Abstract
OBJECTIVES
The aim of this study was to evaluate early- and mid-term outcome and aortic remodelling in patients undergoing implantation of 2 different frozen elephant trunk prostheses, either the Thoraflex™ hybrid (Vascutek, Inchinnan, UK) and the E-vita Open (Jotec Inc., Hechingen, Germany) for acute aortic dissection.
METHODS
All consecutive patients [n = 88; median age 59 (49–67) years; 69% male] undergoing surgery with a frozen elephant trunk prosthesis for acute aortic dissection from August 2005 until March 2018 were included in this study. The Thoraflex™ device was implanted in 55 patients and the E-vita Open graft in 33 patients.
RESULTS
Preoperative characteristics did not differ significantly between groups. There was also no statistically significant difference in postoperative outcome: in-hospital mortality (11% vs 12%; P > 0.99), stroke (18% vs 6%; P = 0.12) and spinal cord injury (6% vs 6%; P > 0.99). While there was no statistically significant difference in the occurrence of distal stent graft-induced new entries (16% vs 18%; P = 0.77), there was a significantly higher rate of secondary endovascular aortic interventions in the Thoraflex™ hybrid group (22% vs 0%; P = 0.003). There was a trend towards a higher rate of false lumen thrombosis at the level of the stent graft (74% vs 95%; P = 0.085) and was comparable at the thoraco-abdominal transition (53% vs 80%; P = 0.36) 1 year after implantation of the prostheses.
CONCLUSIONS
In this comparison of 2 frozen elephant trunk prostheses, there is no evidence that different surgical techniques influence in-hospital outcome. At 1-year follow-up, patients who underwent implantation of the E-vita Open prosthesis showed a significantly reduced rate of secondary aortic interventions and a trend towards a higher rate of false lumen thrombosis which might be attributed to a longer coverage of the descending aorta due to a longer stent graft design and significantly more frequent implantation in zone 3.
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Czerny M, Schmidli J, Bertoglio L, Carrel T, Chiesa R, Clough RE, Grabenwöger M, Kari FA, Mestres CA, Rylski B, Schönhoff F, Tsagakis K, Wyss TR. Clinical Cases Referring to Diagnosis and Management of Patients With Thoracic Aortic Pathologies Involving the Aortic Arch: A Companion Document of the 2018 European Association for Cardio-Thoracic Surgery (EACTS) and the European Society for Vascular Surgery (ESVS) Expert Consensus Document Addressing Current Options and Recommendations for the Treatment of Thoracic Aortic Pathologies Involving the Aortic Arch. Eur J Vasc Endovasc Surg 2019; 57:452-460. [DOI: 10.1016/j.ejvs.2018.12.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2018] [Revised: 09/27/2018] [Accepted: 09/28/2018] [Indexed: 11/28/2022]
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Berezowski M, Kosiorowska K, Beyersdorf F, Riesterer T, Jasinski M, Plonek T, Siepe M, Czerny M, Rylski B. Modelling of predissection aortic size in acute descending aortic dissection. Interact Cardiovasc Thorac Surg 2019; 29:124-129. [DOI: 10.1093/icvts/ivz028] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 01/17/2019] [Accepted: 01/19/2019] [Indexed: 11/13/2022] Open
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Rylski B, Muñoz C, Beyersdorf F, Siepe M, Reser D, Carrel T, Schoenhoff F, Schlensak C, Lescan M, Eckstein HH, Reutersberg B, Erbel R, Janosi RA, Czerny M. How does descending aorta geometry change when it dissects? Eur J Cardiothorac Surg 2019; 53:815-821. [PMID: 28958027 DOI: 10.1093/ejcts/ezx292] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2017] [Accepted: 07/15/2017] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVES Thoracic endovascular aortic repair is the treatment of choice in complicated acute type B aortic dissection. How to infer predissection aortic diameter is not well understood. Our aim was to delineate changes in descending aortic geometry due to dissection. METHODS Five tertiary centres reviewed their acute aortic dissection type B databases containing 802 patients. All patients who had undergone computed tomography angiography less than 2 years before and immediately after aortic dissection onset were included. We compared the aortic geometry before and after the dissection onset. RESULTS Altogether 25 patients were included [median age 60 (first quartile 52, third quartile 72) years; 60% men]. In all except 1 patient, the maximum descending aortic diameter was less than 45 mm before aortic dissection onset. The largest increase in diameter induced by the dissection was observed in the proximal descending aorta 28.2 (25.1, 32.1) vs 34.6 (31.3, 39.1) mm (+6.4 mm; +23%; P < 0.001). The thoracic descending aortic length increased after the dissection onset [253.3 (229.3, 271.9) vs 261.3 (247.9, 285.4) mm; P = 0.003]. The predissection aortic diameter of the proximal thoracic descending aorta was 7.9 (5.2, 10.7) mm larger (P < 0.001) than the post-dissection area-derived true-lumen diameter and 2.5 (1.3, 6.1) mm larger than the maximum true-lumen diameter (P < 0.001). CONCLUSIONS Type B aortic dissection increases the diameter, length and volume of the descending thoracic aorta. The predissection aortic diameter most closely resembles the post-dissection maximum diameter of the true lumen.
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Czerny M, Schmidli J, Adler S, van den Berg JC, Bertoglio L, Carrel T, Chiesa R, Clough RE, Eberle B, Etz C, Grabenwöger M, Haulon S, Jakob H, Kari FA, Mestres CA, Pacini D, Resch T, Rylski B, Schoenhoff F, Shrestha M, von Tengg-Kobligk H, Tsagakis K, Wyss TR, Debus S, de Borst GJ, Di Bartolomeo R, Lindholt J, Ma WG, Suwalski P, Vermassen F, Wahba A, von Ballmoos MCW. Current options and recommendations for the treatment of thoracic aortic pathologies involving the aortic arch: an expert consensus document of the European Association for Cardio-Thoracic surgery (EACTS) and the European Society for Vascular Surgery (ESVS). Eur J Cardiothorac Surg 2019; 55:133-162. [PMID: 30312382 DOI: 10.1093/ejcts/ezy313] [Citation(s) in RCA: 269] [Impact Index Per Article: 53.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
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132
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Kreibich M, Soekeland T, Beyersdorf F, Bavaria JE, Schröfel H, Czerny M, Rylski B. Anatomic feasibility of an endovascular valve–carrying conduit for the treatment of type A aortic dissection. J Thorac Cardiovasc Surg 2019; 157:26-34.e1. [DOI: 10.1016/j.jtcvs.2018.05.045] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Revised: 05/07/2018] [Accepted: 05/08/2018] [Indexed: 12/27/2022]
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133
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Kreibich M, Berger T, Chen Z, Kondov S, Rylski B, Beyersdorf F, Siepe M, Czerny M. Aortic Reinterventions after the Frozen Elephant Trunk Procedure for Aortic Dissection. Thorac Cardiovasc Surg 2019. [DOI: 10.1055/s-0039-1678813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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134
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Berkarda Z, Kondov S, Kreibich M, Scheumann J, Schröfel H, Czerny M, Beyersdorf F, Rylski B. Landing Zone Remodeling after Endovascular Aortic Repair of Dissected Descending Aorta. Thorac Cardiovasc Surg 2019. [DOI: 10.1055/s-0039-1678816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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135
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Lescan M, Czerny M, Berezowski M, Andic M, Bamberg F, Beyersdorf F, Schlensak C, Rylski B. Morphological Performance Analysis of a “Nonbare Stent” Stent Graft in Dissected Thoracic Aorta. Thorac Cardiovasc Surg 2019. [DOI: 10.1055/s-0039-1678817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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136
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Czerny M, Schmidli J, Adler S, van den Berg JC, Bertoglio L, Carrel T, Chiesa R, Clough RE, Eberle B, Etz C, Grabenwöger M, Haulon S, Jakob H, Kari FA, Mestres CA, Pacini D, Resch T, Rylski B, Schoenhoff F, Shrestha M, von Tengg-Kobligk H, Tsagakis K, Wyss TR. Current options and recommendations for the treatment of thoracic aortic pathologies involving the aortic arch: an expert consensus document of the European Association for Cardio-Thoracic surgery (EACTS) and the European Society for Vascular Surgery (ESVS). EUROPEAN JOURNAL OF CARDIO-THORACIC SURGERY : OFFICIAL JOURNAL OF THE EUROPEAN ASSOCIATION FOR CARDIO-THORACIC SURGERY 2019. [PMID: 30312382 DOI: 10.1093/ejcts/ezy313.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Kreibich M, Desai N, Bavaria J, Okamura H, Kimura N, Yamaguchi A, Beyersdorf F, Rylski B. Common Carotid Artery Occlusion Secondary to Type A Aortic Dissection. Thorac Cardiovasc Surg 2019. [DOI: 10.1055/s-0039-1678943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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138
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Berger T, Kreibich M, Kondov S, Rylski B, Morlock J, Scheumann J, Kari A, Staier K, Maier S, Beyersdorf F, Czerny M, Siepe M. Evaluation of Myocardial Injury, the Need of Vasopressors and Inotropic Support in Beating-Heart Aortic Arch Surgery. Thorac Cardiovasc Surg 2019. [DOI: 10.1055/s-0039-1678857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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139
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Juraszek A, Rylski B, Kondov S, Scheumann J, Kreibich M, Morlock J, Schröfel H, Berger T, Kari F, Siepe M, Beyersdorf F, Czerny M. Late Surgical Conversions after EVAR: Underlying Mechanisms, Clinical Results, and Strategies for Prevention. Thorac Cardiovasc Surg 2019. [DOI: 10.1055/s-0039-1678979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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140
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Sievers HH, Baier A, Beyersdorf F, Czerny M, Kreibich M, Siepe M, Rylski B. Aortic Dissection Rethought: A New Classification System Adding Clarity and Allowing Prediction of In-Hospital Mortality. Thorac Cardiovasc Surg 2019. [DOI: 10.1055/s-0039-1678940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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141
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Riesterer T, Beyersdorf F, Scheumann J, Berezowski M, Schröfel H, Kondov S, Czerny M, Rylski B. Accuracy of deployment of the Relay non-bare stent graft in the aortic arch. Interact Cardiovasc Thorac Surg 2018; 28:797-802. [DOI: 10.1093/icvts/ivy345] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 10/15/2018] [Accepted: 11/07/2018] [Indexed: 11/13/2022] Open
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Kimura N, Aizawa K, Kawahito K, Itagaki R, Yamaguchi A, Misawa Y, Siepe M, Czerny M, Beyersdorf F, Kari FA, Rylski B. Outcomes of Early-Onset Acute Type A Aortic Dissection - Influence of Etiologic Factors. Circ J 2018; 83:285-294. [PMID: 30584230 DOI: 10.1253/circj.cj-18-0969] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Outcomes of early-onset acute type A aortic dissection (ATAAD) associated with Marfan syndrome (MFS) are known, but not with other etiologies. Methods and Results: ATAAD patients from 2 centers (n=1,001) were divided into 2 groups: age ≤45 years (n=93) and age >45 years (n=908). Although in-hospital death and 10-year survival were similar (12% vs. 7% and 62.6% vs. 67.3%), the 10-year aortic event-free survival differed (50.0% vs. 80.2%; P<0.01). ATAAD patients from 3 centers (n=132), all aged ≤45 years, were divided into 5 groups: lone hypertension (HTN, n=71), MFS (n=23), non-syndromic familial thoracic aortic aneurysm and dissection (NS-FTAAD, n=16), bicuspid aortic valve (BAV, n=11), and no known etiologic factor (n=11). The incidence of severe aortic insufficiency varied between groups (HTN: 11%, MFS: 39%, NS-FTAAD: 38%, BAV: 55%, no known factor: 46%; P<0.01), whereas in-hospital death did not (14%, 22%, 0%, 0%, and 9%; P=0.061). The 10-year survival was 52.2%, 64.7%, 83.6%, 100%, and 90.9%, respectively, and 10-year aortic event-free survival was 55.6%, 36.3%, 77.5%, 90.0%, and 30.0%. Median descending aorta growth (mm/year) was 1.1 (0.1-3.4), 2.3 (0.3-5.3), 1.9 (1.3-2.7), 0.9 (-0.1-2.0), and 1.0 (-0.2-2.9) (P=0.15), respectively. CONCLUSIONS Late aortic events are common in young ATAAD patients. Known etiologic factors, though not BAV, negatively influence late outcomes in these patients.
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Rylski B. Distal Landing in TEVAR: Challenges in Reaching "The Dead Centre". Eur J Vasc Endovasc Surg 2018; 57:475-476. [PMID: 30553583 DOI: 10.1016/j.ejvs.2018.10.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Accepted: 10/20/2018] [Indexed: 10/27/2022]
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Czerny M, Schmidli J, Bertoglio L, Carrel T, Chiesa R, Clough RE, Grabenwöger M, Kari FA, Mestres CA, Rylski B, Schönhoff F, Tsagakis K, Wyss TR. Clinical cases referring to diagnosis and management of patients with thoracic aortic pathologies involving the aortic arch: a companion document of the 2018 European Association for Cardio-Thoracic Surgery (EACTS) and the European Society for Vascular Surgery (ESVS) expert consensus document addressing current options and recommendations for the treatment of thoracic aortic pathologies involving the aortic arch. Eur J Cardiothorac Surg 2018; 55:163-171. [DOI: 10.1093/ejcts/ezy383] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2018] [Accepted: 09/28/2018] [Indexed: 11/14/2022] Open
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Vukovic E, Czerny M, Beyersdorf F, Wolkewitz M, Berezowski M, Siepe M, Blanke P, Rylski B. Abdominal aortic aneurysm neck remodeling after Anaconda stent graft implantation. J Vasc Surg 2018; 68:1354-1359.e2. [DOI: 10.1016/j.jvs.2018.02.041] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Accepted: 02/20/2018] [Indexed: 10/16/2022]
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146
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Plonek T, Berezowski M, Bochenek M, Filip G, Rylski B, Golesworthy T, Jasinski M. A comparison of aortic root measurements by echocardiography and computed tomography. J Thorac Cardiovasc Surg 2018; 157:479-486. [PMID: 30227996 DOI: 10.1016/j.jtcvs.2018.07.053] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Revised: 06/05/2018] [Accepted: 07/17/2018] [Indexed: 01/16/2023]
Abstract
OBJECTIVES The aim of the study is to evaluate an optimal way to assess the dimensions of the aortic root and each of the sinuses of Valsalva and examine how a single measurement in 1 plane (echocardiography or 2-dimensional computed tomography) can underestimate the maximum dimension of the aortic root. METHODS Computed tomography and transthoracic echocardiography images of the aortic root and ascending aorta of 112 patients were analyzed. The minimum and maximum aortic root dimensions, the root perimeter, and the total area of all 3 sinuses of Valsalva were measured on a plane perpendicular to the long axis of the aorta using 3-dimensional multiplanar reconstruction. Moreover, the maximum root dimension was compared with the measurements obtained from the echocardiography and 2-dimensional computed tomography angiography measurements. RESULTS The difference in the measurements of the minimum and maximum root dimension was 5.4 ± 3.2 mm (range, 0-21 mm, P < .0001) and was significantly larger in patients with bicuspid aortic valves compared with those with tricuspid valves (6.3 ± 4 mm, range, 0-21 mm vs 4.9 ± 2.6 mm, range, 0-15 mm, P = .036). The maximum root dimension measured in 3-dimensional multiplanar reconstruction (49.1 ± 9.0 mm) differed significantly from the root dimension measured in transthoracic echocardiography in the parasternal long-axis view (44.8 ± 8.4 mm) and 2-dimensional computed tomography (axial plane: 45.5 ± 9.0 mm, coronal plane: 46.1 ± 8.8 mm, sagittal plane: 45.1 ± 8.9 mm) (P < .001). CONCLUSIONS The difference in the measurements of the minimum and maximum aortic root dimensions is significant and may exceed 20 mm, especially in patients with bicuspid aortic valves. Therefore, aortic root dimensions can be significantly underestimated with the measurement (echocardiography, computed tomography angiography) performed in only 1 plane.
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147
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Plonek T, Berezowski M, Kurcz J, Podgorski P, Sąsiadek M, Rylski B, Mysiak A, Jasinski M. The evaluation of the aortic annulus displacement during cardiac cycle using magnetic resonance imaging. BMC Cardiovasc Disord 2018; 18:154. [PMID: 30064358 PMCID: PMC6069890 DOI: 10.1186/s12872-018-0891-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 07/18/2018] [Indexed: 01/16/2023] Open
Abstract
Background The stress in the ascending aorta results from many biomechanical factors including the geometry of the vessel and its maximum dimensions, arterial blood pressure and longitudinal systolic stretching due to heart motion. The stretching of the ascending aorta resulting from the longitudinal displacement of the aortic annulus during the heart cycle has not been examined in the general population so far. The aim of the study is to evaluate this parameter using cardiovascular magnetic resonance (CMR) imaging in the general population in all age groups. Methods The cardiac magnetic resonance images of 73 patients were evaluated. The maximum distance to which the ventriculo-aortic junction was pulled by the contracting heart (LDAA – longitudinal displacement of the aortic annulus) was measured in the cine coronal sequences. Moreover, the maximum dimensions of the aortic root and the ascending aorta were assessed. Results The LDAA value was on average 11.6 ± 2.9 mm (range: 3-19 mm; 95% CI: 10.9–12.3 mm) and did not differ between males and females (11.8 ± 2.9 mm vs. 11.2 ± 2.9 mm, p = .408). The diameter of the ascending aorta was 32 ± 6.3 mm (range: 20-57 mm). The maximal dimension of the aortic root was 35 ± 5.1 mm (range: 18-42 mm). There was a statistically significant negative correlation between the LDAA and the age of patients (r = −.38, p = .001). There was no significant correlation between the LDAA and aortic root dimension (r = .1, p = .409) and between the LDAA and diameter of the ascending aorta (r = .16, p = .170). Conclusions Human aortic root and ascending aorta are significantly stretched during systole and the distance to which the aorta is stretched decreases with age. The measurement of the longitudinal displacement of the aortic annulus using the CMR is feasible and reproducible.
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Kondov S, Rylski B, Beyersdorf F, Czerny M, Siepe M. Valve sparing aortic root replacement and beating-heart aortic arch replacement in Frozen Elephant Trunk technique. Multimed Man Cardiothorac Surg 2018; 2018. [PMID: 30070786 DOI: 10.1510/mmcts.2018.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Correction of extensive aortic pathology often requires a combined surgical approach. This video tutorial presents the technical aspects of beating-heart aortic arch replacement in the frozen elephant trunk technique in combination with valve-sparing aortic root replacement.
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149
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Kondov S, Kreibich M, Rylski B, Siepe M, Beyersdorf F, Czerny M. The endovascular repair of the aortic arch using a double branched prosthesis. J Vis Surg 2018. [DOI: 10.21037/jovs.2018.05.27] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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150
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Le UT, Bronsert P, Picardo F, Riethdorf S, Haager B, Rylski B, Czerny M, Beyersdorf F, Wiesemann S, Pantel K, Passlick B, Kaifi JT, Schmid S. Intraoperative detection of circulating tumor cells in pulmonary venous blood during metastasectomy for colorectal lung metastases. Sci Rep 2018; 8:8751. [PMID: 29884810 PMCID: PMC5993733 DOI: 10.1038/s41598-018-26410-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Accepted: 05/10/2018] [Indexed: 01/15/2023] Open
Abstract
Circulating tumor cells (CTC) have been studied extensively in various tumor types and are a well-established prognosticator in colorectal cancer (CRC). This is the first study to isolate CTC directly from the tumor outflow in secondary lung tumors. For this purpose in 24 patients with CRC who underwent pulmonary metastasectomy in curative intent blood was drawn intraoperatively from the pulmonary vein (tumor outflow). In 22 samples CTC-enumeration was performed using CellSieve-microfilters and immunohistochemical- and Giemsa-staining. Additionally 10 blood samples were analyzed using the CellSearch-System. We could isolate more CTC in pulmonary venous blood (total 41, range 0-15) than in samples taken from the periphery at the same time (total 6, range 0-5, p = 0.09). Tumor positive lymph nodes correlated with presence of CTC in pulmonary venous blood as in all cases CTC were present (p = 0.006). Our findings suggest a tumor cell release from pulmonary metastases in CRC and a correlation of CTC isolated from the tumor outflow with established negative prognostic markers in metastasized CRC. The presented data warrant further investigations regarding the significance of local tumor compartments when analyzing circulating markers and the possibility of tumor cell shedding from secondary lung tumors.
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