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Nishida H, Nakamura R, Tamaki R, Abe K. Inconsistent False Lumen Enhancement Predicts Late Aortic Events After Hemiarch Replacement in Acute Type A Aortic Dissection. Am J Cardiol 2024; 221:77-83. [PMID: 38636625 DOI: 10.1016/j.amjcard.2024.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Revised: 03/01/2024] [Accepted: 04/09/2024] [Indexed: 04/20/2024]
Abstract
The impact of inconsistent enhancement within the patent false lumen on the occurrence of late aortic events remains uncertain. We enrolled 55patients who exhibited a patent false lumen after hemiarch replacement. The Hounsfield unit (HU) measurements in the patent false lumen were obtained at 2 specific locations: the aortic arch (a) and the descending aorta (b). The false lumen HU score was calculated as the absolute value of 1 - a/b, representing the discrepancy in HUs within the patent false lumen. We investigated the cut-off value of the false lumen HU score with the receiver operating characteristics curve to predict the incidence of late aortic events. We divided the patients based on the cut-off value and compared the cumulative incidence of the late aortic events. The analysis of the receiver operating characteristics curve showed that the cut-off value of the false lumen HU score was 0.345. Based on this cut-off value, we divided them into 2 groups: Group A (score <0.345, n = 26) and Group B (score ≥0.345, n = 29). The baseline characteristics were similar between the 2 groups. The cumulative incidence of the late aortic events was significantly lower in Group A (7.8% at 5 years) than in Group B (39.9% at 5 years) (p = 0.02). The false lumen HU score might be useful to predict the incidence of late aortic events after hemiarch replacement.
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Affiliation(s)
- Hidefumi Nishida
- Department of Cardiovascular Surgery, St. Luke's International Hospital, Tokyo, Japan.
| | - Ryota Nakamura
- Department of Cardiovascular Surgery, St. Luke's International Hospital, Tokyo, Japan
| | - Rihito Tamaki
- Department of Cardiovascular Surgery, St. Luke's International Hospital, Tokyo, Japan
| | - Kohei Abe
- Department of Cardiovascular Surgery, St. Luke's International Hospital, Tokyo, Japan
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Kim JK, Goh JH, Kim JB, Song JK, Yang DH, Kang JW, Kim SO, Koo HJ. Predictors of Late Adverse Events in Patients with Surgically Treated Type I Aortic Dissection. Eur J Vasc Endovasc Surg 2024:S1078-5884(24)00382-4. [PMID: 38719137 DOI: 10.1016/j.ejvs.2024.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Revised: 04/11/2024] [Accepted: 05/01/2024] [Indexed: 06/17/2024]
Abstract
OBJECTIVE Residual aortic dissection (AD) following DeBakey type I AD repair is associated with a high rate of adverse events that need additional intervention or surgery. This study aimed to identify clinical and early post-operative computed tomography (CT) imaging factors associated with adverse events in patients with type I AD after ascending aorta replacement. METHODS This single centre, retrospective cohort study included consecutive patients with type I AD who underwent ascending aorta replacement from January 2011 to December 2017 and post-operative CT within three months. The primary outcome was AD related adverse events, defined as AD related death and re-operation due to aortic aneurysm or impending rupture. The location and size of the primary intimal tears, aortic diameter, and false lumen status were evaluated. Regression analyses were performed to identify factors associated with AD related adverse events. A decision tree model was used to classify patients as high or low risk. RESULTS Of 103 participants (55.43 ± 13.94 years; 49.5% male), 24 (23.3%) experienced AD related adverse events. In multivariable Cox regression analysis, connective tissue disease (hazard ratio [HR] 15.33; p < .001), maximum aortic diameter ≥ 40 mm (HR 4.90; p < .001), and multiple (three or more) intimal tears (HR 7.12; p < .001) were associated with AD related adverse events. The three year cumulative survival free from AD related events was lower in the high risk group with aortic diameter ≥ 40 mm and multiple intimal tears (41.7% vs. 90.9%; p < .001). CONCLUSION Early post-operative CT findings indicating a maximum aortic diameter ≥ 40 mm and multiple intimal tears may predict a higher risk of adverse events. These findings suggest the need for careful monitoring and more vigilant management approaches in these cases.
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Affiliation(s)
- Jin Kyoung Kim
- Department of Thoracic and Cardiovascular Surgery, University of Ulsan College of Medicine, Asan Medical Centre, Seoul, Republic of Korea
| | - Jung Hwan Goh
- University of Ulsan College of Medicine, Asan Medical Centre, Seoul, Republic of Korea
| | - Joon Bum Kim
- Department of Thoracic and Cardiovascular Surgery, University of Ulsan College of Medicine, Asan Medical Centre, Seoul, Republic of Korea
| | - Jae-Kwan Song
- Division of Cardiology, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Centre, Seoul, Republic of Korea
| | - Dong Hyun Yang
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Centre, Seoul, Republic of Korea
| | - Joon-Won Kang
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Centre, Seoul, Republic of Korea
| | - Seon-Ok Kim
- Department of Clinical Epidemiology and Biostatistics, University of Ulsan College of Medicine, Asan Medical Centre, Seoul, Republic of Korea
| | - Hyun Jung Koo
- Department of Clinical Epidemiology and Biostatistics, University of Ulsan College of Medicine, Asan Medical Centre, Seoul, Republic of Korea.
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Morjan M, Mestres CA, Savic V, Gerçek M, Van Hemelrijck M, Sromicki J, Dzemali O, Reser D. Indications and outcomes of second aortic procedures after acute type A dissection repair. INTERDISCIPLINARY CARDIOVASCULAR AND THORACIC SURGERY 2024; 38:ivae076. [PMID: 38688455 DOI: 10.1093/icvts/ivae076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Revised: 02/23/2024] [Accepted: 04/07/2024] [Indexed: 05/02/2024]
Abstract
OBJECTIVES Aortic arch or aortic root replacement is not performed in all cases of acute type A aortic dissection (ATAD), and a second aortic procedure will become necessary over time for some patients. Indications and outcomes, of second aortic procedures have not been studied extensively. METHODS Characteristics and in-hospital outcomes of all patients undergoing surgical repair for type A acute aortic dissection were analysed and patients needing second aortic procedure during follow-up were identified. The latter group was divided in 2 subgroups: on-pump includes patients operated on using cardiopulmonary bypass and off-pump without cardiopulmonary bypass. RESULTS A total of 638 patients underwent surgery for ATAD; 8% required a second aortic procedure. The most frequent indication for the second aortic procedure was dehiscence of suture lines (44%), followed by arch dilatation (24%). In-hospital mortality was 12%. Isolated ascending aorta replacement at the first surgery was associated with higher incidence of second aortic procedure (P = 0.006). Most patients in the on-pump group underwent a proximal reoperation (75%), with a mortality rate of 14.2%. In-hospital mortality of patients in the off-pump group was 7.7%. Long-term survival analysis showed no difference between groups (P = 0,526), Off-pump patients have greater likelihood of a second intervention during follow-up (P = 0.004). CONCLUSIONS Extended aortic root surgery and customized aortic arch repair in ATAD could be reasonable to reduce the incidence and mortality of high-risk second aortic procedures.
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Affiliation(s)
- Mohammed Morjan
- Department of Cardiac Surgery, University Hospital Zürich, Zürich, Switzerland
- Department of Cardiovascular Surgery, Heinrich Heine University, Medical Faculty, Duesseldorf, Germany
| | - Carlos-A Mestres
- Department of Cardiac Surgery, University Hospital Zürich, Zürich, Switzerland
| | - Vedran Savic
- Department of Cardiac Surgery, University Hospital Zürich, Zürich, Switzerland
| | - Mustafa Gerçek
- Clinic for Cardiac Surgery and Pediatric Cardiac Surgery, Heart Center Duisburg, Duisburg, Germany
| | | | - Juri Sromicki
- Department of Cardiac Surgery, University Hospital Zürich, Zürich, Switzerland
| | - Omer Dzemali
- Department of Cardiac Surgery, University Hospital Zürich, Zürich, Switzerland
| | - Diana Reser
- Department of Cardiac Surgery, University Hospital Zürich, Zürich, Switzerland
- Herzklinik Hirslanden, Zürich, Switzerland
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4
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Shim WJ, Kim YH. [Endovascular Treatment of Aortic Dissection due to Suture Line Dehiscence after Aortic Graft Replacement for Type A Aortic Dissection: A Report of Two Cases]. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2024; 85:668-675. [PMID: 38873388 PMCID: PMC11166580 DOI: 10.3348/jksr.2023.0142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 01/04/2024] [Accepted: 01/25/2024] [Indexed: 06/15/2024]
Abstract
Aortic anastomotic leak is an uncommon complication after ascending aortic replacement for acute aortic dissection. Redo-surgery is the traditional standard treatment despite high mortality and morbidity. Recently, endovascular treatment has been attempted as an alternative approach in a few case reports. Here, we present two cases of aortic anastomotic leak due to suture line dehiscence after aortic graft replacement for type A aortic dissection, which were successfully treated by coil with subsequent N-butyl cyanoacrylate embolization and an Amplatzer™ vascular plug.
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Kanemura T, Nakahara Y, Tateishi R, Haba F, Ono S. Occurrence of pseudoaneurysm of the coronary button due to aortic remodeling after Bentall operation. J Surg Case Rep 2024; 2024:rjae080. [PMID: 38404454 PMCID: PMC10884727 DOI: 10.1093/jscr/rjae080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 01/26/2024] [Indexed: 02/27/2024] Open
Abstract
Here, we present a case report detailing a pseudoaneurysm of the coronary button due to aortic remodeling that occurred 2 years after aortic root replacement. The patient was referred to our hospital with a diagnosis of left coronary artery pseudoaneurysm. Intraoperative findings revealed substantially loosened sutures in both the left and right coronary arteries with bleeding. Specifically, the left coronary artery was detached at the 6-9 o'clock positions. The operation was concluded with ligation of the loose suture and addition of a new suture. Chronic dissection thickened the aortic wall of the coronary artery ostium in the initial Bentall operation, whereas the sutured coronary button in this operation exhibited a normal arterial wall without a thickened dissected intima. This suggests that aortic wall remodelling of the coronary ostium leads to suture loosening and subsequent haemorrhage. Aortic wall remodeling may lead to bleeding or pseudoaneurysms during the remote period.
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Affiliation(s)
- Takeyuki Kanemura
- Department of Cardiovascular Surgery, IMS Katsushika Heart Center, 3-30-1 Horikiri, Katsushika Ward, Tokyo 124-0006, Japan
| | - Yoshinori Nakahara
- Department of Cardiovascular Surgery, IMS Katsushika Heart Center, 3-30-1 Horikiri, Katsushika Ward, Tokyo 124-0006, Japan
| | - Retsu Tateishi
- Department of Cardiovascular Surgery, IMS Katsushika Heart Center, 3-30-1 Horikiri, Katsushika Ward, Tokyo 124-0006, Japan
| | - Fumiya Haba
- Department of Cardiovascular Surgery, IMS Katsushika Heart Center, 3-30-1 Horikiri, Katsushika Ward, Tokyo 124-0006, Japan
| | - Shunya Ono
- Department of Cardiovascular Surgery, IMS Katsushika Heart Center, 3-30-1 Horikiri, Katsushika Ward, Tokyo 124-0006, Japan
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Manchev G, Gegouskov V, Kornovski V, Yankov G, Goranovska V, Ilieva V, Petrova V. Can Open Distal Repair Be Safely Used in All Patients with Type A Acute Aortic Dissection? Ann Thorac Cardiovasc Surg 2024; 30:n/a. [PMID: 37730310 PMCID: PMC10902668 DOI: 10.5761/atcs.oa.23-00086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/22/2023] Open
Abstract
PURPOSE The distal suture line during aortic dissection repair can be performed by a closed technique or by an open technique. This study presents a retrospective comparison of both methods regarding their postoperative outcomes. PATIENTS AND METHODS 120 patients who underwent surgery for acute aortic dissection type A were divided into two groups. In group A (n = 81), open distal anastomosis was performed under hypothermic circulatory arrest and selective cerebral perfusion. In group B (n = 39), distal anastomosis was performed with the aorta cross-clamped under mildly hypothermic cardiopulmonary bypass. Primary outcomes were operative mortality, neurologic morbidity, and long-term survival. RESULTS Hospital mortality (17.3% for the open group vs. 12.8% for the closed group, p = 0.53), permanent neurologic dysfunction (8.7% vs. 8.3%, p = 1.0), and temporary neurologic dysfunction (31.9% vs. 22.2%, p = 0.298) were not significantly different between groups. No significant difference in actuarial 5- and 10-year survival was observed (88% vs. 86% and 53 vs. 73%, respectively, p = 0.396). After propensity-score adjustment, the technique of distal aortic repair was not found to be a predictor of the primary outcomes. CONCLUSION We conclude that the open repair can be used in most if not all cases of surgical repair of type A acute aortic dissection.
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Affiliation(s)
- Georgi Manchev
- Department of Cardiac Surgery, St. Anna University Hospital, Sofia, Bulgaria
- Medical University Pleven, Pleven, Bulgaria
| | - Vassil Gegouskov
- Department of Cardiac Surgery, St. Anna University Hospital, Sofia, Bulgaria
- Medical University Pleven, Pleven, Bulgaria
| | - Vladimir Kornovski
- Department of Cardiac Surgery, Heart and Brain University Hospital, Burgas, Bulgaria
| | - Georgi Yankov
- Department of Thoracic Surgery, Ivan Rilski University Hospital, Sofia, Bulgaria
| | - Valya Goranovska
- Department of Cardiac Surgery, St. Anna University Hospital, Sofia, Bulgaria
- Medical University Pleven, Pleven, Bulgaria
| | - Vicktoria Ilieva
- Department of Anesthesia and Intensive Care, Ivan Rilski University Hospital, Sofia, Bulgaria
| | - Vicktoria Petrova
- Department of Anesthesia and Intensive Care, Ivan Rilski University Hospital, Sofia, Bulgaria
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Becker D, Stana J, Prendes CF, Konstantinou N, Öz T, Pichlmaier M, Peterss S, Tsilimparis N. Endovascular arch repair of anastomotic aneurysm and pseudoaneurysm in patients after open repair of the ascending aorta and aortic arch: a case series. Eur J Cardiothorac Surg 2023; 64:ezad345. [PMID: 37889250 DOI: 10.1093/ejcts/ezad345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 10/05/2023] [Indexed: 10/28/2023] Open
Abstract
OBJECTIVES The aim of the study was to investigate the outcomes of branched endovascular arch repair (b-TEVAR) with a custom-made double- or triple-branched arch endograft in patients with distal anastomotic aneurysms after open repair of the ascending aorta or proximal arch replacement. METHODS Retrospective analysis was conducted of all consecutive patients with anastomotic aneurysms after open surgical repair involving the ascending aorta and/or aortic arch treated with b-TEVAR. All patients were treated with a custom-made double or triple inner-branched arch endograft. Study end points were technical success, 30-day and follow-up mortality/morbidity and re-interventions. RESULTS Between 2018 and 2022, 10 patients were treated with custom-made double- or triple-branched thoracic endovascular aortic repair due to anastomotic aneurysms after open ascending aorta and/or proximal aortic arch replacement. Eight patients received a triple and 2 a double arch-branched endograft. Eight cases were performed electively and 2 urgently for contained rupture. Technical success was achieved in 9 cases (90%). All elective patients survived. Two patients treated due to contained ruptures expired. Within 30 postoperative days, 1 transient ischaemic attack occurred. No early endograft-related re-interventions were necessary. The median follow-up was 20 months. One patient died 2 months after discharge due to sepsis caused by pneumonia. No further deaths or endograft-related re-interventions were observed. CONCLUSIONS Endovascular aortic arch repair with double or triple inner-branched arch endograft for anastomotic aneurysms after open ascending and/or proximal arch replacement is technically feasible and a promising alternative in a patient cohort unfit for surgery.
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Affiliation(s)
- Daniel Becker
- University Aortic Center Munich, LMU University Hospital, Munich, Germany
- Department of Vascular Surgery, LMU University Hospital, Munich, Germany
| | - Jan Stana
- University Aortic Center Munich, LMU University Hospital, Munich, Germany
- Department of Vascular Surgery, LMU University Hospital, Munich, Germany
| | - Carlota F Prendes
- University Aortic Center Munich, LMU University Hospital, Munich, Germany
- Department of Vascular Surgery, LMU University Hospital, Munich, Germany
| | - Nikolaos Konstantinou
- University Aortic Center Munich, LMU University Hospital, Munich, Germany
- Department of Vascular Surgery, LMU University Hospital, Munich, Germany
| | - Tugce Öz
- University Aortic Center Munich, LMU University Hospital, Munich, Germany
- Department of Vascular Surgery, LMU University Hospital, Munich, Germany
| | - Maximilian Pichlmaier
- University Aortic Center Munich, LMU University Hospital, Munich, Germany
- Department of Cardiac Surgery, LMU University Hospital, Munich, Germany
| | - Sven Peterss
- University Aortic Center Munich, LMU University Hospital, Munich, Germany
- Department of Cardiac Surgery, LMU University Hospital, Munich, Germany
| | - Nikolaos Tsilimparis
- University Aortic Center Munich, LMU University Hospital, Munich, Germany
- Department of Vascular Surgery, LMU University Hospital, Munich, Germany
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8
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Ogino H, Iida O, Akutsu K, Chiba Y, Hayashi H, Ishibashi-Ueda H, Kaji S, Kato M, Komori K, Matsuda H, Minatoya K, Morisaki H, Ohki T, Saiki Y, Shigematsu K, Shiiya N, Shimizu H, Azuma N, Higami H, Ichihashi S, Iwahashi T, Kamiya K, Katsumata T, Kawaharada N, Kinoshita Y, Matsumoto T, Miyamoto S, Morisaki T, Morota T, Nanto K, Nishibe T, Okada K, Orihashi K, Tazaki J, Toma M, Tsukube T, Uchida K, Ueda T, Usui A, Yamanaka K, Yamauchi H, Yoshioka K, Kimura T, Miyata T, Okita Y, Ono M, Ueda Y. JCS/JSCVS/JATS/JSVS 2020 Guideline on Diagnosis and Treatment of Aortic Aneurysm and Aortic Dissection. Circ J 2023; 87:1410-1621. [PMID: 37661428 DOI: 10.1253/circj.cj-22-0794] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/05/2023]
Affiliation(s)
- Hitoshi Ogino
- Department of Cardiovascular Surgery, Tokyo Medical University
| | - Osamu Iida
- Cardiovascular Center, Kansai Rosai Hospital
| | - Koichi Akutsu
- Cardiovascular Medicine, Nippon Medical School Hospital
| | - Yoshiro Chiba
- Department of Cardiology, Mito Saiseikai General Hospital
| | | | | | - Shuichiro Kaji
- Department of Cardiovascular Medicine, Kansai Electric Power Hospital
| | - Masaaki Kato
- Department of Cardiovascular Surgery, Morinomiya Hospital
| | - Kimihiro Komori
- Division of Vascular and Endovascular Surgery, Department of Surgery, Nagoya University Graduate School of Medicine
| | - Hitoshi Matsuda
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center
| | - Kenji Minatoya
- Department of Cardiovascular Surgery, Graduate School of Medicine, Kyoto University
| | | | - Takao Ohki
- Division of Vascular Surgery, Department of Surgery, The Jikei University School of Medicine
| | - Yoshikatsu Saiki
- Division of Cardiovascular Surgery, Graduate School of Medicine, Tohoku University
| | - Kunihiro Shigematsu
- Department of Vascular Surgery, International University of Health and Welfare Mita Hospital
| | - Norihiko Shiiya
- First Department of Surgery, Hamamatsu University School of Medicine
| | | | - Nobuyoshi Azuma
- Department of Vascular Surgery, Asahikawa Medical University
| | - Hirooki Higami
- Department of Cardiology, Japanese Red Cross Otsu Hospital
| | | | - Toru Iwahashi
- Department of Cardiovascular Surgery, Tokyo Medical University
| | - Kentaro Kamiya
- Department of Cardiovascular Surgery, Tokyo Medical University
| | - Takahiro Katsumata
- Department of Thoracic and Cardiovascular Surgery, Osaka Medical College
| | - Nobuyoshi Kawaharada
- Department of Cardiovascular Surgery, Sapporo Medical University School of Medicine
| | | | - Takuya Matsumoto
- Department of Vascular Surgery, International University of Health and Welfare
| | | | - Takayuki Morisaki
- Department of General Medicine, IMSUT Hospital, the Institute of Medical Science, the University of Tokyo
| | - Tetsuro Morota
- Department of Cardiovascular Surgery, Nippon Medical School Hospital
| | | | - Toshiya Nishibe
- Department of Cardiovascular Surgery, Tokyo Medical University
| | - Kenji Okada
- Department of Surgery, Division of Cardiovascular Surgery, Kobe University Graduate School of Medicine
| | | | - Junichi Tazaki
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
| | - Masanao Toma
- Department of Cardiology, Hyogo Prefectural Amagasaki General Medical Center
| | - Takuro Tsukube
- Department of Cardiovascular Surgery, Japanese Red Cross Kobe Hospital
| | - Keiji Uchida
- Cardiovascular Center, Yokohama City University Medical Center
| | - Tatsuo Ueda
- Department of Radiology, Nippon Medical School
| | - Akihiko Usui
- Department of Cardiac Surgery, Nagoya University Graduate School of Medicine
| | - Kazuo Yamanaka
- Cardiovascular Center, Nara Prefecture General Medical Center
| | - Haruo Yamauchi
- Department of Cardiac Surgery, The University of Tokyo Hospital
| | | | - Takeshi Kimura
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
| | | | - Yutaka Okita
- Department of Surgery, Division of Cardiovascular Surgery, Kobe University Graduate School of Medicine
| | - Minoru Ono
- Department of Cardiac Surgery, Graduate School of Medicine, The University of Tokyo
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9
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Ohira S, Malekan R, Kai M, Goldberg JB, Laskowski I, De La Pena C, Mason I, Lansman SL, Spielvogel D. Aortic Reoperation After Prior Acute Type A Aortic Dissection Repair: Don't Despair the Repair. Ann Thorac Surg 2023; 116:43-50. [PMID: 36653324 DOI: 10.1016/j.athoracsur.2022.10.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 09/29/2022] [Accepted: 10/03/2022] [Indexed: 01/20/2023]
Abstract
BACKGROUND There is paucity of data regarding reoperation after acute type A aortic dissection (ATAD) repair. METHODS From October 2006 to March 2022, 75 patients received 123 reoperations after ATAD (proximal, n = 17; distal, n = 103; and both, n = 3) utilizing redo sternotomy (RS, n = 68), left thoracotomy (LT, n = 44), and endovascular approach (TEVAR, n = 11). The axillary artery cannulation was utilized in 97.1% of the RS cases. A classic elephant trunk technique was used as a 2-staged procedure for distal pathology. Most LT repairs (95.5%) were completed above the celiac axis. RESULTS Index ATAD repairs were predominantly ascending/hemiarch repair (73.3%). The median duration from the index repair was 2.0 years. Most reoperations were elective procedures (82.1%). Hospital mortality was 2.4% (RS, 1.5%; LT, 4.5%; TEVAR, 0%), and the stroke rate was 1.6%. There was no spinal cord ischemia. The 5-year overall survival and freedom from aortic mortality or procedure were 85.2% ± 5.6% and 80.6% ± 6.1%, respectively. There were 7 distal reinterventions (prior TEVAR, n = 3; prior LT, n = 4). Two patients required LT repair after prior TEVAR and 3 patients received infrarenal aortic repair after prior LT repair. Computed tomography after completion of the distal repair (n = 45) showed an increase of distal aorta at each level as follows: celiac axis 1.2 mm/y; renal artery 1.0 mm/y; and terminal aorta 1.2 mm/y. CONCLUSIONS Reoperation after ATAD repair can be safely performed as an elective procedure at experienced centers. Staged distal interventions utilizing classic elephant trunk insertion and open repair above the celiac axis showed durable outcomes.
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Affiliation(s)
- Suguru Ohira
- Division of Cardiothoracic Surgery, Department of Surgery, Westchester Medical Center/New York Medical College, Valhalla, New York.
| | - Ramin Malekan
- Division of Cardiothoracic Surgery, Department of Surgery, Westchester Medical Center/New York Medical College, Valhalla, New York
| | - Masashi Kai
- Division of Cardiothoracic Surgery, Department of Surgery, Westchester Medical Center/New York Medical College, Valhalla, New York
| | - Joshua B Goldberg
- Division of Cardiothoracic Surgery, Department of Surgery, Westchester Medical Center/New York Medical College, Valhalla, New York
| | - Igor Laskowski
- Division of Vascular Surgery, Department of Surgery, Westchester Medical Center/New York Medical College, Valhalla, New York
| | - Corazon De La Pena
- Division of Cardiothoracic Surgery, Department of Surgery, Westchester Medical Center/New York Medical College, Valhalla, New York
| | - Ian Mason
- New York Medical College, Valhalla, New York
| | - Steven L Lansman
- Division of Cardiothoracic Surgery, Department of Surgery, Westchester Medical Center/New York Medical College, Valhalla, New York
| | - David Spielvogel
- Division of Cardiothoracic Surgery, Department of Surgery, Westchester Medical Center/New York Medical College, Valhalla, New York
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10
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Lopez-Marco A, Yates MT, Adams B, Lall K, Yap J, Di Salvo C, Uppal R, Oo A. Managing the Root in Acute Type A Aortic Dissections: Are We Ready for a Standardized Approach? AORTA (STAMFORD, CONN.) 2023; 11:1-9. [PMID: 36848907 PMCID: PMC9970750 DOI: 10.1055/s-0042-1757947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 07/11/2022] [Indexed: 06/18/2023]
Abstract
OBJECTIVES Surgical repair of Type A aortic dissection (TAAD) requires exclusion of the primary entry tear and reestablishment of flow into the distal true lumen. Provided that the majority of tears occur within the ascending aorta (AA), replacing only that segment seems a safe option; however, this strategy leaves the root susceptible to dilatation and need for reintervention. We aimed to review the outcomes of the two strategies: aortic root replacement (ARR) and isolated ascending aortic replacement. METHODS Retrospective analysis of prospectively collected data for all consecutive patients who underwent repair of acute TAAD at our institution from 2015 to 2020 was conducted. Patients were divided into two groups: (1) ARR and (2) isolated AA replacement as index operation for TAAD repair. Primary outcomes were mortality and need for reintervention during the follow-up. RESULTS A total of 194 patients were included in the study; 68 (35%) in the ARR group and 126 (65%) in the AA group. There were no significant differences in postoperative complications or in-hospital mortality (23%; p = 0.51) between groups. Seven patients (4.7%) died during follow-up and eight patients underwent aortic reinterventions, including proximal aortic segments (two patients) and distal procedures (six patients). CONCLUSION Both aortic root and AA replacement are acceptable and safe techniques. The growth of an untouched root is slow, and reintervention in this aortic segment is infrequent compared with distal aortic segments, hence preserving the root could be an option for older patients provided that there is no primary tear within the root.
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Affiliation(s)
- Ana Lopez-Marco
- Department of Cardiothoracic Surgery, St. Bartholomew's Hospital, London, United Kingdom
| | - Martin T. Yates
- Department of Cardiothoracic Surgery, St. Bartholomew's Hospital, London, United Kingdom
| | - Benjamin Adams
- Department of Cardiothoracic Surgery, St. Bartholomew's Hospital, London, United Kingdom
| | - Kulvinder Lall
- Department of Cardiothoracic Surgery, St. Bartholomew's Hospital, London, United Kingdom
| | - John Yap
- Department of Cardiothoracic Surgery, St. Bartholomew's Hospital, London, United Kingdom
| | - Carmelo Di Salvo
- Department of Cardiothoracic Surgery, St. Bartholomew's Hospital, London, United Kingdom
| | - Rakesh Uppal
- Department of Cardiothoracic Surgery, St. Bartholomew's Hospital, London, United Kingdom
| | - Aung Oo
- Department of Cardiothoracic Surgery, St. Bartholomew's Hospital, London, United Kingdom
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11
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Chemtob RA, Ede J, Herou E, Larsson M, Nozohoor S, Sjögren J, Wierup P, Zindovic I. Limited Distal Repair Results in Low Rates of Distal Events Following Surgery for Acute Type A Aortic Dissection. Semin Thorac Cardiovasc Surg 2023; 35:7-15. [PMID: 34774770 DOI: 10.1053/j.semtcvs.2021.11.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 11/05/2021] [Indexed: 11/11/2022]
Abstract
To investigate mortality and reoperation rates following limited distal repair after acute type A aortic dissection (ATAAD) at a single medium volume institution. We analyzed all patients that underwent limited distal repair (ascending aortic or hemiarch replacement) following ATAAD between January 1998 and April 2020 at our institution. During the study period, 489 patients underwent ATAAD surgery, of which 457 (94%) underwent limited distal repair with a 30-day mortality of 12.9%. Among 30-day survivors, late follow-up was 97.7% complete with a mean follow-up of 6.0 ± 5.5 years. In all, 50 patients (11%) required a reoperation during the study period at a mean of 3.4 ± 3.4 years after initial repair, with a 30-day mortality of 12%. An aortic reoperation was required in 4.1 (2.0-6.1)%, 10.3 (7.1-13.6)%, 15.1 (10.9-19.4)%, and 18.0 (13.0-22.9)% of patients at 1, 5, 10, and 15 years. A distal reoperation was required in 3.0 (1.2-4.7)%, 8.0 (5.1-10.9)%, 10.3 (6.8-13.8)%, and 12.4 (8.2-16.5)% of patients and 4.4 (2.3-6.4)%, 10.4 (7.1-13.7)%, 13.9 (9.8-18.0)%, and 16.9 (12.0-21.9)% of patents had a distal event at 1, 5, 10, and 15 years, respectively. Limited distal repair with an ascending aortic or hemiarch replacement was associated with acceptable survival and rates of reoperations and distal events. Limited distal repair is a safe and feasible standard approach to ATAAD surgery at a medium-volume center.
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Affiliation(s)
- Raphaelle A Chemtob
- Department of Cardiothoracic Surgery, Lund University, Skåne University Hospital, Lund, Sweden; Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH
| | - Jacob Ede
- Department of Cardiothoracic Surgery, Lund University, Skåne University Hospital, Lund, Sweden
| | - Erik Herou
- Department of Cardiothoracic Surgery, Lund University, Skåne University Hospital, Lund, Sweden
| | - Mårten Larsson
- Department of Cardiothoracic Surgery, Lund University, Skåne University Hospital, Lund, Sweden
| | - Shahab Nozohoor
- Department of Cardiothoracic Surgery, Lund University, Skåne University Hospital, Lund, Sweden
| | - Johan Sjögren
- Department of Cardiothoracic Surgery, Lund University, Skåne University Hospital, Lund, Sweden
| | - Per Wierup
- Department of Cardiothoracic Surgery, Lund University, Skåne University Hospital, Lund, Sweden; Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH
| | - Igor Zindovic
- Department of Cardiothoracic Surgery, Lund University, Skåne University Hospital, Lund, Sweden.
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12
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Heuts S, Schalla S, Ramaekers MJFG, Bidar E, Mihl C, Wildberger JE, Adriaans BP. Imaging surveillance for complications after primary surgery for type A aortic dissection. HEART (BRITISH CARDIAC SOCIETY) 2022; 109:96-101. [PMID: 35321890 DOI: 10.1136/heartjnl-2022-320881] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Accepted: 03/03/2022] [Indexed: 02/04/2023]
Abstract
Acute type A aortic dissection (ATAAD) is a life-threatening condition that requires emergency surgery to avert fatal outcome. Conventional surgical procedures comprise excision of the entry tear and replacement of the proximal aorta with a synthetic vascular graft. In patients with DeBakey type I dissection, this approach leaves a chronically dissected distal aorta, putting them at risk for progressive dilatation, dissection propagation and aortic rupture. Therefore, ATAAD survivors should undergo serial imaging for evaluation of the aortic valve, proximal and distal anastomoses, and the aortic segments beyond the distal anastomosis. The current narrative review aims to describe potential complications in the early and late phases after ATAAD surgery, with focus on their specific imaging findings.
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Affiliation(s)
- Samuel Heuts
- Department of Cardiothoracic Surgery, Maastricht Universitair Medisch Centrum+, Maastricht, Limburg, The Netherlands
| | - Simon Schalla
- Department of Cardiology, Maastricht University Medical Centre+, Maastricht, Limburg, The Netherlands.,Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre+, Maastricht, Limburg, The Netherlands.,CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, Limburg, The Netherlands
| | - Mitch J F G Ramaekers
- Department of Cardiology, Maastricht University Medical Centre+, Maastricht, Limburg, The Netherlands.,Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre+, Maastricht, Limburg, The Netherlands.,CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, Limburg, The Netherlands
| | - Elham Bidar
- Department of Cardiothoracic Surgery, Maastricht Universitair Medisch Centrum+, Maastricht, Limburg, The Netherlands.,CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, Limburg, The Netherlands
| | - Casper Mihl
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre+, Maastricht, Limburg, The Netherlands.,CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, Limburg, The Netherlands
| | - Joachim E Wildberger
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre+, Maastricht, Limburg, The Netherlands.,CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, Limburg, The Netherlands
| | - Bouke P Adriaans
- Department of Cardiology, Maastricht University Medical Centre+, Maastricht, Limburg, The Netherlands.,Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre+, Maastricht, Limburg, The Netherlands.,CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, Limburg, The Netherlands
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13
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Luc JGY, Preventza O. Optimal Extent of Repair for Acute Type I Aortic Dissection-Frozen Elephant Trunk? How Long and Why? AORTA (STAMFORD, CONN.) 2022; 10:169-174. [PMID: 36521808 PMCID: PMC9754864 DOI: 10.1055/s-0042-1756664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Acute Type A dissection is a life-threatening condition requiring urgent surgical treatment. The operative technique involves repairs of a variety of distal extents of the transverse aortic arch and the downstream aorta. We review the evidence surrounding the extent of repair for acute Type A aortic dissection and describe our approach to this disease.
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Affiliation(s)
- Jessica G. Y. Luc
- Division of Cardiovascular Surgery, Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Ourania Preventza
- Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas,Department of Cardiovascular Surgery, Texas Heart Institute, Houston, Texas,Address for correspondence Ourania Preventza, MD, MBA Division of Cardiothoracic Surgery, Michael E. DeBakey Department of SurgeryBCM 390, One Baylor Plaza, Baylor College of Medicine, Houston, TX 77030
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14
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Fang C, Gao S, Ren X, Pang X, Zhao X, Ma Z, Wang C, Liu K. Comparison of two techniques in proximal anastomosis in acute type A aortic dissection. Front Cardiovasc Med 2022; 9:1047939. [PMID: 36386353 PMCID: PMC9643206 DOI: 10.3389/fcvm.2022.1047939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 10/10/2022] [Indexed: 11/27/2022] Open
Abstract
Background The proximal anastomosis is an important procedure during the acute type A aortic dissection (AAAD) surgery. The conventional method is a double patch sandwich technique with Teflon felt. Adventitial eversion and prosthesis eversion technique as a novel approach has been applied to many patients in our center. Herein, This technique would be introduced, and the perioperative and 1-year follow-up results of the two different anastomosis methods were also evaluated. Methods Between December 2017 and May 2021, 143 AAAD patients who underwent total arch replacement (TAR) and frozen elephant trunk (FET) implantation were included in this retrospective study. Patients were divided into the eversion technique group (adventitial eversion and prosthesis eversion technique for proximal anastomosis, n = 64) and the sandwich technique group (n = 79). Results The medical records were analyzed and compared between the groups. The mean operation time was 466 ± 73 min in the eversion technique group and 513 ± 81 min in the sandwich technique group (P < 0.001). Compared with the sandwich technique group, the eversion technique group also showed a shorter time on proximal anastomosis (38 ± 12 min vs. 58 ± 20 min, P < 0.001), cardiopulmonary bypass (195 ± 26 vs. 211 ± 40 min, P = 0.003), and aortic cross-clamp (120 ± 23 min vs. 134 ± 27 min, P = 0.002). Furthermore, a decreased proportion of >600 ml fresh frozen plasmas transfusion was observed in eversion technique group (10.9% vs. 34.2%, P = 0.002). No statistical differences were found in the postoperative morbidities and 1-year follow-up outcomes. Conclusion Proximal anastomosis with adventitial eversion and prosthesis eversion technique is a promising surgical option for AAAD patients, with favorable perioperative and 1-year follow-up results.
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Affiliation(s)
- Changcun Fang
- Department of Cardiovascular Surgery, Thoracoscopy Institute of Cardiac Surgery, Qilu Hospital of Shandong University, Jinan, China
| | - Shan Gao
- Department of Anesthesia, Zhangqiu People’s Hospital, Jinan, China
| | - Xiao Ren
- Department of Extracorporeal Circulation, Wuhan Asia Heart Hospital, Wuhan, China
| | - Xinyan Pang
- Department of Cardiovascular Surgery, The Second Hospital of Shandong University, Jinan, China
| | - Xin Zhao
- Department of Cardiovascular Surgery, Thoracoscopy Institute of Cardiac Surgery, Qilu Hospital of Shandong University, Jinan, China
| | - Zengshan Ma
- Department of Cardiovascular Surgery, Thoracoscopy Institute of Cardiac Surgery, Qilu Hospital of Shandong University, Jinan, China
| | - Chen Wang
- Department of Cardiovascular Surgery, The Second Hospital of Shandong University, Jinan, China
| | - Kai Liu
- Department of Cardiovascular Surgery, Thoracoscopy Institute of Cardiac Surgery, Qilu Hospital of Shandong University, Jinan, China
- *Correspondence: Kai Liu,
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15
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Gaudry M, Guivier-Curien C, Blanchard A, Porto A, Bal L, Omnes V, De Masi M, Lu C, Jacquier A, Piquet P, Deplano V. Volume Analysis to Predict the Long-Term Evolution of Residual Aortic Dissection after Type A Repair. J Cardiovasc Dev Dis 2022; 9:jcdd9100349. [PMID: 36286301 PMCID: PMC9604488 DOI: 10.3390/jcdd9100349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 09/26/2022] [Accepted: 10/08/2022] [Indexed: 11/05/2022] Open
Abstract
Background: The aim of this study was to evaluate the aortic diameter and volume during the first year after a type A repair to predict the long-term prognosis of a residual aortic dissection (RAD). Methods: All patients treated in our center for an acute type A dissection with a RAD and follow-up > 3 years were included. We defined two groups: group 1 with dissection-related events (defined as an aneurysmal evolution, distal reintervention, or aortic-related death) and group 2 without dissection-related events. The aortic diameters and volume analysis were evaluated on three postoperative CT scans: pre-discharge (T1), 3−6 months (T2) and 1 year (T3). Results: Between 2009 and 2016, 54 patients were included. Following a mean follow-up of 75.4 months (SD 31.5), the rate of dissection-related events was 62.9% (34/54). The total aortic diameters of the descending thoracic aorta were greater in group 1 at T1, T2 and T3, with greater diameters in the FL (p < 0.01). The aortic diameter evolution at 3 months was not predictive of long-term dissection-related events. The total thoracic aortic volume was significantly greater in group 1 at T1 (p < 0.01), T2 (p < 0.01), and T3 (p < 0.01). At 3 months, the increase in the FL volume was significantly greater in group 1 (p < 0.01) and was predictive for long-term dissection-related events. Conclusion: This study shows that an initial CT scan volume analysis coupled with another at 3 months is predictive for the long-term evolution in a RAD. Based on this finding, more aggressive treatment could be given at an earlier stage.
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Affiliation(s)
- Marine Gaudry
- Timone Aortic Center, Department of Vascular Surgery, APHM, Timone Hospital, 13005 Marseille, France
- Correspondence: ; Tel.: +33-491-388-120
| | | | - Arnaud Blanchard
- Timone Aortic Center, Department of Vascular Surgery, APHM, Timone Hospital, 13005 Marseille, France
| | - Alizée Porto
- Timone Aortic Center, Department of Vascular Surgery, APHM, Timone Hospital, 13005 Marseille, France
- Department of Cardiac Surgery, APHM, Timone Hospital, 13005 Marseille, France
| | - Laurence Bal
- Timone Aortic Center, Department of Vascular Surgery, APHM, Timone Hospital, 13005 Marseille, France
| | - Virgile Omnes
- Timone Aortic Center, Department of Vascular Surgery, APHM, Timone Hospital, 13005 Marseille, France
| | - Mariangela De Masi
- Timone Aortic Center, Department of Vascular Surgery, APHM, Timone Hospital, 13005 Marseille, France
| | - Charlotte Lu
- Department of Radiology, APHM, Timone Hospital, 13005 Marseille, France
| | - Alexis Jacquier
- Department of Radiology, APHM, Timone Hospital, 13005 Marseille, France
| | - Philippe Piquet
- Timone Aortic Center, Department of Vascular Surgery, APHM, Timone Hospital, 13005 Marseille, France
| | - Valerie Deplano
- CNRS, Centrale Marseille, IRPHE, Aix Marseille University, 13013 Marseille, France
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16
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Hauck SR, Kern M, Dachs TM, Haider L, Stelzmüller ME, Ehrlich M, Loewe C, Funovics MA. Applicability of endovascular branched and fenestrated aortic arch repair devices to treat residual type A dissection after ascending replacement. J Vasc Surg 2022; 76:1440-1448. [PMID: 36028159 DOI: 10.1016/j.jvs.2022.08.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Revised: 08/14/2022] [Accepted: 08/17/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Endovascular repair of post-type-A aortic dissection after open ascending replacement (PTAD) has recently been shown as safe and feasible, but with limited anatomic applicability since only one stent graft was evaluated. We assessed anatomic and clinical applicability of six commercially available branched/fenestrated stent grafts for endovascular repair of PTAD. METHODS On postoperative CT-scans of 101 patients, we measured aortic diameter at: sino-tubular junction, supra-aortic vessels (SAV), and descending aorta, as well as the distances between these landmarks along the outer curvature of the arch and the diameters of the SAV. Anatomical applicability was evaluated according to the instructions-for-use, clinical applicability with regard to supra-aortic and iliac arteries. Assessed devices were: Cook aortic double branch; Terumo double branch; Najuta fenestrated; Endospan Nexus; Medtronic Mona LSA; and Gore TAG thoracic branch. RESULTS Single devices were anatomically and clinically applicable between 19/101 (Mona LSA) and 83/101 (Najuta) cases. Reasons for rejection varied considerably across devices. With all devices available, anatomical applicability was 97/101 and clinical applicability 95/101. Combinations of a fenestrated and a branched device showed the most favorable clinical applicability for a pair of two devices, ranging from 86/101 to 94/101. CONCLUSIONS Anatomical and clinical applicability of endovascular devices for the repair of PTAD is high for fenestrated and branched devices, and very high for the combination of fenestrated and branched devices. Manufacturers should amend specific device requirements for PTAD. Surgeons should emphasize the need for a sufficiently long and straight graft as a potential landing zone.
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Affiliation(s)
- Sven R Hauck
- Division of Cardiovascular and Interventional Radiology, Department of Bio-medical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Maximilian Kern
- Division of Cardiovascular and Interventional Radiology, Department of Bio-medical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Theresa-Marie Dachs
- Division of Cardiovascular and Interventional Radiology, Department of Bio-medical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Lukas Haider
- Division of Cardiovascular and Interventional Radiology, Department of Bio-medical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | | | - Marek Ehrlich
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Christian Loewe
- Division of Cardiovascular and Interventional Radiology, Department of Bio-medical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Martin A Funovics
- Division of Cardiovascular and Interventional Radiology, Department of Bio-medical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria.
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17
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Widenka KJ, Kosiorowska M, Jakob H, Pacini D, Hemmer W, Grabenwoeger M, Sioris T, Moritz A, Tsagakis K. Early and midterm results of frozen elephant trunk operation with Evita open stent-graft in patients with Marfan syndrome: results of a multicentre study. BMC Cardiovasc Disord 2022; 22:333. [PMID: 35883019 PMCID: PMC9317434 DOI: 10.1186/s12872-022-02777-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 06/13/2022] [Indexed: 11/20/2022] Open
Abstract
Background Endovascular treatment of patients with Marfan syndrome (MFS) is not recommended. Hybrid procedures such as frozen elephant trunk (FET), which combines stent-graft deployment with an integrated non-stented fabric graft for proximal grafting and suturing, have not been previously evaluated. The aim of this study was to assess the safety and feasibility of FET operation in patients with MFS. Methods Patients enrolled in the International E-vita Open Registry (IEOR) who underwent FET procedure between January 2001 and February 2020 meeting Ghent criteria for MFS were included in the study. Early and midterm results were retrospectively analyzed. Preoperative, postoperative and follow-up computed tomography angiography scans were analysed. Results We analyzed 37 patients [mean age 38 ± 11 years, 65% men]. Acute or chronic aortic dissection was present in 35 (95%) patients (14 and 21 patients respectively). Two (5%) patients had an aneurysm without dissection. Malperfusion syndrome was present in 4 patients. Twenty-nine (78%) patients had history of aortic surgical interventions. The 30-day and in-hospital mortality amounted to 8 and 14% respectively. False lumen exclusion was present in 73% in stented segment in last postoperative CT. The overall 5-year survival was 71% and freedom from reintervention downstream was 58% at 5 years. Of the nine patients who required reintervention for distal aortic disease, one patient died. Conclusions FET operation for patients with MFS can be performed with acceptable mortality and morbidity. In long-term follow-up no reinterventions on the aortic arch were required. FET allows for easier second stage operations providing platform for surgical and endovascular reinterventions.
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Affiliation(s)
- Kazimierz Jan Widenka
- Department of Cardiac Surgery, University of Rzeszow Poland, 60 Lwowska Street 60, 35-301, Rzeszow, Poland.
| | - Monika Kosiorowska
- Department of Cardiac Surgery, University of Rzeszow Poland, 60 Lwowska Street 60, 35-301, Rzeszow, Poland
| | - Heinz Jakob
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital of Essen, Essen, Germany
| | - Davide Pacini
- Department of Cardiac Surgery, S. Orsola Hospital, University of Bologna, Bologna, Italy
| | - Wolfgang Hemmer
- Department of Cardiac Surgery, Sana Cardiac Surgery Stuttgart GmbH, Stuttgart, Germany
| | | | - Thanos Sioris
- Tampere University Hospital Heart Center, Tampere, Finland
| | - Anton Moritz
- Department of Thoracic and Cardiovascular Surgery, University Hospital Frankfurt, Frankfurt, Germany
| | - Konstantinos Tsagakis
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital of Essen, Essen, Germany
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18
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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] [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.
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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
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19
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Chang Y, Qian X, Guo H, Wei Y, Yu C, Sun X, Wei B, Ma Q, Shi Y. Perioperative and Short-Term Outcomes of Sinus Replacement and Conservative Repair for Aortic Root in Acute Type A Aortic Dissection: A Prospective Cohort Study. Front Cardiovasc Med 2022; 9:880411. [PMID: 35665244 PMCID: PMC9160325 DOI: 10.3389/fcvm.2022.880411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 04/19/2022] [Indexed: 11/22/2022] Open
Abstract
Background To compare outcomes between sinus replacement (SR) and conservative repair (CR) for dissected roots with normal size. Methods From October 2018 to April 2021, a prospective cohort study was carried out. Patients were assigned to two groups (SR group and CR group) according to whether they underwent sinus replacement. Propensity score matching was applied to adjust preoperative variables and Kaplan–Meier method was used for survival analysis. Results Three hundred and eighty-seven patients were enrolled. In the whole cohort, 18 patients (4.7%) died postoperatively. The operative mortality of SR group was comparable to CR group (3.2% vs. 6.0%, p = 0.192 before matching; 3.5% vs. 7.0%, p = 0.267 after matching) and the incidence of hemostasis management under restarted cardiopulmonary bypass for root bleeding was lower in SR group (1.6% vs. 7.0%, p = 0.002 before matching; 2.1% vs. 8.5%, p = 0.03 after matching). The median follow-up duration was 12 months. There were 3 reoperations in the CR group. The estimated cumulative event rate of reoperation was 1.1 % at 12 months and 1.6% at 24 months in CR group, with a trend of a lower rate in the SR group (log-rank p = 0.089 before matching, p = 0.075 after matching). There was one late death in each group. The estimated cumulative event rate of death was 3.8% at 12 months and 24 months in the SR group, and was 6.6% in the CR group with no significant difference (log-rank p = 0.218 before matching, p = 0.120 after matching). Aortic regurgitation significantly improved postoperatively and remained stable during follow-up. Conclusions Sinus replacement is a simple, safe, and effective technique for repairing severely dissected sinus with a comparable time spent in operation and excellent immediate and short-term results. It had the advantages of eliminating false lumen and avoiding aortic root bleeding.
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20
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Eranki A, Wilson-Smith A, Williams ML, Saxena A, Mejia R. Quality of life following surgical repair of acute type A aortic dissection: a systematic review. J Cardiothorac Surg 2022; 17:118. [PMID: 35578309 PMCID: PMC9112611 DOI: 10.1186/s13019-022-01875-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 04/30/2022] [Indexed: 11/21/2022] Open
Abstract
Background The outcomes of surgery for acute Stanford Type A aortic dissection (ATAAD) extend beyond mortality and morbidity. The aim of this systematic review was to summarise the literature surrounding health related quality of life (HR-QOL) following ATAAD, compare the outcomes to the standardised population, and to assess the impact of advanced age on HRQOL outcomes following surgery. Methods A systematic review of studies after January 2000 was performed to identify HR-QOL in patients following surgery for ATAAD. Electronic searches of three databases were performed and clinical studies extracted by two independent reviewers. Strict inclusion and exclusion criteria were applied. Quality appraisal was conducted utilizing predefined criteria on pilot forms. HR-QOL results were synthesized through a narrative review of included studies. Results There was significant attrition in HR-QOL of patients following surgery for ATAAD. Outcomes fared worse when compared to an age adjusted normative population. Of note, elderly patients were physically vulnerable, whereas younger populations may be more mentally vulnerable to postoperative sequalae. The included studies were quite heterogeneous in their study designs, methods, HR-QOL measures reported and follow up time-frames which limited direct comparison between studies. Conclusion HR-QOL outcomes are adversely affected when compared to preoperative status and physical health demonstrates significant attrition over time. HR-QOL outcomes are worse off when compared to an age matched general population. In terms of age, advancing age is associated with worse physical component scores but emotional health may fare better than younger patients. Supplementary Information The online version contains supplementary material available at 10.1186/s13019-022-01875-x.
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Affiliation(s)
- Aditya Eranki
- Department of Cardiothoracic Surgery, John Hunter Hospital, Newcastle, NSW, 2305, Australia.
| | - Ashley Wilson-Smith
- Department of Cardiothoracic Surgery, John Hunter Hospital, Newcastle, NSW, 2305, Australia.,The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia
| | - Michael L Williams
- Department of Cardiothoracic Surgery, John Hunter Hospital, Newcastle, NSW, 2305, Australia.,The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia.,School of Medicine and Public Health, University of Newcastle, Newcastle, Australia
| | - Akshat Saxena
- Department of Cardiothoracic Surgery, Fiona Stanley Hospital, Perth, Australia
| | - Ross Mejia
- Department of Cardiothoracic Surgery, John Hunter Hospital, Newcastle, NSW, 2305, Australia
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21
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Shimada A, Yamamoto T, Endo D, Nishida K, Matsushita S, Asai T, Amano A. Pseudoaneurysm with a fistula to the right ventricle late after surgical repair of type A aortic dissection in a patient with systemic lupus erythematosus. J Cardiothorac Surg 2022; 17:83. [PMID: 35477534 PMCID: PMC9044762 DOI: 10.1186/s13019-022-01827-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 04/11/2022] [Indexed: 11/18/2022] Open
Abstract
Background Pseudoaneurysm with a shunt to the right ventricle after aortic repair for acute aortic dissection is an extremely rare and life-threatening condition. Surgical treatment is unavoidable, but surgery is complicated, and there are some pitfalls. This study describes the reoperation performed in a patient at a high surgical risk by clarifying the shunt site using multimodality imaging before surgery. Case presentation A 69-year-old woman with a history of systemic lupus erythematosus (SLE) and Sjogren’s syndrome presented with a pseudoaneurysm 1 year after emergency surgery for acute type A aortic dissection. Eight years after the first surgery, she experienced sudden chest pain and presented to the emergency department. Her dyspnea worsened; therefore, echocardiography and three-dimensional computed tomography (3DCT) were performed, and a pseudoaneurysm and shunt to the right ventricle were identified. The medical team attempted to close the shunt with a percutaneous catheter but was unsuccessful, and she was referred to our department for surgical treatment. The pseudoaneurysm originating from the proximal side of the aorta was large (diameter = 55 mm), and echocardiography-gated 3DCT identified the shunt from the pseudoaneurysm to the right ventricle. First, extracorporeal circulation was initiated, and resternotomy was performed. We could not insert the left ventricular venting tube from the right side because of the pseudoaneurysm size. Instead, the tube was inserted from the left atrial appendage. We found a half-circumferential disengaged anastomosis around the proximal anastomosis, which formed the large pseudoaneurysm leading to a fistula in the right ventricle. We closed the fistula and performed a Bentall operation. The patient had a good postoperative course and was discharged on postoperative day 21. She continued treatment for SLE and Sjogren’s syndrome, and her inflammatory reaction improved. Conclusions We performed a Bentall operation and fistula closure with resternotomy in a patient with type A aortic dissection with SLE and Sjogren’s syndrome. Multimodal imaging is essential in defining the pseudoaneurysm and the fistula surrounding the anatomy while ensuring their resolution and guiding the approach for operation.
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Affiliation(s)
- Akie Shimada
- Department of Cardiovascular Surgery, Nerima Hospital, Juntendo University, 3-1-10, Takanodai, Nerima-ku, Tokyo, 177-8521, Japan
| | - Taira Yamamoto
- Department of Cardiovascular Surgery, Nerima Hospital, Juntendo University, 3-1-10, Takanodai, Nerima-ku, Tokyo, 177-8521, Japan.
| | - Daisuke Endo
- Department of Cardiovascular Surgery, Juntendo University, Bunkyo-Ku, Tokyo, Japan
| | - Kousuke Nishida
- Department of Cardiovascular Surgery, Juntendo University, Bunkyo-Ku, Tokyo, Japan
| | - Satoshi Matsushita
- Department of Cardiovascular Surgery, Juntendo University, Bunkyo-Ku, Tokyo, Japan
| | - Tohru Asai
- Department of Cardiovascular Surgery, Juntendo University, Bunkyo-Ku, Tokyo, Japan
| | - Atsushi Amano
- Department of Cardiovascular Surgery, Juntendo University, Bunkyo-Ku, Tokyo, Japan
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22
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Salagaev GI, Lysenko AV, Lednev PV, Belov YV. [Hemostatic measures in reconstructive aortic root surgery]. Khirurgiia (Mosk) 2021:83-87. [PMID: 34786920 DOI: 10.17116/hirurgia202111183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Bleeding is a significant cause of complications and mortality in surgery for ascending aorta and aortic root disease. This is especially true after complex reconstructions associated with hypothermic circulatory arrest and long-standing cardiopulmonary bypass. The review is devoted to modern methods of hemostasis in reconstructive aortic root surgery.
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Affiliation(s)
- G I Salagaev
- Petrovsky National Research Center of Surgery, Moscow, Russia
| | - A V Lysenko
- Petrovsky National Research Center of Surgery, Moscow, Russia
| | - P V Lednev
- Petrovsky National Research Center of Surgery, Moscow, Russia
| | - Yu V Belov
- Petrovsky National Research Center of Surgery, Moscow, Russia.,Sechenov First Moscow State Medical University, Moscow, Russia
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23
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White A, Bozso SJ, Ouzounian M, Chu MW, Moon MC. Acute type A aortic dissection and the consequences of a patent false lumen. JTCVS Tech 2021; 9:1-8. [PMID: 34647041 PMCID: PMC8500985 DOI: 10.1016/j.xjtc.2021.05.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 05/03/2021] [Indexed: 11/15/2022] Open
Affiliation(s)
- Abigail White
- Division of Cardiac Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Sabin J. Bozso
- Division of Cardiac Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Maral Ouzounian
- Division of Cardiac Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Michael W.A. Chu
- Division of Cardiac Surgery, Western University, London, Ontario, Canada
| | - Michael C. Moon
- Division of Cardiac Surgery, University of Alberta, Edmonton, Alberta, Canada
- Address for reprints: Michael C. Moon, MD, Division of Cardiac Surgery, Mazankowski Alberta Heart Institute, Department of Surgery, University of Alberta, 8602 112 St NW, Edmonton, Alberta T6G 2E1, Canada.
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24
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Technical eligibility for endovascular treatment of the aortic arch after open type A aortic dissection repair. J Thorac Cardiovasc Surg 2021; 162:770-777. [DOI: 10.1016/j.jtcvs.2019.12.113] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 12/22/2019] [Accepted: 12/28/2019] [Indexed: 01/16/2023]
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25
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Rathore KS. Distal Aortic Remodeling after Type A Dissection Repair: An Ongoing Mirage. J Chest Surg 2021; 54:439-448. [PMID: 34376627 PMCID: PMC8646062 DOI: 10.5090/jcs.21.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 05/29/2021] [Accepted: 06/03/2021] [Indexed: 11/24/2022] Open
Abstract
Remodeling is a commonly encountered term in the field of cardiothoracic surgery that is often used to describe various pathophysiological changes in the dimension, structure, and function of various cardiac chambers, including the aorta. Stanford type A or DeBakey type 1 aortic dissection (TAAD) is a perplexing pathologic condition that can present surgical teams with the need to navigate a maze of complex decision-making. Ascending or hemi-arch replacement leaves behind a significant amount of distal diseased aortic tissue, which might have a persistent false lumen or primary or secondary intimal tears (or communications between lumina), which can lead to dilatation of the aortic arch. Unfavorable aortic remodeling is a major cause of distal aortic deterioration after the index surgery. Cardiac surgeons are aware of post-surgical cardiac chamber remodeling, but the concept of distal aortic remodeling is still idealized. The contemporary literature from established aortic centers supports aggressive management of the residual aortic pathology during the index surgery, and with continuing technical advancements, endovascular stenting options are readily available for patients with TAAD or for complicated type B aortic dissection cases. This review discusses the pathophysiology and treatment options for favorable distal aortic remodeling, as well as its impact on mid- to long-term outcomes following TAAD repair.
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26
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Gaudry M, Porto A, Guivier-Curien C, Blanchard A, Bal L, Resseguier N, Omnes V, De Masi M, Ejargue M, Jacquier A, Gariboldi V, Deplano V, Piquet P. Results of a prospective follow-up study after type A aortic dissection repair: a high rate of distal aneurysmal evolution and reinterventions. Eur J Cardiothorac Surg 2021; 61:152-159. [PMID: 34355742 DOI: 10.1093/ejcts/ezab317] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 06/08/2021] [Accepted: 06/10/2021] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES We investigated the anatomical evolution of residual aortic dissection after type A repair and factors associated with poor prognosis at a high-volume aortic centre. METHODS Between 2017 and 2019, all type A aortic dissections were included for prospective follow-up. Patients without follow-up computed tomography (CT) scan available for radiological analysis and patients without residual aortic dissection were excluded from this study. The primary end point was a composite end point defined as dissection-related events including aneurysmal evolution (increased diameter > 5 mm/year), aortic reintervention for malperfusion syndrome, aortic diameter >55 mm, rapid aortic growth >10 mm/year or aortic rupture and death. The secondary end points were risk factors for dissection-related events and reintervention analysis. All immediate and last postoperative CT scans were analysed. RESULTS Among 104 patients, after a mean follow-up of 20.4 months (8-41), the risk of dissection-related events was 46.1% (48/104) and the risk of distal reintervention was 17.3% (18/104). Marfan syndrome (P < 0.01), aortic bicuspid valve (P = 0.038), innominate artery debranching (P = 0.025), short aortic cross-clamp time (P = 0.011), initial aortic diameter >40 mm (P < 0.01) and absence of resection of the primary entry tear (P = 0.015) were associated with an increased risk of dissection-related events or reintervention during follow-up. CONCLUSIONS Residual aortic dissection is a serious disease requiring close follow-up at an expert centre. This study shows higher reintervention and aneurysmal development rates than currently published. To improve long-term outcomes, the early demographic and anatomic poor prognostic factors identified may be used for more aggressive treatment at an early phase.
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Affiliation(s)
- Marine Gaudry
- Department of Vascular Surgery, APHM, Timone Hospital, Timone Aortic Center, Marseille, France
| | - Alizée Porto
- Department of Cardiac Surgery, APHM, Timone Hospital, Marseille, France
| | - Carine Guivier-Curien
- Aix-Marseille Université, CNRS, Ecole Centrale Marseille, IRPHE UMR 7342, Marseille, France
| | - Arnaud Blanchard
- Department of Vascular Surgery, APHM, Timone Hospital, Timone Aortic Center, Marseille, France
| | - Laurence Bal
- Department of Vascular Surgery, APHM, Timone Hospital, Timone Aortic Center, Marseille, France
| | - Noemie Resseguier
- Department of Epidemiology and Public Health Cost, APHM, Marseille, France
| | - Virgile Omnes
- Department of Vascular Surgery, APHM, Timone Hospital, Timone Aortic Center, Marseille, France
| | - Mariangela De Masi
- Department of Vascular Surgery, APHM, Timone Hospital, Timone Aortic Center, Marseille, France
| | - Meghann Ejargue
- Department of Vascular Surgery, APHM, Timone Hospital, Timone Aortic Center, Marseille, France
| | - Alexis Jacquier
- Department of Radiology, APHM, Timone Hospital, Marseille, France
| | - Vlad Gariboldi
- Department of Cardiac Surgery, APHM, Timone Hospital, Marseille, France
| | - Valérie Deplano
- Aix-Marseille Université, CNRS, Ecole Centrale Marseille, IRPHE UMR 7342, Marseille, France
| | - Philippe Piquet
- Department of Vascular Surgery, APHM, Timone Hospital, Timone Aortic Center, Marseille, France
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27
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Wang C, Zhang W, Peng J, He J, Wenliu X, Chen G, Fan X. Outcomes of long versus short stent cronus hybrid prosthesis in type A aortic dissection: A single centre experience. J Card Surg 2021; 36:3261-3268. [PMID: 34164847 DOI: 10.1111/jocs.15766] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 05/06/2021] [Accepted: 05/09/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The frozen elephant trunk (FET) technique has become an important tool in the treatment of acute type A aortic dissection. The aim of this study was to evaluate the effect of long FET on spinal cord injury (SCI) and distal aortic remodeling after acute type A aortic dissection based on clinical and radiological outcomes. METHODS From January 2018 to November 2019, 158 patients (mean age 51.8 years [range: 32-78 years], 88.6% male) with acute type A aortic dissection were treated by FET with 100 mm (n = 113) or 150 mm (n = 45) open hybrid stent graft prosthesis. Patients were divided into two groups according to the length of FET. The clinical and radiological outcomes of the patients were reviewed retrospectively. RESULTS Postoperative outcomes did not differ significantly: in-hospital mortality (9.7% vs. 6.7%, p = .758) and SCI (5.3% vs. 2.2%, p = .674). Aortic remodeling, which was evaluated by aortic diameter, true lumen diameter, false lumen (FL) diameter and the rate of FL complete thrombosis, was more positive in long FET group in the descending thoracic aorta during the follow-up period. At the abdominal level, there was no statistically significant difference between the two groups. CONCLUSIONS The long version of FET does not increase the risk of SCI in patients with acute type A aortic dissection. The application of long FET can achieve better results in terms of remodeling of the thoracic aorta in the short- and medium-term follow-up.
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Affiliation(s)
- Chaojie Wang
- Department of Cardiovascular Surgery, Guangdong Provincial Hospital of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China.,The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Wenqian Zhang
- Department of Cardiovascular Surgery, Guangdong Provincial Hospital of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China.,The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Jihai Peng
- Department of Rehabilitation, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Jie He
- Department of Vascular Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Xu Wenliu
- Department of Cardiovascular Surgery, Guangdong Provincial Hospital of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China.,The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Guangtian Chen
- Department of Cardiovascular Surgery, Laboratory of South China Structural Heart Disease, Guangdong Academy of Medical Sciences, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangzhou, Guangdong, China
| | - Xiaoping Fan
- Department of Cardiovascular Surgery, Guangdong Provincial Hospital of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China.,The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
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28
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Bojko MM, Habertheuer A, Bavaria JE, Suhail M, Hu RW, Harmon J, Desai ND, Milewski RK, Williams ML, Szeto WY, Mossey J, Vallabhajosyula P. Recurrent aortic insufficiency after emergency surgery for acute type A aortic dissection with aortic root preservation. J Thorac Cardiovasc Surg 2021; 161:1989-2000.e6. [DOI: 10.1016/j.jtcvs.2020.01.116] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 01/02/2020] [Accepted: 01/07/2020] [Indexed: 12/18/2022]
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Endovascular Treatment of Post Type A Chronic Aortic Arch Dissection With a Branched Endograft: Early Results From a Retrospective International Multicenter Study. Ann Surg 2021; 273:997-1003. [PMID: 30973389 DOI: 10.1097/sla.0000000000003310] [Citation(s) in RCA: 71] [Impact Index Per Article: 23.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE The objective of this study was to evaluate the outcome of endovascular aortic arch repair for chronic dissection with a custom-made branched endograft. BACKGROUND Acute type A aortic dissections are often treated with prosthetic replacement of the ascending aorta. During follow-up, repair of an aneurysmal evolution of the false lumen distal to the ascending prosthesis can be a challenge both for the surgeon and the patient. METHODS We conducted a multicenter, retrospective study of consecutive patients from 14 vascular units treated with a custom-made, inner-branched device (Cook Medical, Bloomington, IN) for chronic aortic arch dissection. Rates of in-hospital mortality and stroke, technical success, early and late complications, reinterventions, and mortality during follow-up were evaluated. RESULTS Seventy consecutive patients were treated between 2011 and 2018. All patients were considered unfit for conventional surgery. In-hospital combined mortality and stroke rate was 4% (n = 3), including 1 minor stroke, 1 major stroke causing death, and 1 death following multiorgan failure. Technical success rate was 94.3%. Twelve (17.1%) patients required early reinterventions: 8 for vascular access complication, 2 for endoleak correction, and 2 for pericardial effusion drainage. Median follow-up was 301 (138-642) days. During follow-up, 20 (29%) patients underwent secondary interventions: 9 endoleak corrections, 1 open repair for prosthetic kink, and 10 distal extensions of the graft to the thoracic or thoracoabdominal aorta. Eight patients (11%) died during follow-up because of nonaortic-related cause in 7 cases. CONCLUSIONS Endovascular treatment of aortic arch chronic dissections with a branched endograft is associated with low mortality and stroke rates but has a high reintervention rate. Further follow-up is required to confirm the benefits of this novel approach.
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30
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Hagiya K, Ozaki K, Nanasato M, Iguchi N, Takayama M, Shimokawa T, Tanabe N, Minamino T, Isobe M. Relationship Between Heart Rate at Discharge and Long-Term Outcomes of Surgically Treated Patients With Type A Acute Aortic Dissections. Circ J 2021; 85:2191-2200. [PMID: 33790141 DOI: 10.1253/circj.cj-20-0914] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Resting heart rate (HR) at discharge is an important predictor of mortality after acute myocardial infarction. However, in patients with Stanford type A acute aortic dissections (TA-AADs), the relationship between HR and long-term outcomes is unclear. Therefore, this relationship was investigated in the present study.Methods and Results:Surgically treated consecutive patients with TA-AAD (n=721) were retrospectively categorized according to HR quartiles, recorded within 24 h before discharge (<70, 70-77, 78-83, and ≥84 beats/min). The study endpoints included aortic aneurysm-related deaths, sudden deaths, aortic surgeries, and hospitalizations for recurrence of acute aortic dissections. The mean (±SD) patient age was 65.8±13.0 years. During a median observation period of 5.8 years (interquartile range 3.9-8.5 years), 17.2% of patients (n=124) experienced late aortic events. Late aortic surgery was performed in 14.0% of patients. After adjusting for potential confounders, including β-blocker use, HR at discharge remained an independent predictor of long-term aortic outcomes. Patients with discharge HR ≥84 beats/min had a higher risk (hazard ratio 1.86; 95% confidence interval 1.06-3.25; P=0.029) of long-term aortic events than those with HR <70 beats/min; the cumulative survival rates were similar among the groups (log-rank, P=0.905). CONCLUSIONS In surgically treated patients with TA-AAD, HR at discharge independently predicted long-term aortic outcomes. Consequently, HR in patients with TA-AAD should be optimized before discharge, particularly if the HR is ≥84 beats/min.
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Affiliation(s)
- Kenichi Hagiya
- Department of Cardiology, Sakakibara Heart Institute.,Department of Cardiovascular Biology and Medicine, Niigata University Graduate School of Medical and Dental Sciences
| | - Kazuyuki Ozaki
- Department of Cardiovascular Biology and Medicine, Niigata University Graduate School of Medical and Dental Sciences
| | | | - Nobuo Iguchi
- Department of Cardiology, Sakakibara Heart Institute
| | | | - Tomoki Shimokawa
- Department of Cardiovascular Surgery, Sakakibara Heart Institute
| | - Naohito Tanabe
- Department of Health and Nutrition, Faculty of Human Life Studies, University of Niigata Prefecture
| | - Tohru Minamino
- Department of Cardiovascular Biology and Medicine, Niigata University Graduate School of Medical and Dental Sciences
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A 10-Year Aortic Center Experience with Hybrid Repair of Chronic "Residual" Aortic Dissection After Type A Repair. Cardiovasc Drugs Ther 2021; 36:285-294. [PMID: 33528720 DOI: 10.1007/s10557-021-07150-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/24/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE Hybrid aortic arch repair in patients with chronic residual aortic dissection (RAD) is a less invasive alternative to conventional surgical treatment. The aim of this study was to describe the short-term and long-term results of hybrid treatment for RAD after type A repair. METHODS In this retrospective single-center cohort study, all patients treated for chronic RAD with hybrid aortic arch repair were included. Indications for treatment were rapid aortic growth, aortic diameter > 55 mm, or aortic rupture. RESULTS Between 2009 and 2020, we performed 29 hybrid treatments for chronic RAD. Twenty-four patients were treated for complete supra-aortic debranching in zones 0 and 5 with left subclavian artery debranching alone in zone 2. There was 1 perioperative death (3.4%): The patient was treated for an aortic rupture. There was no spinal cord ischemia and 1 minor stroke (3.4%). After a median follow-up of 25.4 months (range 3-97 months), the long-term mortality was 10.3% (3/29) with no late aortic-related deaths. Twenty-seven patients (93.1%) developed FL thrombosis of the descending thoracic aorta; the rate of aneurysmal progression on thoraco-abdominal aorta was 41.4% (12/29), and the rate of aortic reintervention was 34.5% (10/29). CONCLUSION In a high-volume aortic center, hybrid repair of RAD is associated with good anatomical results and a low risk of perioperative morbidity and mortality, including that of patients treated in zone 0. A redo replacement of the ascending aortic segment is sometimes necessary to provide a safer proximal landing zone and reduce the risk of type 1 endoleak after TEVAR.
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32
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Wu W, Ke Y, Zhao H, Huang L, Pu J. Trans-catheter closure of aortic anastomosis leak after aortic replacement: classifications and techniques. J Thorac Dis 2020; 12:4883-4891. [PMID: 33145062 PMCID: PMC7578451 DOI: 10.21037/jtd-20-1496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Aortic anastomotic leak (AAL) is knotty complication after aortic replacement. We aimed to evaluate the feasibility and efficacy of the techniques of trans-catheter AAL closure as well as to evaluate the impact of the new classification on the interventional closure. Methods From October 2015 to November 2017, 20 consecutive high surgical risk patients (mean age 47±12 years, 13 males) were referred to our center for trans-catheter closure AALs. Due to the variation of leak, we therefore developed a new-classification based on transesophageal echocardiography (TEE) and computed tomography angiography (CTA) assessments: type I: aorta-to-right atrium fistula, n=6; type II: pseudoaneurysm induced by a suture line dehiscence, n=4; type III: patency of the false lumen in aortic dissection, n=10. Outcomes were analyzed by assessing TEE and CTA in different types of AALs. Results Successful closure was accomplished in 17 subjects (85%). The severity of AAL reduced significantly in 15 patients (88%); two patients required a second procedure. At follow-up, we found that in type I, the right atrium systolic pressure reduced (from 25.3±4.1 to 7.0±1.2 mmHg) with the improved NYHA (3.5±0.6 vs. 1.0±0.0), the diameter of pseudoaneurysm significantly decreased (5.0±1.8 to 2.0±1.8 mm) in type II, and complete thrombosis was achieved in all type III patients. Conclusions Trans-catheter closure of AAL displays satisfactory results even in those defined as high-risk patients, and it could be considered be a viable alternative approach. New classification is helpful in decision-making.
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Affiliation(s)
- Wenhui Wu
- Interventional Department, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yutong Ke
- Echocardiography Department, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Honglei Zhao
- Cardiology Surgery Department, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Lianjun Huang
- Interventional Department, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Junzhou Pu
- Interventional Department, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
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33
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Management of the aortic arch in patients with Loeys–Dietz syndrome. J Thorac Cardiovasc Surg 2020; 160:1166-1175. [DOI: 10.1016/j.jtcvs.2019.07.130] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Revised: 07/05/2019] [Accepted: 07/11/2019] [Indexed: 01/14/2023]
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Morgant MC, Malapert G, Bernard C, Laubriet A, Pujos C, Varin T, Lansac E, Bouchot O. Aortic root remodeling with external annuloplasty for acute type A aortic dissection: Midterm results. J Card Surg 2020; 36:1770-1778. [PMID: 33032374 DOI: 10.1111/jocs.15095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 09/22/2020] [Accepted: 09/24/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND To evaluate the role of aortic root remodeling with external aortic annuloplasty (ARREAA) in acute type A aortic dissection (AAAD). METHODS From May 2011 to May 2020, 59 patients out of 240 with AAAD underwent ARREAA. Data were retrospectively collected and analyzed. RESULTS The mean age was 61.4 ± 8.6 years and 43 patients were males (73%). Hemiarch and total arch replacement were performed in 37 (62.7%) and 14 (23.7%) patients. An aortic valvuloplasty was performed in seven patients (11.8%). Five patients (8.5%) required coronary artery bypass graft. Re-exploration for bleeding was required in six patients (10.1%). The 30-day mortality rate was 18.6%. Preoperative hemodynamic instability (odds ratio [OR] = 8.57, 95% confidence interval [CI] = 1.57-46.71; p = 0.013), consciousness disorder (OR = 19.18, 95% CI = 3.02-121.72]; p = 0.002) or myocardial ischemia (OR = 6.28, 95% CI = 1.27-31.10; p = 0.013) were significantly associated with postoperative mortality. No patient was reoperated for aortic valve during the postoperative period. One patient suffered a stroke postoperatively with partial recovery. Kidney failure requiring temporary dialysis occurred in 12 patients (20.3%). At discharge, a transthoracic echocardiogram showed moderate aortic regurgitation (AR; grade 2) in two patients. During follow-up (mean = 58.4 ± 32.4 months), three patients died. The rate of mortality was 6.2%. Actuarial survival at 5 years was 76.3%. No patient required reoperation on the proximal aorta or aortic valve. At 4 years, freedom from any aortic valve or root reintervention and AR > 2 were both 100%. CONCLUSION In a center with expertise in valve-sparing procedures, ARREAA is a reasonable option in the surgical management of AAAD in selected patients. This technique stabilizes the aortic annulus and preserves root anatomy for durable outcomes.
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Affiliation(s)
| | - Ghislain Malapert
- Department of Cardiovascular and Thoracic Surgery, Dijon University Hospital, Dijon, France
| | - Chloé Bernard
- Department of Cardiovascular and Thoracic Surgery, Dijon University Hospital, Dijon, France
| | - Aline Laubriet
- Department of Cardiovascular and Thoracic Surgery, Dijon University Hospital, Dijon, France
| | - Charline Pujos
- Department of Cardiovascular and Thoracic Surgery, Dijon University Hospital, Dijon, France
| | - Thomas Varin
- Department of Cardiovascular and Thoracic Surgery, Dijon University Hospital, Dijon, France
| | - Emmanuel Lansac
- Department of Cardiac Surgery, Mutualist Montsouris Institute, Paris, France
| | - Olivier Bouchot
- Department of Cardiovascular and Thoracic Surgery, Dijon University Hospital, Dijon, France
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Hohri Y, Yamasaki T, Matsuzaki Y, Hiramatsu T. Early and mid-term outcome of frozen elephant trunk using spinal cord protective perfusion strategy for acute type A aortic dissection. Gen Thorac Cardiovasc Surg 2020; 68:1119-1127. [PMID: 32152953 PMCID: PMC7522075 DOI: 10.1007/s11748-020-01328-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Accepted: 02/26/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVE This study aimed to evaluate the prevalence of spinal cord injury in total arch replacement with frozen elephant trunk for acute type A aortic dissection using our spinal cord protection technique. METHODS Between January 2013 and December 2017, 33 patients underwent total arch replacement with frozen elephant trunk for acute type A aortic dissection (mean age 67.9 ± 13.3 years). Our spinal cord protection technique involved maintaining extracorporeal circulation through the left subclavian artery in all procedures, using aortic occlusion balloon during distal anastomosis, and inserting frozen elephant trunk above Th 8 with transesophageal echocardiographic guidance. Computed tomography was performed within 1-2 weeks, 12 months, and 36 months postoperatively. We compared the degree of thrombosis of the descending aorta between preoperation and early postoperative period by Fisher's exact test. Moreover, we evaluated postoperative mortality and mobility (including spinal cord injury) at follow-up. RESULTS The operative mortality within 30 days was 6.1%. Neither paraplegia nor paraparesis was noted. We observed significant thrombosis of the false lumen at the distal arch and aortic valve level of the descending aorta in postoperative early term period (p < 0.01). At mid-term follow-up (mean 33.9 months), survival probability and 3-year freedom from reoperation rates were 93.9 ± 4.1% and 95.0 ± 4.9%, respectively. CONCLUSIONS The frozen elephant trunk technique with our spinal protection strategy provides good postoperative outcomes. Our strategy can maintain spinal cord perfusion without complete ischemia time even during lower body ischemia time. Implementation of our spinal protection strategy will help prevent spinal cord injury and dilated downstream aorta.
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Affiliation(s)
- Yu Hohri
- Department of Cardiovascular Surgery, Japanese Red Cross Kyoto Daini Hospital, 355-5 Haruobi-cho, Kamigyo-ku, Kyoto, 602-8026, Japan.
| | - Takuma Yamasaki
- Department of Cardiovascular Surgery, Japanese Red Cross Kyoto Daini Hospital, 355-5 Haruobi-cho, Kamigyo-ku, Kyoto, 602-8026, Japan
| | - Yuichi Matsuzaki
- Department of Cardiovascular Surgery, Japanese Red Cross Kyoto Daini Hospital, 355-5 Haruobi-cho, Kamigyo-ku, Kyoto, 602-8026, Japan
| | - Takeshi Hiramatsu
- Department of Cardiovascular Surgery, Japanese Red Cross Kyoto Daini Hospital, 355-5 Haruobi-cho, Kamigyo-ku, Kyoto, 602-8026, Japan
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Abdelhameed AS, Xin F, Wei X. Early Mortality in Patients who Received Extensive Surgical Management for Acute Type A Aortic Dissection - Analysis of 452 Consecutive Cases from a Single-center Experience. Braz J Cardiovasc Surg 2020; 35:521-529. [PMID: 32864933 PMCID: PMC7454641 DOI: 10.21470/1678-9741-2019-0258] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Objective To detect the potential risk factors associated with early mortality in patients who received extensive surgical management, in the form of total arch replacement plus frozen elephant trunk and arch debranching (hybrid repair technique), for acute type A aortic dissection. Methods The clinical and surgical data of 452 surgically treated patients with acute type A aortic dissection at our center, between March 2010 and December 2016, have been retrieved. Uni and multivariate logistic regression analyses were carried out to detect the effect of various preoperative demographics and different perioperative variables on early mortality. Results Overall 30-day mortality occurred in 70 out of 452 patients (15.4%). The principal causes of death were multiple organ failure (n=38), cardiac failure (n=18), and severe pulmonary infection (n=10). Risk factors for early mortality were identified with multivariate analysis. Preoperatively, overweight (P<0.025), alcohol drinking (P<0.002), coronary artery disease (P<0.014), hemodynamic shock (P<0.006), and elevated white blood cells count (P<0.002) were associated with higher mortality rate. Postoperatively, prolonged operation time (P<0.008), stroke (P<0.0001), and acute renal dysfunction (P<0.0001) were highly associated with death. Conclusion Considering the advantages of extensive surgical management for acute type A aortic dissection over the other less aggressive surgical approaches, it should be advised whenever indicated, provided that being carried out by experts in the field of adult aortic surgery in high-volume centers. The surgeon should be aware of the patient’s preoperative comorbidities and other risk factors for early mortality, in particular, prolonged operation time.
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Affiliation(s)
- Ahmed Sayed Abdelhameed
- Department of Cardiothoracic Surgery, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China
| | - Feng Xin
- Department of Cardiothoracic Surgery, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China
| | - Xiang Wei
- Department of Cardiothoracic Surgery, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China
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Frankel WC, Green SY, Orozco-Sevilla V, Preventza O, Coselli JS. Contemporary Surgical Strategies for Acute Type A Aortic Dissection. Semin Thorac Cardiovasc Surg 2020; 32:617-629. [PMID: 32615305 DOI: 10.1053/j.semtcvs.2020.06.025] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 05/21/2020] [Accepted: 06/13/2020] [Indexed: 11/11/2022]
Abstract
Surgical techniques and organ protection strategies for acute type A aortic dissection (ATAAD) have evolved considerably over the years. Nonetheless, open surgical repair remains a complex procedure, and there is a lack of consensus regarding many aspects of repair. In patients with dissection limited to the ascending aorta (DeBakey type II), repair typically involves replacement of only the affected segment, barring substantial aortic dilation to address elsewhere. In contrast, most patients with ATAAD have dissection extending into the thoracoabdominal aorta (DeBakey type I); in these cases, consideration must be given as to how much of the aortic arch and distal aorta to incorporate into the index repair, and several open and hybrid options exist. Herein, we review contemporary surgical strategies for ATAAD and clarify specific areas of controversy, in an effort to elucidate the optimal operative approach. In general, a limited index repair aimed at ensuring operative survival is typically the best option, whereas extended repair should be reserved for carefully selected patients who are most likely to benefit.
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Affiliation(s)
- William C Frankel
- Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Susan Y Green
- Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Vicente Orozco-Sevilla
- Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas; Section of Adult Cardiac Surgery, Department of Cardiovascular Surgery, Texas Heart Institute, Houston, Texas; CHI St Luke's Health-Baylor St Luke's Medical Center, Houston, Texas
| | - Ourania Preventza
- Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas; Section of Adult Cardiac Surgery, Department of Cardiovascular Surgery, Texas Heart Institute, Houston, Texas; CHI St Luke's Health-Baylor St Luke's Medical Center, Houston, Texas
| | - Joseph S Coselli
- Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas; Section of Adult Cardiac Surgery, Department of Cardiovascular Surgery, Texas Heart Institute, Houston, Texas; CHI St Luke's Health-Baylor St Luke's Medical Center, Houston, Texas; Cardiovascular Research Institute, Baylor College of Medicine, Houston, Texas.
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Velayudhan BV, Idhrees AM. Alternatives to the frozen elephant trunk in acute type A aortic dissection. Asian Cardiovasc Thorac Ann 2020; 29:623-626. [PMID: 32436716 DOI: 10.1177/0218492320928744] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Acute type A aortic dissection remains one of the most challenging condition in cardiothoracic surgery, with a high mortality rate. Various improvements and innovations have happened over the years to better the outcome of this lethal condition. The frozen elephant trunk prosthesis has been developed to negate the long-term complications of acute type A aortic dissection, but at the cost of increased morbidity compared to hemiarch replacement. Although hemiarch and total arch replacement seem have less morbidity than the frozen elephant trunk technique, they do not address the long-term complications of the distal dissected aorta. Few surgeons now suggest hybrid aortic arch repair as a solution for acute type A aortic dissection. The long-term results need to be studied in all procedures before standardizing them. Although multiple strategies are evolving, the short-term goal of acute type A aortic dissection has not changed: to save the patient's life. The surgical strategy has to be tailored according to the patient's condition and the surgeon's experience.
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Affiliation(s)
- Bashi V Velayudhan
- Institute of Cardiac and Aortic Disorders, SRM Institutes for Medical Science (SIMS Hospital), Chennai, India
| | - A Mohammed Idhrees
- Institute of Cardiac and Aortic Disorders, SRM Institutes for Medical Science (SIMS Hospital), Chennai, India
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A New Aortic Arch Inclusion Technique With Frozen Elephant Trunk for Type A Aortic Dissection. Ann Surg 2020; 271:978-983. [DOI: 10.1097/sla.0000000000003122] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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40
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Midterm outcomes and durability of sinus segment preservation compared with root replacement for acute type A aortic dissection. J Thorac Cardiovasc Surg 2020; 163:900-910.e2. [DOI: 10.1016/j.jtcvs.2020.04.064] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2019] [Revised: 03/12/2020] [Accepted: 04/10/2020] [Indexed: 11/21/2022]
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Yoshitake A, Tochii M, Tokunaga C, Hayashi J, Takazawa A, Yamashita K, Chubachi F, Hori Y, Nakajima H, Iguchi A, Gatate Y, Nakano S, Asakura T. Early and long-term results of total arch replacement with the frozen elephant trunk technique for acute type A aortic dissection. Eur J Cardiothorac Surg 2020; 58:707-713. [DOI: 10.1093/ejcts/ezaa099] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Revised: 02/20/2020] [Accepted: 02/24/2020] [Indexed: 11/15/2022] Open
Abstract
Abstract
OBJECTIVES
We evaluated the operative and long-term outcomes of the frozen elephant trunk (FET) technique for acute type A aortic dissection.
METHODS
This study evaluated 426 consecutive patients who underwent aortic repair for acute type A aortic dissection from June 2007 to December 2018 at our centre. Of these, 139 patients underwent total arch replacement with FET (FET group), and 287 underwent other procedures (no FET group). Ninety-two patients in the FET group were matched to 92 patients in the no FET group by using propensity score matching analysis.
RESULTS
Thirty-day mortality and neurological dysfunction were not significantly different between the FET and no FET groups (1.4% vs 2.4%, P = 0.50 and 5.0% vs 6.3%, P = 0.61, respectively). Long-term survival was better in the FET group than in the no FET group (P = 0.008). Freedom from distal thoracic reintervention was similar in the FET and no FET groups (P = 0.74). In the propensity-matched patients, freedom from aortic-related death was better in the FET group than in the no FET group (P = 0.044).
CONCLUSIONS
Operative outcomes showed no significant difference between the 2 groups. FET contributes to better long-term survival in patients with acute type A aortic dissection.
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Affiliation(s)
- Akihiro Yoshitake
- Department of Cardiovascular Surgery, Saitama Medical University International Medical Center, Saitama, Japan
| | - Masato Tochii
- Department of Cardiovascular Surgery, Saitama Medical University International Medical Center, Saitama, Japan
| | - Chiho Tokunaga
- Department of Cardiovascular Surgery, Saitama Medical University International Medical Center, Saitama, Japan
| | - Jun Hayashi
- Department of Cardiovascular Surgery, Saitama Medical University International Medical Center, Saitama, Japan
| | - Akitoshi Takazawa
- Department of Cardiovascular Surgery, Saitama Medical University International Medical Center, Saitama, Japan
| | - Kentaro Yamashita
- Department of Cardiovascular Surgery, Saitama Medical University International Medical Center, Saitama, Japan
| | - Fumiya Chubachi
- Department of Cardiovascular Surgery, Saitama Medical University International Medical Center, Saitama, Japan
| | - Yuuto Hori
- Department of Cardiovascular Surgery, Saitama Medical University International Medical Center, Saitama, Japan
| | - Hiroyuki Nakajima
- Department of Cardiovascular Surgery, Saitama Medical University International Medical Center, Saitama, Japan
| | - Atsushi Iguchi
- Department of Cardiovascular Surgery, Saitama Medical University International Medical Center, Saitama, Japan
| | - Yodo Gatate
- Department of Cardiology, Saitama Medical University International Medical Center, Saitama, Japan
| | - Shintaro Nakano
- Department of Cardiology, Saitama Medical University International Medical Center, Saitama, Japan
| | - Toshihisa Asakura
- Department of Cardiovascular Surgery, Saitama Medical University International Medical Center, Saitama, Japan
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Kim DJ, Lee S, Lee SH, Youn YN, Chang BC, Yoo KJ, Joo HC. The fate of residual aortic regurgitation after ascending aorta replacement in type A aortic dissection. J Thorac Cardiovasc Surg 2020; 160:1421-1430.e5. [PMID: 32217020 DOI: 10.1016/j.jtcvs.2019.12.118] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Revised: 12/18/2019] [Accepted: 12/20/2019] [Indexed: 12/19/2022]
Abstract
OBJECTIVE This study aimed to evaluate the changes in postoperative aortic regurgitation (AR) and determine the predictors of significant AR and root reoperation after ascending aortic replacement (AAR) in patients with acute type A aortic dissection. METHODS From January 1995 to December 2017, 271 consecutive patients underwent valve/root-preserving AAR (n = 225) and root replacement (n = 46). AR grade trend over time was analyzed by the ordinal mixed-effects model. Significant AR was defined as AR grade ≥3+ during the follow-up period. Predischarge and follow-up echocardiograms were obtained in 95.6% and 88.8% of enrolled patients, respectively. RESULTS At predischarge, postoperative ≥2+ AR was present in 20 (9.3%) and 1 (2.3%) patients in the AAR and root replacement groups, respectively. With increasing time after surgery, the grade of AR increased. At 10 years, 4.6% of patients had developed 3+ or 4+ AR. Considering death as the competing risk, the 10-year cumulative incidence of significant AR was significantly higher in the AAR than in the root replacement group (12.3% vs 2.2%; P = .047). The risk of root reoperation at 10 years was not different between the groups (P = .118). On Cox analysis, preoperative ≥3+ AR (P = .002), postoperative ≥2+ AR (P = .040), and false to true lumen ratio (P = .005) were associated predictors of significant AR. CONCLUSIONS Although valve/root-preserving AAR demonstrated reasonable long-term outcomes when compared with root replacement, preoperative ≥3+ AR, postoperative ≥2+ AR, and high false to true lumen ratio significantly increased the risk of significant AR. Therefore, careful echocardiographic surveillance may be warranted in patients with postoperative ≥2+ AR and small true lumen.
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Affiliation(s)
- Do Jung Kim
- Department of Thoracic and Cardiovascular Surgery, Ajou University School of Medicine, Suwon, South Korea
| | - Sak Lee
- Division of Cardiovascular Surgery, Department of Thoracic and Cardiovascular Surgery, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Seung Hyun Lee
- Division of Cardiovascular Surgery, Department of Thoracic and Cardiovascular Surgery, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Young-Nam Youn
- Division of Cardiovascular Surgery, Department of Thoracic and Cardiovascular Surgery, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Byung-Chul Chang
- Department of Thoracic and Cardiovascular Surgery, Cha Bundang Medical Center, Cha University, Seongnam, South Korea
| | - Kyung-Jong Yoo
- Division of Cardiovascular Surgery, Department of Thoracic and Cardiovascular Surgery, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Hyun-Chel Joo
- Division of Cardiovascular Surgery, Department of Thoracic and Cardiovascular Surgery, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, South Korea.
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Idhrees M. Acute aortic dissection: playing Dhoni 'the finisher' vs Dhoni 'the anchor'. Indian J Thorac Cardiovasc Surg 2020; 36:256-258. [PMID: 33061137 DOI: 10.1007/s12055-020-00933-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Revised: 01/27/2020] [Accepted: 01/29/2020] [Indexed: 11/26/2022] Open
Abstract
Even in the present era, acute type A aortic dissection (ATAAD) remains one of the most challenging condition in cardiothoracic surgery with a high mortality rate. There have been various surgical techniques and innovations over the years to reduce the mortality and morbidity of these patients. Though there is consensus that the ascending aorta has to be replaced, the controversy still exists on the distal extend of replacing the aorta. Few surgeons opt for a less extensive approach, while others back the extensive frozen elephant trunk. The former defend that extensive surgery has increased morbidity and mortality, while the later argue that multiple entry points are taken care of helping in false lumen thrombosis. But eventually, the short-term goal remains the same - save the patient's life by addressing the tear in the ascending aorta.
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Affiliation(s)
- Mohammed Idhrees
- Institute of Cardiac and Aortic Disorders (ICAD), SRM Institutes for Medical Science (SIMS Hospital), Vadapalani, Chennai, India
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44
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Ma M, Shi J, Feng X, Wang J, Liu L, Wei X. The elevated admission white blood cell count relates to adverse surgical outcome of acute Stanford type a aortic dissection. J Cardiothorac Surg 2020; 15:48. [PMID: 32171309 PMCID: PMC7071739 DOI: 10.1186/s13019-020-1078-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 02/17/2020] [Indexed: 11/13/2022] Open
Abstract
Background The purpose of the study was to examine the association between white blood cell count (WBCc) on admission and early outcome in patients with the acute Stanford type A aortic dissection (TAAD). Methods From January 2012 to December 2018, we retrospectively evaluated a series of 331 consecutive patients underwent surgery for TAAD in Tongji Hospital. The patients were divided into 2 groups based on the WBCc, i.e. the normal WBCc group (WBCc≤11 × 109/L) and leukocytosis group (WBCc> 11 × 109/L). The perioperative data were compared between the 2 groups. The in-hospital mortality and the compositive adverse event including multi-organ dysfunction syndrome, postoperative stroke, tracheotomy, and re-exploration for stopping bleeding were set as end points. Cox regression were used to assess the potential risk factors. Results The in-hospital mortality was nearly 3 time higher in the leukocytosis group than in the normal WBCc group (20.9% vs.8.1%, P = 0.001), and 15.1% overall. For the circulatory arrest, there was significant higher mortality in patients with leukocytosis than normal WBCc group (26.1%vs.8.9%, P = 0.001). After adjustment for confounding factors, the leukocytosis was found to be a strong independent predictor of in-hospital mortality (odds ratio = 3.10; 95% confidence interval 1.38 to 6.97, P = 0.006). The leukocytosis was also a risk factor of adverse events (odds ratio = 1.80; 95% confidence interval 1.07 to 3.04, P = 0.027). Conclusions The WBCc within 24 h of admission for TAAD is a strong and independent predictor of in-hospital mortality as well as short-term clinical events. The results of this study have important clinical implications for risk-stratifying patients with TAAD.
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Affiliation(s)
- Mingjia Ma
- Division of Cardiothoracic and Vascular Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095# Jiefang Ave. Wuhan, Wuhan,, 430030, China
| | - Juan Shi
- Division of Cardiothoracic and Vascular Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095# Jiefang Ave. Wuhan, Wuhan,, 430030, China
| | - Xin Feng
- Division of Cardiothoracic and Vascular Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095# Jiefang Ave. Wuhan, Wuhan,, 430030, China
| | - Jing Wang
- Division of Cardiothoracic and Vascular Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095# Jiefang Ave. Wuhan, Wuhan,, 430030, China
| | - Ligang Liu
- Division of Cardiothoracic and Vascular Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095# Jiefang Ave. Wuhan, Wuhan,, 430030, China
| | - Xiang Wei
- Division of Cardiothoracic and Vascular Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095# Jiefang Ave. Wuhan, Wuhan,, 430030, China.
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Concomitant true and false lumen "parallel thoracic endovascular aortic repair" as an endovascular alternative to open arch/descending aortic reconstruction for chronic DeBakey type I dissection with aneurysmal degeneration. JOURNAL OF VASCULAR SURGERY CASES INNOVATIONS AND TECHNIQUES 2019; 5:557-560. [PMID: 31867472 PMCID: PMC6906654 DOI: 10.1016/j.jvscit.2019.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Accepted: 08/15/2019] [Indexed: 11/22/2022]
Abstract
A 77-year-old woman presented with symptomatic thoracic aortic aneurysm within a dissected thoracoabdominal aorta distal to a previous Dacron ascending aortic replacement. She was not a candidate for open repair and had no proximal landing zone for conventional thoracic endovascular aortic repair (TEVAR) resulting from dissection extension into the brachiocephalic vessels. A concomitant parallel graft true and false lumen TEVAR was performed from the distal aortic arch to diaphragm. Follow-up imaging demonstrated successful exclusion of the false lumen aneurysm and successful protection of the true lumen with the adjacent parallel TEVAR device.
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The fate of aortic root and aortic regurgitation after supracoronary ascending aortic replacement for acute type A aortic dissection. J Thorac Cardiovasc Surg 2019; 161:483-493.e1. [PMID: 31839222 DOI: 10.1016/j.jtcvs.2019.09.183] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 09/05/2019] [Accepted: 09/18/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND The aim of this study was to evaluate the fate of the preserved aortic root after supracoronary aortic replacement for acute type A aortic dissection. METHODS Between October 1999 and March 2018, 339 patients underwent supracoronary aortic replacement for acute type A aortic dissection at our institution. Late outcomes were evaluated, including overall survival, aortic-related death, and aortic root-related reoperation. The median follow-up was 3.7 years (1.4-8.4 years). RESULTS Operative mortality was 46 patients (13.6%). The cumulative incidences at 5 years for aortic root-related reoperation, aortic-related death, and non-aortic related death were 2.5%, 14.5% and 12.4%, respectively. Multivariable Cox hazard regression analysis demonstrated greater sinus of Valsalva diameter and number of commissural detachments to be significant risk factors for a composite outcome consisting of aortic-related death or aortic root-related reoperation. Mixed-effects regression demonstrated that sinus of Valsalva diameter significantly increased with time (P < .001), and aortic regurgitation significantly worsened (P < .001). CONCLUSIONS Sinus of Valsalva diameter and commissural detachment were independent predictors of unfavorable outcomes after supracoronary aortic replacement. Close follow-up is particularly necessary for these patients, and aortic root replacement at the time of initial operation may lead to more favorable late outcomes.
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Zhu C, Piao H, Wang Y, Wang T, Li D, Xu R, Zhu Z, Li B, Zhang Y, Liu K. A New Aortic Root Reinforcement Technique for Acute Type A Aortic Dissection Surgery. Int Heart J 2019; 60:1131-1136. [DOI: 10.1536/ihj.18-609] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Cuilin Zhu
- Department of Cardiovascular Surgery, The Second Hospital of Jilin University
| | - Hulin Piao
- Department of Cardiovascular Surgery, The Second Hospital of Jilin University
| | - Yong Wang
- Department of Cardiovascular Surgery, The Second Hospital of Jilin University
| | - Tiance Wang
- Department of Cardiovascular Surgery, The Second Hospital of Jilin University
| | - Dan Li
- Department of Cardiovascular Surgery, The Second Hospital of Jilin University
| | - Rihao Xu
- Department of Cardiovascular Surgery, The Second Hospital of Jilin University
| | - Zhicheng Zhu
- Department of Cardiovascular Surgery, The Second Hospital of Jilin University
| | - Bo Li
- Department of Cardiovascular Surgery, The Second Hospital of Jilin University
| | - Yixin Zhang
- Department of Cardiovascular Surgery, The Second Hospital of Jilin University
| | - Kexiang Liu
- Department of Cardiovascular Surgery, The Second Hospital of Jilin University
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Gudbjartsson T, Ahlsson A, Geirsson A, Gunn J, Hjortdal V, Jeppsson A, Mennander A, Zindovic I, Olsson C. Acute type A aortic dissection - a review. SCAND CARDIOVASC J 2019; 54:1-13. [PMID: 31542960 DOI: 10.1080/14017431.2019.1660401] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Acute type A aortic dissection (ATAAD) is still one of the most challenging diseases that cardiac surgeons encounter. This review is based on the current literature and includes the results from the Nordic Consortium for Acute Type-A Aortic Dissection (NORCAAD) database. It covers different aspects of ATAAD and concentrates on the outcome of surgical repair. The diagnosis is occasionally delayed, and ATAAD is usually lethal if prompt repair is not performed. The dynamic nature of the disease, the variation in presentation and clinical course, and the urgency of treatment require significant attentiveness. Many surgical techniques and perfusion strategies of varying complexity have been described, ranging from simple interposition graft to total arch replacement with frozen elephant trunk and valve-sparing root reconstruction. Although more complex techniques may provide long-term benefit in selected patients, they require significant surgical expertise and experience. Short-term survival is first priority so an expedited operation that fits in with the surgeon's level of expertise is in most cases appropriate.
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Affiliation(s)
- Tomas Gudbjartsson
- Department of Cardiothoracic Surgery, Landspitali University Hospital, Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Anders Ahlsson
- Department of Cardiothoracic Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Arnar Geirsson
- Division of Cardiac Surgery, Yale School of Medicine, New Haven, CT, USA
| | - Jarmo Gunn
- Department of Cardiothoracic Surgery, Turku University Hospital, University of Turku, Turku, Finland
| | - Vibeke Hjortdal
- Department of Cardiothoracic Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Anders Jeppsson
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, Gothenburg University, Sweden and Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Ari Mennander
- Tampere University Heart Hospital and Tampere University, Tampere, Finland
| | - Igor Zindovic
- Lund University, Skåne University Hospital, Department of Clinical Sciences, Department of Cardiothoracic Surgery, Lund, Sweden
| | - Christian Olsson
- Department of Cardiothoracic Surgery, Karolinska University Hospital, Stockholm, Sweden
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Iida Y, Fujii S, Shimizu H, Sawa S. Patterns of aortic remodelling after total arch replacement with frozen elephant trunk for acute aortic dissection. Interact Cardiovasc Thorac Surg 2019; 29:923-929. [DOI: 10.1093/icvts/ivz185] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 06/22/2019] [Accepted: 07/02/2019] [Indexed: 11/12/2022] Open
Abstract
Abstract
OBJECTIVES
We investigated the outcomes of total arch replacement with frozen elephant trunk (FET) for Stanford type A acute aortic dissection and the patterns of postoperative aortic remodelling from computed tomographic (CT) findings.
METHODS
From April 2015 to November 2018, we performed total arch replacement with FET for Stanford type A aortic dissection in 30 patients. Postoperative contrast-enhanced CT showed the position of the FET distal end, the number and the site of communications between the lumina and the presence or absence of aortic remodelling.
RESULTS
Primary entry tear was found in the ascending aorta (n = 6), proximal arch (n = 6), aortic arch (n = 11) and distal arch (n = 7). The mean diameter and length of FET were 26 ± 2 and 84 ± 18 mm, respectively. Postoperative contrast-enhanced CT was performed in 26 patients. When the number of communications between the lumina was 0, complete aortic remodelling was achieved in all cases (n = 12). In the case of the most proximal tear in the descending aorta (n = 9), aortic remodelling was not recognized in 3 cases, and additional TEVAR was performed because of diameter enlargement. In the remaining 6 patients, neither aortic remodelling nor aortic diameter enlargement was recognized. When the most proximal tear was below the diaphragm (n = 5), aortic remodelling occurred up to the most proximal tear, but not in the periphery.
CONCLUSIONS
We investigated the patterns of aortic remodelling after total arch replacement with FET for Stanford type A aortic dissection from postoperative CT findings. Regardless of the position of the most proximal tear in the descending aorta, aortic remodelling did not occur as long as the most proximal tear was located in the descending aorta. When the most proximal tear occurred in the descending aorta, TEVAR as a pre-emptive treatment can be effective in preventing postoperative aortic adverse events.
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Affiliation(s)
- Yasunori Iida
- Department of Cardiovascular Surgery, Ogikubo Hospital, Tokyo, Japan
- Department of Cardiovascular Surgery, Keio University, Tokyo, Japan
| | - Susumu Fujii
- Department of Cardiovascular Surgery, Ogikubo Hospital, Tokyo, Japan
| | - Hideyuki Shimizu
- Department of Cardiovascular Surgery, Keio University, Tokyo, Japan
| | - Shigeharu Sawa
- Department of Cardiovascular Surgery, Ogikubo Hospital, Tokyo, Japan
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Sun G, Sun L, Zhu J, Liu Y, Ge Y, Xu S. Efficacy of Total Aortic Arch Replacement Combined with Frozen Elephant Trunk in Aortic Reoperation. Med Sci Monit 2019; 25:3998-4004. [PMID: 31141498 PMCID: PMC6559180 DOI: 10.12659/msm.916938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Background The aim of this study was to estimate the long-term efficacy of total aortic arch replacement combined with the frozen elephant trunk (TAR+FET) technique for aortic disease following a prior cardiac surgery procedure. Material/Methods We performed TAR+FET for 118 patients for major vessel disease following a prior cardiac procedure with median sternotomy incision. All patients were divided into 5 groups: in group A, the prior major procedure was aortic valve replacement (AVR); in group B, the prior major procedure was isolated ascending aorta replacement; in group C, the prior major procedure was aortic root replacement; in group D, the prior major procedure was aortic arch replacement or intervention; and in group E, the prior major procedure was ‘other’ cardiac operative procedure. The long-term follow-up visit results were estimated using the Kaplan-Meier method. Results The 30-day mortality rate after the operation was 13.6% (16/118) – 2 died in group A, 1 in group B, 8 in group C, 4 in group D, and 1 in group E. Follow-up visits were completed in 99% of patients. The mean follow-up time was 47.6±36.3 months and 12 patients had died by follow-up, so the total long-term survival rate was 76.3%. One-year survival rates of the 5 groups were 85% (group A), 93.8% (group B), 82.3% (group C), 50% (group D), and 50% (group E), respectively. Five-year survival rates of the 5 groups were 85%, 93.8%, 80.6%, 50%, and 50%, respectively. Conclusions The TAR+FET technique is feasible and efficacious for aortic reoperation in patients who previously underwent cardiac surgery since the short-term mortality in patients with recurrent aortic arch disease after cardiac surgery is not high.
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Affiliation(s)
- Guanglong Sun
- Department of Cardiovascular Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China (mainland)
| | - Lizhong Sun
- Department of Cardiovascular Surgery, Beijing Aortic Disease Center, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung, and Blood Vessel Disease, Beijing, China (mainland)
| | - Junming Zhu
- Department of Cardiovascular Surgery, Beijing Aortic Disease Center, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung, and Blood Vessel Disease, Beijing, China (mainland)
| | - Yongmin Liu
- Department of Cardiovascular Surgery, Beijing Aortic Disease Center, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung, and Blood Vessel Disease, Beijing, China (mainland)
| | - Yipeng Ge
- Department of Cardiovascular Surgery, Beijing Aortic Disease Center, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung, and Blood Vessel Disease, Beijing, China (mainland)
| | - Shijun Xu
- Department of Cardiovascular Surgery, Beijing Aortic Disease Center, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung, and Blood Vessel Disease, Beijing, China (mainland)
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