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Kim JK, Kim GS, Kim WS, Kim HJ, Choo SJ, Kim JB. Differential impacts of clinical, anatomical, and procedural factors on early and late mortality following open thoracoabdominal aortic repair: a retrospective observational study. J Cardiothorac Surg 2024; 19:360. [PMID: 38915060 PMCID: PMC11194940 DOI: 10.1186/s13019-024-02933-2] [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] [Received: 01/17/2023] [Accepted: 06/15/2024] [Indexed: 06/26/2024] Open
Abstract
BACKGROUND The operative outcomes of thoracoabdominal aortic aneurysms (TAAAs) are challenged by high operative mortality and disabling complications. This study aimed to explore the baseline clinical, anatomical, and procedural risk factors that impact early and late outcomes following open repair of TAAAs. METHODS We reviewed the medical records of 290 patients who underwent open repair of TAAAs between 1992 and 2020 at a tertiary referral center. Determinants of early mortality (within 30 days or in hospital) were analyzed using multivariable logistic regression models, while those of overall follow-up mortality were explored using multivariable Cox proportional hazards models and landmark analyses. RESULTS The rates of early mortality and spinal cord deficits were 13.1% and 11.0%, respectively, with Crawford extent II showing the highest rates. In the logistic regression models, older age (P < 0.001), high cardiopulmonary bypass (CPB) time (P < 0.001), and low surgical volume of the surgeon (P < 0.001) emerged as independent factors significantly associated with early mortality. During follow-up (median, 5.0 years; interquartile range, 1.1-7.6 years), 82 late deaths occurred (5.7%/patient-year). Cox proportional hazards models demonstrated that older age (P < 0.001) and low hemoglobin level (P = 0.032) were significant risk factors of overall mortality, while the landmark analyses revealed that the significant impacts of low surgical volume (P = 0.017), high CPB time (P = 0.002), and Crawford extent II (P = 0.017) on mortality only remained in the early postoperative period, without significant late impacts (all P > 0.05). CONCLUSION There were differential temporal impacts of perioperative risk variables on mortality in open repair of TAAAs, with older age and low hemoglobin level having significant impacts throughout the postoperative period, and low surgical volume, high CPB time, and Crawford extent II having impacts in the early postoperative phase.
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Affiliation(s)
- Jin Kyoung Kim
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, 05505, Republic of Korea
| | - Gwan Sic Kim
- Department of Thoracic and Cardiovascular Surgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
| | - Woo Seok Kim
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, 05505, Republic of Korea
| | - Ho Jin Kim
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, 05505, Republic of Korea
| | - Suk Jung Choo
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, 05505, Republic of Korea
| | - Joon Bum Kim
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, 05505, Republic of Korea.
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Papakonstantinou NA, Martinez-Lopez D, Chung JCY. The frozen elephant trunk: seeking a more definitive treatment for acute type A aortic dissection. Eur J Cardiothorac Surg 2024; 65:ezae176. [PMID: 38676575 DOI: 10.1093/ejcts/ezae176] [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: 01/04/2024] [Revised: 04/10/2024] [Accepted: 04/24/2024] [Indexed: 04/29/2024] Open
Abstract
OBJECTIVES Conventional treatment for type A aortic dissection includes replacement of the ascending aorta with an open distal anastomosis in the hemiarch position. The frozen elephant trunk (FET) is a hybrid technique that extends the repair to the descending thoracic aorta. The goal is to improve resolution of malperfusion syndrome and to induce positive aortic remodelling and reduce the need for reintervention on the downstream aorta. We aim to summarize the data on the short and long-term outcomes of this technique. METHODS A thorough search of the literature was conducted isolating all articles dealing with aortic remodelling after the use of FET in case of type A acute aortic dissection. Keywords 'aortic dissection', 'frozen elephant trunk', 'aortic remodelling' and 'false lumen thrombosis' were used. Data for type B and chronic aortic dissections were excluded. RESULTS FET use favourably influences aortic remodelling. The main advantages lie in the exclusion of distal entry tears in either the aortic arch or descending aorta thus restoring antegrade blood flow in the true lumen and inducing false lumen thrombosis. False lumen thrombosis is not only induced at the level of the stent deployment but also lower in the distal descending aorta. Moreover, it offers an adequate landing zone in the mid-descending aorta for second-stage endovascular or open surgical aortic repair, if needed. CONCLUSIONS FET can be advantageous in the treatment of acute type A aortic dissection dealing with extended aortic pathology.
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Affiliation(s)
- Nikolaos A Papakonstantinou
- 2nd Cardiac Surgery Department, Onassis Cardiac Surgery Center, Athens, Greece
- Division of Cardiovascular Surgery, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network and University of Toronto, Toronto, ON, Canada
| | - Daniel Martinez-Lopez
- Division of Cardiovascular Surgery, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network and University of Toronto, Toronto, ON, Canada
- Cardiac Surgery Department, Hospital Universitario Puerta de Hierro, Madrid, Spain
| | - Jennifer Chia-Ying Chung
- Division of Cardiovascular Surgery, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network and University of Toronto, Toronto, ON, Canada
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Wang S, Wang C, Gao Y, Tian Y, Liu J, Wang Y. Risk factors of 30-day and long-term mortality and outcomes in open repair of thoracoabdominal aortic aneurysm. J Cardiothorac Surg 2024; 19:170. [PMID: 38566230 PMCID: PMC10986091 DOI: 10.1186/s13019-024-02666-2] [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] [Received: 09/07/2023] [Accepted: 03/20/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Open repair of thoracoabdominal aortic aneurysm (TAAA) was characterized by significant risk of postoperative mortality and morbidity. The aim of this study was to determine the perioperative predictors of early and long-term mortality in patients undergoing open repair of TAAA. Besides, the postoperative outcomes in patients with open repair of TAAA were described. METHODS This is a single-center retrospective study, and 146 patients with open repair of TAAA from January 4, 2011, to November 22, 2018 was involved. Categorical variables were analyzed by the Chi-square test or Fisher's exact test, and continuous variables were analyzed by the independent sample t-test and the WilCoxon rank-sum test. Multivariate Logistic regression and Cox regression were applied to identify the predictors of 30-day and long-term mortality, respectively. The Kaplan Meier curves were used to illustrate survival with the Log-rank test. RESULTS The 30-day mortality was 9.59% (n = 14). Older than 50 years, the intraoperative volume of red blood cell (RBC) and epinephrine use were independently associated with postoperative 30-day mortality in open repair of TAAA. Long-term mortality was 17.12% (n = 25) (median of 3.5 years (IQR = 2-5 years) of follow-up). Prior open thoracoabdominal aortic aneurysm (TAAA) repair, aortic cross-clamping (ACC) time, intraoperative volume of RBC and use of epinephrine were independently correlated with long-term mortality. CONCLUSIONS Identifying perioperative risk factors of early and long-term mortaliy is crucial for surgeons. Intraoperative volume of RBC and use of epinephrine were predictors of both early and long-term mortality. In addition, patients of advanced age, prior open repair of TAAA and prolonged ACC time should be paid more attention.
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Affiliation(s)
- Sudena Wang
- Department of Anesthesiology, Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Chunrong Wang
- Department of Anesthesiology, Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Yuchen Gao
- Department of Anesthesiology, Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Yu Tian
- Department of Anesthesiology, Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Jia Liu
- Department of Anesthesiology, Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Yuefu Wang
- Department of Surgery Intensive Care Unit, Beijing Shijitan Hospital, Capital Medical University, Beijing, China.
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Oh AR, Lim SK, Sung K, Lee SM, Lee JH. Outcomes of open repair for descending thoracic and thoracoabdominal aortic aneurysm in recent 10 years: experience of a high-volume centre in Korea. Eur J Cardiothorac Surg 2023; 64:ezad338. [PMID: 37847652 DOI: 10.1093/ejcts/ezad338] [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: 07/03/2023] [Revised: 09/13/2023] [Indexed: 10/19/2023] Open
Abstract
OBJECTIVES Although recent studies and guidelines suggest the preferred outcomes after surgical repair of thoracic aortic aneurysm (TAA) and thoracoabdominal aortic aneurysm (TAAA), published results are limited to those from high-volume hospitals and based on old data gathered before optimal management was established. Here, we analysed our outcomes over the previous 10 years from cases of open TAA and TAAA repair to offer updated and real-world results of those complex procedures performed in a high-volume centre. METHODS From November 2013 to April 2022, 212 consecutive adult patients who underwent open TAA and TAAA repair were enrolled. We analysed early and late outcomes after surgery, including postoperative complications and mortality. RESULTS There were 154 (73%) men, and the median age at surgery was 61 years. Intraoperative death occurred in 1 patient due to uncontrolled bleeding. Nine patients (4%) died during follow-up, and the survival estimates at 5 years were 94 ± 3% and 95 ± 3% after descending TAA and TAAA repair, respectively. Ten patients (4%) suffered from spinal cord ischaemic injury (9 with paraplegia and 1 with paresthesia), but permanent paraplegia persisted in only 1 case. CONCLUSIONS We report very low postoperative complication rates and excellent early and late survival rates after open TAA and TAAA repair from our recent 10-year data analysis. These findings may assist when choosing treatment options for these complicated diseases.
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Affiliation(s)
- Ah Ran Oh
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Suk Kyung Lim
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Kiick Sung
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Sangmin Maria Lee
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Jong-Hwan Lee
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
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Yuan L, Xu J, Qin F, Yi X, Zhong Z, Gu X, Gong G. USP18 overexpression protects against spinal cord ischemia/reperfusion injury via regulating autophagy. Neurosci Lett 2023; 810:137359. [PMID: 37356565 DOI: 10.1016/j.neulet.2023.137359] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 06/19/2023] [Accepted: 06/20/2023] [Indexed: 06/27/2023]
Abstract
BACKGROUND Spinal cord ischemia-reperfusion injury (SCII) is usually caused by spinal surgery, often leading to severe neurological deficits. The ubiquitin-specific protease 18 (USP18) plays a significant role in neurological diseases. OBJECTIVE The present study was designed to assess the effects and mechanisms of USP18 on SCII. METHODS By inducing transient aortic occlusion and subsequent reperfusion, a rat model of SCII was successfully established. The Basso-Beattie-Bresnahan scores, the inclined plane test, and hematoxylin and eosin (HE) were used to measure locomotor activity and histological changes in the injured spinal cords. Moreover, the SCII cell model was established using PC12 cells under oxygen-glucose deprivation and reoxygenation (OGD/R). Proinflammatory factors (TNF-α, IL-6, and INF-α) were examined using an ELISA kit. Cell apoptosis was assessed by Annexin V-FITC/PI double-staining and TUNEL assays. Western blot was used to detect the expression levels of proteins related to apoptosis and autophagy. RESULTS USP18 expression was decreasedin vivo and in vitro SCII models. The upregulation of USP18 ameliorated hind limbs' motor function, inhibiting inflammation and apoptosis after SCII in rats. USP18 overexpression in vitro may protect PC12 cells from OGD/R-induced damage by modulating inflammatory responses and apoptosis. Moreover, Overexpression of USP18 enhanced autophagy to inhibit cell apoptosis induced by SCII in vivo and in vitro. CONCLUSIONS In summary, USP18 overexpression protects against SCII via regulating autophagy.
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Affiliation(s)
- Libang Yuan
- Department of Anesthesia, People's Liberation Army The General Hospital of Western Theater Command, Chengdu, Sichuan 610083, China
| | - Jin Xu
- School of Electrical Engineering and Information, Southwest Petroleum University, Chengdu, Sichuan 610083, China
| | - Fuen Qin
- Department of Anesthesia, People's Liberation Army The General Hospital of Western Theater Command, Chengdu, Sichuan 610083, China
| | - Xiaobo Yi
- Department of Anesthesia, People's Liberation Army The General Hospital of Western Theater Command, Chengdu, Sichuan 610083, China
| | - Zuling Zhong
- Department of Anesthesia, People's Liberation Army The General Hospital of Western Theater Command, Chengdu, Sichuan 610083, China
| | - Xiaoping Gu
- Department of Anesthesia, People's Liberation Army The General Hospital of Western Theater Command, Chengdu, Sichuan 610083, China
| | - Gu Gong
- Department of Anesthesia, People's Liberation Army The General Hospital of Western Theater Command, Chengdu, Sichuan 610083, China.
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Abstract
PURPOSE OF REVIEW Structural genomic variants have emerged as a relevant cause for several disorders, including intellectual disability, neuropsychiatric disorders, cancer and congenital heart disease. In this review, we will discuss the current knowledge about the involvement of structural genomic variants and, in particular, copy number variants in the development of thoracic aortic and aortic valve disease. RECENT FINDINGS There is a growing interest in the identification of structural variants in aortopathy. Copy number variants identified in thoracic aortic aneurysms and dissections, bicuspid aortic valve related aortopathy, Williams-Beuren syndrome and Turner syndrome are discussed in detail. Most recently, the first inversion disrupting FBN1 has been reported as a cause for Marfan syndrome. SUMMARY During the past 15 years, the knowledge on the role of copy number variants as a cause for aortopathy has grown significantly, which is partially due to the development of novel technologies including next-generation sequencing. Although copy number variants are now often investigated on a routine basis in diagnostic laboratories, more complex structural variants such as inversions, which require the use of whole genome sequencing, are still relatively new to the field of thoracic aortic and aortic valve disease.
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Affiliation(s)
- Josephina A.N. Meester
- Center of Medical Genetics, University of Antwerp and Antwerp University Hospital, Antwerp, Belgium
| | - Anne Hebert
- Center of Medical Genetics, University of Antwerp and Antwerp University Hospital, Antwerp, Belgium
| | - Bart L. Loeys
- Center of Medical Genetics, University of Antwerp and Antwerp University Hospital, Antwerp, Belgium
- Department of Clinical Genetics, Radboud University Medical Center, Nijmegen, The Netherlands
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Sultan S, Acharya Y, Chua Vi Long K, Hatem M, Hezima M, Veerasingham D, Soliman O, Hynes N. Management of acute aortic syndrome with evolving individualized precision medicine solutions: Lessons learned over two decades and literature review. Front Surg 2023; 10:1157457. [PMID: 37065997 PMCID: PMC10097442 DOI: 10.3389/fsurg.2023.1157457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 03/15/2023] [Indexed: 03/30/2023] Open
Abstract
BackgroundThoracoabdominal acute aortic syndrome is associated with high morbidity and mortality. We aim to scrutinize our evolving strategies for acute aortic syndrome (AAS) management using minimally invasive and adaptive surgical techniques over two decades.MethodsThis is a longitudinal observational study at our tertiary vascular centre from 2002 to 2021. Out of 22,349 aortic referrals, we performed 1,555 aortic interventions over twenty years. Amongst 96 presented with symptomatic aortic thoracic pathology, 71 patients had AAS. Our primary endpoint is combined aneurysm-related and cardiovascular-related mortality.ResultsThere were 43 males and 28 females (5 Traumatic Aortic Transection (TAT), 8 Acute Aortic Intramural Hematoma (IMH), 27 Symptomatic Aortic Dissection (SAD) and 31 Thoracic Aortic Aneurysm (TAA) post-SAD) with a mean age of 69. All the patients with AAS received optimal medical therapy (OMT), but TAT patients underwent emergency thoracic endovascular aortic repair (TEVAR). Fifty-eight patients had an aortic dissection, of which 31 developed TAA. These 31 patients with SAD and TAA received OMT initially and interval surgical intervention with TEVAR or sTaged hybrId sinGle lumEn Reconstruction (TIGER). To increase our landing area, we performed a left subclavian chimney graft with TEVAR in twelve patients. The average follow-up duration was 78.2 months, and eleven patients (15.5%) had combined aneurysm and cardiovascular-related mortality. Twenty-six percentage of the patients developed endoleaks (EL), of which 15% required re-intervention for type II and III. Four patients who had paraplegia (5.7%) and developed renal failure died. None of our patients had a stroke or bowel ischaemia. Twenty patients had OMT, eight of these were patients with acute aortic hematoma, and all eight died within 30 days of presentation.ConclusionAcute aortic hematoma is a sinister finding, which must be closely monitored, and consideration is given to early intervention. Paraplegia and renal failure result in an increased mortality rate. TIGER technique with interval TEVAR has salvaged complex situations in young patients. Left subclavian chimney increases our landing area and abolishes SINE. Our experience shows that minimally invasive techniques could be a viable option for AAS.
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Affiliation(s)
- Sherif Sultan
- Western Vascular Institute, Department of Vascular and Endovascular Surgery, University Hospital Galway, University of Galway, Galway, Ireland
- Department of Vascular Surgery and Endovascular Surgery, Galway Clinic, Royal College of Surgeons in Ireland and University of Galway, Galway Affiliated Hospital, Doughiska, Ireland
- CORRIB-CURAM-Vascular Group, University of Galway, Galway, Ireland
- Correspondence: Sherif Sultan
| | - Yogesh Acharya
- Western Vascular Institute, Department of Vascular and Endovascular Surgery, University Hospital Galway, University of Galway, Galway, Ireland
- Department of Vascular Surgery and Endovascular Surgery, Galway Clinic, Royal College of Surgeons in Ireland and University of Galway, Galway Affiliated Hospital, Doughiska, Ireland
| | - Keegan Chua Vi Long
- Western Vascular Institute, Department of Vascular and Endovascular Surgery, University Hospital Galway, University of Galway, Galway, Ireland
| | - Mohamed Hatem
- Western Vascular Institute, Department of Vascular and Endovascular Surgery, University Hospital Galway, University of Galway, Galway, Ireland
| | - Mohieldin Hezima
- Western Vascular Institute, Department of Vascular and Endovascular Surgery, University Hospital Galway, University of Galway, Galway, Ireland
| | - David Veerasingham
- Department of Cardiothoracic Surgery, University Hospital Galway, University of Galway, Galway, Ireland
| | - Osama Soliman
- CORRIB-CURAM-Vascular Group, University of Galway, Galway, Ireland
| | - Niamh Hynes
- Department of Vascular Surgery and Endovascular Surgery, Galway Clinic, Royal College of Surgeons in Ireland and University of Galway, Galway Affiliated Hospital, Doughiska, Ireland
- CORRIB-CURAM-Vascular Group, University of Galway, Galway, Ireland
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Kahlberg A, Tshomba Y, Baccellieri D, Bertoglio L, Rinaldi E, Ardita V, Colombo E, Moscato U, Melissano G, Chiesa R. Renal perfusion with histidine-tryptophan-ketoglutarate compared with Ringer's solution in patients undergoing thoracoabdominal aortic open repair. J Thorac Cardiovasc Surg 2023; 165:569-579.e5. [PMID: 33820636 DOI: 10.1016/j.jtcvs.2021.02.090] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 02/22/2021] [Accepted: 02/22/2021] [Indexed: 01/18/2023]
Abstract
OBJECTIVE The objective of this study was to compare the efficacy of renal perfusion with Custodiol (Dr Franz-Kohler Chemie GmbH, Bensheim, Germany) versus enriched Ringer's solution for renal protection in patients undergoing open thoracoabdominal aortic aneurysm (TAAA) repair. METHODS Ninety consecutive patients scheduled for elective open TAAA repair were enrolled between 2015 and 2017 in a single-center, phase IV, prospective, parallel, randomized, double-blind trial (the CUstodiol versus RInger: whaT Is the Best Agent [CURITIBA] trial), and randomized to renal arteries perfusion with 4°C Custodiol (Dr Franz-Kohler Chemie GmbH, Bensheim, Germany; n = 45) or 4°C lactated Ringer's solution (n = 45). The incidence of acute kidney injury (AKI) in patients undergoing TAAA open surgery using Custodiol renal perfusion versus an enriched Ringer's solution was the primary end point. RESULTS Ninety patients completed the study (45 patients in each group). The incidence of postoperative AKI was significantly lower in the Custodiol group (48.9% vs 75.6%; P = .02). In the multivariable model, only the use of Custodiol solution resulted as protective from the occurrence of any AKI (odds ratio, 0.230; 95% confidence interval, 0.086-0.614; P = .003), whereas TAAA type II extent was associated with the development of severe AKI (odds ratio, 4.277; 95% confidence interval, 1.239-14.762; P = .02). At 1-year follow-up, serum creatinine was not significantly different from the preoperative values in both groups. CONCLUSIONS The use of Custodiol during open TAAA repair was safe and resulted in significantly lower rates of postoperative AKI compared with Ringer's solution. These findings support safety and efficacy of Custodiol in this specific setting, which is currently off-label.
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Affiliation(s)
- Andrea Kahlberg
- Department of Vascular Surgery, Vita-Salute University School of Medicine, San Raffaele Scientific Institute, Milano, Italy.
| | - Yamume Tshomba
- Vascular Surgery Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Domenico Baccellieri
- Department of Vascular Surgery, Vita-Salute University School of Medicine, San Raffaele Scientific Institute, Milano, Italy
| | - Luca Bertoglio
- Department of Vascular Surgery, Vita-Salute University School of Medicine, San Raffaele Scientific Institute, Milano, Italy
| | - Enrico Rinaldi
- Department of Vascular Surgery, Vita-Salute University School of Medicine, San Raffaele Scientific Institute, Milano, Italy
| | - Vincenzo Ardita
- Department of Vascular Surgery, Vita-Salute University School of Medicine, San Raffaele Scientific Institute, Milano, Italy
| | - Elisa Colombo
- Department of Vascular Surgery, Vita-Salute University School of Medicine, San Raffaele Scientific Institute, Milano, Italy
| | - Umberto Moscato
- Department of Women's Health, Child and Public Health Sciences, Hospital Hygiene - and Occupational Health - Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Germano Melissano
- Department of Vascular Surgery, Vita-Salute University School of Medicine, San Raffaele Scientific Institute, Milano, Italy
| | - Roberto Chiesa
- Department of Vascular Surgery, Vita-Salute University School of Medicine, San Raffaele Scientific Institute, Milano, Italy
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Liakopoulos OJ. Commentary: Renal perfusion strategy during thoracoabdominal aortic repair-is Custodiol the answer? J Thorac Cardiovasc Surg 2023; 165:582-583. [PMID: 33992461 DOI: 10.1016/j.jtcvs.2021.04.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Revised: 04/10/2021] [Accepted: 04/12/2021] [Indexed: 01/18/2023]
Affiliation(s)
- Oliver J Liakopoulos
- Department of Cardiac Surgery, Kerckhoff-Clinic Bad Nauheim, Campus Kerckhoff, University of Giessen, Bad Nauheim, Germany.
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10
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A systematic review and meta-analysis on sex disparities in the outcomes of fenestrated branched endovascular aortic aneurysm repair. J Vasc Surg 2022; 77:1822-1832.e3. [DOI: 10.1016/j.jvs.2022.10.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 10/14/2022] [Accepted: 10/17/2022] [Indexed: 11/07/2022]
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Wipper S, Sandhu HK, Kölbel T, Estrera AL, Trepte C, Behem C, Miller CC, Debus ES. In vivo evaluation of a new hybrid graft using retrograde visceral perfusion for thoracoabdominal aortic repair in an animal model. JTCVS Tech 2022; 15:1-8. [PMID: 36276707 PMCID: PMC9579856 DOI: 10.1016/j.xjtc.2022.07.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 07/22/2022] [Indexed: 11/15/2022] Open
Affiliation(s)
- Sabine Wipper
- Department of Vascular Surgery, Medical University Innsbruck, Austria
- Address for reprints: Sabine Wipper, MD, Department for Vascular Surgery, Medical University Innsbruck, Anischstraße 35, 6020 Innsbruck, Austria.
| | - Harleen K. Sandhu
- Department of Cardiothoracic and Vascular Surgery, McGovern Medical School at UTHealth, Houston, Tex
| | - Tilo Kölbel
- Department of Vascular Medicine, University Heart Center Hamburg-Eppendorf, Germany
| | - Anthony L. Estrera
- Department of Cardiothoracic and Vascular Surgery, McGovern Medical School at UTHealth, Houston, Tex
| | - Constantin Trepte
- Department of Anaesthesiology, University Hospital Hamburg Eppendorf, Germany
| | - Christoph Behem
- Department of Anaesthesiology, University Hospital Hamburg Eppendorf, Germany
| | - Charles C. Miller
- Department of Cardiothoracic and Vascular Surgery, McGovern Medical School at UTHealth, Houston, Tex
| | - E. Sebastian Debus
- Department of Vascular Medicine, University Heart Center Hamburg-Eppendorf, Germany
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Visceral and renal protection in thoracoabdominal aortic surgery. Indian J Thorac Cardiovasc Surg 2022; 38:157-162. [PMID: 35463708 PMCID: PMC8980969 DOI: 10.1007/s12055-020-01129-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 12/22/2020] [Accepted: 12/23/2020] [Indexed: 10/22/2022] Open
Abstract
Ischemic renal failure and visceral ischemia are two serious complications of the surgery for thoracoabdominal aortic aneurysm. The introduction of left atrial bypass, partial bypass, total circulatory arrest, and selective visceral perfusion has reduced the incidence of these complications over the past two decades. Yet these complications still persist, suggesting the sub-optimal nature of the available strategies.
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Affiliation(s)
- Andres Schanzer
- From the Division of Vascular and Endovascular Surgery, University of Massachusetts Medical School, Worcester (A.S.); and the Division of Vascular and Endovascular Surgery, University of Texas Health Science Center, Houston (G.S.O.)
| | - Gustavo S Oderich
- From the Division of Vascular and Endovascular Surgery, University of Massachusetts Medical School, Worcester (A.S.); and the Division of Vascular and Endovascular Surgery, University of Texas Health Science Center, Houston (G.S.O.)
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Jiang X, Chen B, Jiang J, Shi Y, Ma T, Fu W, Dong Z. Outcomes of endovascular therapy for Stanford type B aortic dissection in patients with Marfan syndrome. J Thorac Cardiovasc Surg 2021; 165:1999-2007.e1. [PMID: 34176615 DOI: 10.1016/j.jtcvs.2021.05.045] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 05/13/2021] [Accepted: 05/18/2021] [Indexed: 01/16/2023]
Abstract
OBJECTIVE To evaluate the mid-term outcomes of thoracic endovascular aorta repair (TEVAR) for Stanford type B aortic dissection (TBAD) in patients with Marfan syndrome (MFS). METHODS Between January 2009 and December 2019, patients with MFS who underwent TEVAR for TBAD were enrolled. Demographic data, preoperative and perioperative clinical profiles, and follow-up data were collected and analyzed. The cumulative survival and freedom from reintervention rates were calculated with Kaplan-Meier analysis. RESULTS A total of 26 patients were enrolled. The mean age was 38.5 ± 10.7 (range, 24-64 years). The in-hospital mortality was 0. The cumulative survival rate was 88.1% (95% confidence interval [CI], 67.5%-98.5%) at 5 years and 82.9% (95% CI, 60.2%-93.3%) at 10 years. Patients with a thrombosed false lumen (FL) along the length of the stent had a significantly higher cumulative survival rate (P < .05) and freedom from reintervention (P = .01) than patients with patent FL. The freedom from reintervention was 83.4% (95% CI, 61.4% to 93.4%) at 5 years and 50.3% (95% CI, 21.4%-97.3%) at 10 years. There was no significant difference freedom from reintervention in freedom from reintervention between patients with and those without a previous aortic root procedure (P = .46). CONCLUSIONS TEVAR can be performed safely and effectively for TBAD in patients with MFS. Perioperative mortality and morbidity were low; however, lifelong close follow-up in the clinic and imaging are mandatory to prevent aortic rupture. Patients with a patent FL were at high risk of late death.
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Affiliation(s)
- Xiaolang Jiang
- Department of Vascular Surgery, Institute of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Bin Chen
- Department of Vascular Surgery, Institute of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Junhao Jiang
- Department of Vascular Surgery, Institute of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yun Shi
- Department of Vascular Surgery, Institute of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Tao Ma
- Department of Vascular Surgery, Institute of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Weiguo Fu
- Department of Vascular Surgery, Institute of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China.
| | - Zhihui Dong
- Department of Vascular Surgery, Institute of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China.
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Elhelali A, Hynes N, Devane D, Sultan S, Kavanagh EP, Morris L, Veerasingam D, Jordan F. Hybrid repair versus conventional open repair for thoracic aortic arch aneurysms. Cochrane Database Syst Rev 2021; 6:CD012923. [PMID: 34085713 PMCID: PMC8407084 DOI: 10.1002/14651858.cd012923.pub2] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Thoracic aortic arch aneurysms (TAAs) can be a life-threatening condition due to the potential risk of rupture. Treatment is recommended when the risk of rupture is greater than the risk of surgical complications. Depending on the cause, size and growth rate of the TAA, treatment may vary from close observation to emergency surgery. Aneurysms of the thoracic aorta can be managed by a number of surgical techniques. Open surgical repair (OSR) of aneurysms involves either partial or total replacement of the aorta, which is dependent on the extent of the diseased segment of the aorta. During OSR, the aneurysm is replaced with a synthetic graft. Hybrid repair (HR) involves a combination of open surgery with endovascular aortic stent graft placement. Hybrid repair requires varying degrees of invasiveness, depending on the number of supra-aortic branches that require debranching. The hybrid technique that combines supra-aortic vascular debranching with stent grafting of the aortic arch has been introduced as a therapeutic alternative. However, the short- and long-term outcomes of HR remain unclear, due to technical difficulties and complications as a result of the angulation of the aortic arch as well as handling of the arch during surgery. OBJECTIVES To assess the effectiveness and safety of HR versus conventional OSR for the treatment of TAAs. SEARCH METHODS The Cochrane Vascular Information Specialist searched the Cochrane Vascular Specialised Register, CENTRAL, MEDLINE, Embase, CINAHL and AMED databases and World Health Organization International Clinical Trials Registry Platform and ClinicalTrials.gov trials registers to 22 March 2021. We also searched references of relevant articles retrieved from the electronic search for additional citations. SELECTION CRITERIA We considered for inclusion in the review all published and unpublished randomised controlled trials (RCTs) and controlled clinical trials (CCTs) comparing HR to OSR for TAAs. DATA COLLECTION AND ANALYSIS Two review authors independently screened all titles and abstracts obtained from the literature search to identify those that met the inclusion criteria. We retrieved the full text of studies deemed as potentially relevant by at least one review author. The same review authors screened the full-text articles independently for inclusion or exclusion. MAIN RESULTS No RCTs or CCTs met the inclusion criteria for this review. AUTHORS' CONCLUSIONS Due to the lack of RCTs or CCTs, we were unable to determine the safety and effectiveness of HR compared to OSR in people with TAAs, and we are unable to provide high-certainty evidence on the optimal surgical intervention for this cohort of patients. High-quality RCTs or CCTs are necessary, addressing the objective of this review.
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Affiliation(s)
- Ala Elhelali
- School of Nursing and Midwifery, National University of Ireland Galway, Galway, Ireland
| | - Niamh Hynes
- Department of Vascular and Endovascular Surgery, The Galway Clinic, Galway, Ireland
| | - Declan Devane
- School of Nursing and Midwifery, National University of Ireland Galway, Galway, Ireland
| | - Sherif Sultan
- Vascular Surgery, Galway University Hospital, Galway, Ireland
| | - Edel P Kavanagh
- Department of Vascular and Endovascular Surgery, The Galway Clinic, Galway, Ireland
| | - Liam Morris
- Mechanical and Industrial Engineering, Galway-Mayo Institute of Technology, Galway, Ireland
| | - Dave Veerasingam
- Cardiothoracic Surgery, Galway University Hospital, Galway, Ireland
| | - Fionnuala Jordan
- School of Nursing and Midwifery, National University of Ireland Galway, Galway, Ireland
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16
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Edman NI, Schanzer A, Crawford A, Oderich GS, Farber MA, Schneider DB, Timaran CH, Beck AW, Eagleton M, Sweet MP. Sex-related outcomes after fenestrated-branched endovascular aneurysm repair for thoracoabdominal aortic aneurysms in the U.S. Fenestrated and Branched Aortic Research Consortium. J Vasc Surg 2021; 74:861-870. [PMID: 33775747 DOI: 10.1016/j.jvs.2021.02.046] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 02/28/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Fenestrated-branched endovascular aneurysm repair (FBEVAR) has expanded the treatment of patients with thoracoabdominal aortic aneurysms (TAAAs). Previous studies have demonstrated that women are less likely to be treated with standard infrarenal endovascular aneurysm repair because of anatomic ineligibility and experience greater mortality after both infrarenal and thoracic aortic aneurysm repair. The purpose of the present study was to describe the sex-related outcomes after FBEVAR for treatment of TAAAs. METHODS The data from 886 patients with extent I to IV TAAAs (excluding pararenal or juxtarenal aneurysms), enrolled in eight prospective, physician-sponsored, investigational device exemption studies from 2013 to 2019, were analyzed. All data were collected prospectively, audited and adjudicated by clinical events committees and/or data safety monitoring boards, and subject to Food and Drug Administration oversight. All the patients had been treated with Cook-manufactured patient-specific FBEVAR devices or the Cook t-Branch off-the-shelf device (Cook Medical, Brisbane, Australia). RESULTS Of the 886 patients who underwent FBEVAR, 288 (33%) were women. The women had more extensive aneurysms and a greater prevalence of diabetes (33% vs 26%; P = .043) but a lower prevalence of coronary artery disease (33% vs 52%; P < .0001) and previous infrarenal endovascular aneurysm repair (7.6% vs 16%; P < .001). The women had required a longer operative time from incision to surgery end (5.0 ± 1.8 hours vs 4.6 ± 1.7 hours; P < .001), experienced lower technical success (93% vs 98%; P = .002), and were less likely to be discharged to home (72% vs 83%; P = .009). Despite the smaller access vessels, the women did not have an increased incidence of access site complications. Also, the 30-day outcomes were broadly similar between the sexes. At 1 year, no differences were found between the women and men in freedom from type I or III endoleak (91.4% vs 92.0%; P = .64), freedom from reintervention (81.7% vs 85.3%; P = .10), target vessel instability (87.5% vs 89.2%; P = .31), and survival (89.6% vs 91.7%; P = .26). The women had a greater incidence of postoperative sac expansion (12% vs 6.5%; P = .006). Multivariable modeling adjusted for age, aneurysm extent, aneurysm size, urgent procedure, and renal function showed that patient sex was not an independent predictor of survival (hazard ratio, 0.83; 95% confidence interval, 0.50-1.37; P = .46). CONCLUSIONS Women undergoing FBEVAR demonstrated metrics of increased complexity and had a lower level of technical success, especially those with extensive aneurysms. Compared with the men, the women had similar 30-day mortality and 1-year outcomes, with the exception of an increased incidence of sac expansion. These data have demonstrated that FBEVAR is safe and effective for women and men but that further efforts to improve outcome parity are indicated.
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Affiliation(s)
- Natasha I Edman
- Division of Vascular Surgery, Department of Surgery, University of Washington Medical Center, Seattle, Wash; Medical Scientist Training Program, University of Washington, Seattle, Wash
| | - Andres Schanzer
- Division of Vascular Surgery, University of Massachusetts, Worcester, Mass
| | - Allison Crawford
- Division of Vascular Surgery, University of Massachusetts, Worcester, Mass
| | - Gustavo S Oderich
- Advanced Endovascular Aortic Program, Division of Vascular and Endovascular Surgery, University of Texas Health Science Center at Houston, McGovern Medical School, Houston, Tex
| | - Mark A Farber
- Division of Vascular Surgery, Department of Surgery, University of North Carolina, Chapel Hill, NC
| | - Darren B Schneider
- Division of Vascular Surgery and Endovascular Therapy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa
| | - Carlos H Timaran
- Clinical Heart and Vascular Center, University of Texas Southwestern, Dallas, Tex
| | - Adam W Beck
- Division of Vascular Surgery and Endovascular Therapy, University of Alabama at Birmingham, Birmingham, Ala
| | - Matthew Eagleton
- Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, Mass
| | - Matthew P Sweet
- Division of Vascular Surgery, Department of Surgery, University of Washington Medical Center, Seattle, Wash.
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17
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Diamond KR, Simons JP, Crawford AS, Arous EJ, Judelson DR, Aiello F, Jones DW, Messina L, Schanzer A. Effect of thoracoabdominal aortic aneurysm extent on outcomes in patients undergoing fenestrated/branched endovascular aneurysm repair. J Vasc Surg 2021; 74:833-842.e2. [PMID: 33617981 DOI: 10.1016/j.jvs.2021.01.062] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 01/20/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVE The outcomes after open repair of thoracoabdominal aneurysms (TAAAs) have been definitively demonstrated to worsen as the TAAA extent increases. However, the effect of TAAA extent on fenestrated/branched endovascular aneurysm repair (F/BEVAR) outcomes is unclear. We investigated the differences in outcomes of F/BEVAR according to the TAAA extent. METHODS We reviewed a single-institution, prospectively maintained database of all F/BEVAR procedures performed in an institutional review board-approved registry and/or physician-sponsored Food and Drug Administration investigational device exemption trial (trial no. G130210). The patients were stratified into two groups: group 1, extensive (extent 1-3) TAAAs; and group 2, nonextensive (juxtarenal, pararenal, and extent 4-5) TAAAs. The perioperative outcomes were compared using the χ2 test. Kaplan-Meier analysis of 3-year survival, target artery patency, reintervention, type I or III endoleak, and branch instability (type Ic or III endoleak, loss of branch patency, target vessel stenosis >50%) was performed. Cox proportional hazards modeling was used to assess the independent effect of extensive TAAA on 1-year mortality. RESULTS During the study period, 299 F/BEVAR procedures were performed for 87 extensive TAAAs (29%) and 212 nonextensive TAAAs (71%). Most repairs had used company-manufactured, custom-made devices (n = 241; 81%). Between the two groups, no perioperative differences were observed in myocardial infarction, stroke, acute kidney injury, dialysis, target artery occlusion, access site complication, or type I or III endoleak (P > .05 for all). The incidence of perioperative paraparesis was greater in the extensive TAAA group (8.1% vs 0.5%; P = .001). However, the incidence of long-term paralysis was equivalent (2.3% vs 0.5%; P = .20), with nearly all patients with paraparesis regaining ambulatory function. On Kaplan-Meier analysis, no differences in survival, target artery patency, or freedom from reintervention were observed at 3 years (P > .05 for all). Freedom from type I or III endoleak (P < .01) and freedom from branch instability (P < .01) were significantly worse in the extensive TAAA group. Cox proportional hazards modeling demonstrated that F/BEVAR for extensive TAAA was not associated with 1-year mortality (hazard ratio, 1.71; 95% confidence interval, 0.91-3.52; P = .13). CONCLUSIONS Unlike open TAAA repair, the F/BEVAR outcomes were similar for extensive and nonextensive TAAAs. The differences in perioperative paraparesis, branch instability, and type I or III endoleak likely resulted from the increasing length of aortic coverage and number of target arteries involved. These findings suggest that high-volume centers performing F/BEVAR should expect comparable outcomes for extensive and nonextensive TAAA repair.
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Affiliation(s)
- Kyle R Diamond
- Division of Vascular and Endovascular Surgery, UMass Memorial Medical Center, Worcester, Mass
| | - Jessica P Simons
- Division of Vascular and Endovascular Surgery, UMass Memorial Medical Center, Worcester, Mass
| | - Allison S Crawford
- Division of Vascular and Endovascular Surgery, UMass Memorial Medical Center, Worcester, Mass
| | - Edward J Arous
- Division of Vascular and Endovascular Surgery, UMass Memorial Medical Center, Worcester, Mass
| | - Dejah R Judelson
- Division of Vascular and Endovascular Surgery, UMass Memorial Medical Center, Worcester, Mass
| | - Francesco Aiello
- Division of Vascular and Endovascular Surgery, UMass Memorial Medical Center, Worcester, Mass
| | - Douglas W Jones
- Division of Vascular and Endovascular Surgery, UMass Memorial Medical Center, Worcester, Mass
| | - Louis Messina
- Division of Vascular and Endovascular Surgery, UMass Memorial Medical Center, Worcester, Mass
| | - Andres Schanzer
- Division of Vascular and Endovascular Surgery, UMass Memorial Medical Center, Worcester, Mass.
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Wang D, Chen F, Fang B, Zhang Z, Dong Y, Tong X, Ma H. MiR-128-3p Alleviates Spinal Cord Ischemia/Reperfusion Injury Associated Neuroinflammation and Cellular Apoptosis via SP1 Suppression in Rat. Front Neurosci 2020; 14:609613. [PMID: 33424542 PMCID: PMC7785963 DOI: 10.3389/fnins.2020.609613] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 12/04/2020] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Neuroinflammation and cellular apoptosis caused by spinal cord ischemia/reperfusion (I/R) injury result in neurological dysfunction. MicroRNAs (miRs) have crucial functions in spinal cord I/R injury pathogenesis according to previous evidences. Herein, whether miR-128-3p contributes to spinal cord I/R injury by regulating specificity protein 1 (SP1) was assessed. METHODS A rat model of spinal cord I/R injury was established by occluding the aortic arch for 14 min. Then, miR-128-3p's interaction with SP1 was detected by dual-luciferase reporter assays. Next, miR-128-3p mimic and inhibitor, as well as adenovirus-delivered shRNA specific for SP1 were injected intrathecally for assessing the effects of miR-128-3p and SP1 on rats with spinal cord I/R injury. SP1, Bax and Bcl-2 expression levels in I/R injured spinal cord tissues were evaluated by Western blotting, while IL-1β, TNF-α, and IL-6 were quantitated by ELISA. Tarlov scores were obtained to detect hind-limb motor function. Evans blue (EB) dye extravasation was utilized to examine blood-spinal cord barrier (BSCB) permeability. Terminal deoxynucleotidyl transferase mediated dUTP nick end labeling (TUNEL) staining was performed for neuronal apoptosis assessment. RESULTS MiR-128-3p expression was decreased, while SP1 amounts were increased in rat spinal cord tissue specimens following I/R. SP1 was identified as a miR-128-3p target and downregulated by miR-128-3p. MiR-128-3p overexpression or SP1 silencing alleviated I/R-induced neuroinflammation and cell apoptosis, and improved Tarlov scores, whereas pretreatment with miR-128-3p inhibitor aggravated the above injuries. CONCLUSION Overexpression of miR-128-3p protects neurons from neuroinflammation and apoptosis during spinal cord I/R injury partially by downregulating SP1.
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Affiliation(s)
| | | | | | | | | | | | - Hong Ma
- Department of Anesthesiology, The First Hospital of China Medical University, Shenyang, China
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19
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Pellenc Q, Roussel A, Senemaud J, Cerceau P, Iquille J, Boitet A, Leclere JB, Milleron O, Jondeau G, Castier Y. Staged hybrid repair of type II thoracoabdominal aneurysms. J Vasc Surg 2020; 74:20-27. [PMID: 33340705 DOI: 10.1016/j.jvs.2020.12.049] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 12/02/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Open repair of type II thoracoabdominal aortic aneurysms (TAAAs) remains a challenging procedure. Staged procedures could decrease the incidence and severity of complications after complex aortic repair. In the present report, we have described a strategy using thoracic endovascular aortic repair (TEVAR) for proximal repair, followed by distal open repair. METHODS From 2014 to 2018, 14 patients had undergone TEVAR, followed by distal open repair, for type II TAAAs. All patients should have a suitable proximal landing zone according to the current guidelines. In cases of chronic dissection, false lumen embolization was performed to achieve total exclusion. RESULTS The mean patient age was 48 ± 15 years. Of the 14 patients, 5 had had Marfan syndrome (36%) and 6 had undergone previous aortic arch repair (43%). Ten patients had had a chronic dissection. The maximal aortic diameter was 73 ± 12 mm. The TEVAR technical success rate was 100%. The aortic length coverage was 211 ± 63 mm. The number of covered segmental arteries was 6 (range, 4-13). Two endoleaks were observed, one type Ib and one type II. The delay between TEVAR and open repair was 12 ± 8 weeks. Cerebrospinal fluid drainage was used in 13 patients. Six patients had undergone segmental artery reattachment during surgery. No spinal cord ischemic event was observed. One patient had died 5 weeks after open repair of multiple organ failure. During the 32 months of follow-up, no aortic-related deaths had occurred. No new aortic procedure was needed. The type Ib endoleak had resolved during open repair, and the type II TAAA had resolved spontaneously. The mean maximal thoracic aortic diameter had significantly decreased to 49 ± 8 mm (P < .0001). Aneurysmal shrinkage of ≥5 mm was observed in 13 patients (93%). CONCLUSIONS Staged hybrid repair of type II TAAAs appears to be efficient, with low morbidity and mortality rates. This technique could improve postoperative outcomes after open repair, and TEVAR might have a role in ischemic preconditioning to protect against spinal cord ischemia.
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Affiliation(s)
- Quentin Pellenc
- Vascular and Thoracic Surgery Department, Bichat Hospital, Assistance Publique-Hopitaux de Paris, Paris, France; Centre de Référence pour le Syndrome de Marfan et apparentés, Bichat Hospital, Assistance Publique-Hopitaux de Paris, Paris, France; Université de Paris, Paris, France; Laboratory for Vascular Translational Science, Inserm U1148, Université de Paris, Paris, France.
| | - Arnaud Roussel
- Vascular and Thoracic Surgery Department, Bichat Hospital, Assistance Publique-Hopitaux de Paris, Paris, France; Centre de Référence pour le Syndrome de Marfan et apparentés, Bichat Hospital, Assistance Publique-Hopitaux de Paris, Paris, France; Université de Paris, Paris, France
| | - Jean Senemaud
- Vascular and Thoracic Surgery Department, Bichat Hospital, Assistance Publique-Hopitaux de Paris, Paris, France; Centre de Référence pour le Syndrome de Marfan et apparentés, Bichat Hospital, Assistance Publique-Hopitaux de Paris, Paris, France; Université de Paris, Paris, France
| | - Pierre Cerceau
- Vascular and Thoracic Surgery Department, Bichat Hospital, Assistance Publique-Hopitaux de Paris, Paris, France
| | - Jules Iquille
- Vascular and Thoracic Surgery Department, Bichat Hospital, Assistance Publique-Hopitaux de Paris, Paris, France; Université de Paris, Paris, France
| | - Auréline Boitet
- Vascular and Thoracic Surgery Department, Bichat Hospital, Assistance Publique-Hopitaux de Paris, Paris, France
| | - Jean-Baptiste Leclere
- Vascular and Thoracic Surgery Department, Bichat Hospital, Assistance Publique-Hopitaux de Paris, Paris, France
| | - Olivier Milleron
- Cardiology Department, Bichat Hospital, Assistance Publique-Hopitaux de Paris, Paris, France; Centre de Référence pour le Syndrome de Marfan et apparentés, Bichat Hospital, Assistance Publique-Hopitaux de Paris, Paris, France; Laboratory for Vascular Translational Science, Inserm U1148, Université de Paris, Paris, France
| | - Guillaume Jondeau
- Cardiology Department, Bichat Hospital, Assistance Publique-Hopitaux de Paris, Paris, France; Centre de Référence pour le Syndrome de Marfan et apparentés, Bichat Hospital, Assistance Publique-Hopitaux de Paris, Paris, France; Université de Paris, Paris, France; Laboratory for Vascular Translational Science, Inserm U1148, Université de Paris, Paris, France
| | - Yves Castier
- Vascular and Thoracic Surgery Department, Bichat Hospital, Assistance Publique-Hopitaux de Paris, Paris, France; Centre de Référence pour le Syndrome de Marfan et apparentés, Bichat Hospital, Assistance Publique-Hopitaux de Paris, Paris, France; Université de Paris, Paris, France; Laboratory for Vascular Translational Science, Inserm U1148, Université de Paris, Paris, France
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Grossart CM, Moores C, Burns PJ, Falah O, Tambyraja AL, Chalmers RT. Centralization of thoracoabdominal services: the Scottish perspective. ITALIAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY 2020. [DOI: 10.23736/s1824-4777.20.01454-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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21
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Coselli JS, Krause HM, Green SY, Zhang Q, Amarasekara HS, Price MD, Preventza O, LeMaire SA. A 23-year experience with the reversed elephant trunk technique for staged repair of extensive thoracic aortic aneurysm. J Thorac Cardiovasc Surg 2020; 163:1252-1264. [PMID: 33419554 DOI: 10.1016/j.jtcvs.2020.09.148] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 09/24/2020] [Accepted: 09/29/2020] [Indexed: 12/20/2022]
Abstract
OBJECTIVE The reversed elephant trunk technique permits staged repair of extensive thoracic aortic aneurysm in patients whose distal (ie, descending thoracic and thoracoabdominal) aorta is symptomatic or disproportionately large compared with their proximal aorta (ie, ascending aorta and transverse aortic arch). We present our 23-year experience with the reversed elephant trunk approach. METHODS Between 1994 and 2017, 94 patients (median age 62 [46-69] years) underwent stage 1 reversed elephant trunk repair of the distal aorta. Fifty-three patients (56%) had aortic dissection, and 31 patients (33%) had heritable thoracic aortic disease. Eighty-eight operations (94%) were Crawford extent I or II thoracoabdominal aortic repairs. Twenty-seven patients (29%) underwent subsequent stage 2 repair of the proximal aorta; 14 patients (52%) required redo median sternotomy. The median time between the stage 1 and 2 operations was 18.8 (4.8-69.3) months. RESULTS The operative mortality was 10% (9/94) for stage 1 repairs and 4% (1/27) for stage 2 repairs; 1 patient with heritable thoracic aortic disease died after stage 1 repair (1/31, 3%), and 1 patient died after stage 2 repair (1/13, 8%). Two patients (2%) had ruptures after stage 1 repair; 1 resulted in death, and 1 precipitated emergency stage 2 repair. In total, 36 patients (38%) who survived stage 1 repair died before stage 2 reversed elephant trunk completion repair could be performed. CONCLUSIONS Managing extensive aortic aneurysm with the 2-stage reversed elephant trunk technique yields acceptable short-term outcomes. This technique is useful for the reversed elephant trunk in patients who require distal aortic repair before proximal repair and is particularly effective in patients with heritable thoracic aortic disease. The low number of patients returning for completion repair is concerning. Rigorous surveillance is needed.
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Affiliation(s)
- Joseph S Coselli
- Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex; Department of Cardiovascular Surgery, Texas Heart Institute, Houston, Tex; Department of Cardiovascular Surgery, CHI St Luke's Health-Baylor St Luke's Medical Center, Houston, Tex; Cardiovascular Research Institute, Baylor College of Medicine, Houston, Tex
| | - Heidi M Krause
- Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex
| | - Susan Y Green
- Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex
| | - Qianzi Zhang
- Office of Surgical Research, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex
| | - Hiruni S Amarasekara
- Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex
| | - Matt D Price
- Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex
| | - Ourania Preventza
- Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex; Department of Cardiovascular Surgery, Texas Heart Institute, Houston, Tex; Department of Cardiovascular Surgery, CHI St Luke's Health-Baylor St Luke's Medical Center, Houston, Tex
| | - Scott A LeMaire
- Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex; Department of Cardiovascular Surgery, Texas Heart Institute, Houston, Tex; Department of Cardiovascular Surgery, CHI St Luke's Health-Baylor St Luke's Medical Center, Houston, Tex; Cardiovascular Research Institute, Baylor College of Medicine, Houston, Tex.
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22
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Son SA, Jung H, Cho JY. Long-term outcomes of intervention between open repair and endovascular aortic repair for descending aortic pathologies: a propensity-matched analysis. BMC Surg 2020; 20:266. [PMID: 33143659 PMCID: PMC7607549 DOI: 10.1186/s12893-020-00923-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 10/22/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The long-term complication rates of open repair and thoracic endovascular aortic repair (TEVAR) have not yet been determined. Therefore, this study aimed to compare the long-term outcomes and aortic reintervention rates between open repair and TEVAR in patients with descending thoracic aortic pathologies. METHODS Between January 2002 and December 2017, 230 patients with descending thoracic aortic pathologies underwent surgery. Of these, 136 patients were included in this retrospective study: 45 patients (10, 2, and 33 with dissection, penetrating atherosclerotic ulcer, and pseudoaneurysm, respectively) underwent open repair and 91 patients (27, 1, and 63 with dissection, penetrating atherosclerotic ulcer, and pseudoaneurysm, respectively) underwent TEVAR. The primary end points were in-hospital mortality, and short-term complications. The secondary end points were long-term mortality and reintervention rates. Based on the propensity score matching (PSM), 35 patients who underwent open repair were matched to 35 patients who underwent TEVAR (ratio = 1:1). RESULTS The mean follow-up period was 70.2 ± 51.9 months. Shorter intensive care unit and hospital stay were seen in the TEVAR group than in the open repair group before and after PSM (p < 0.001 and p < 0.001, respectively). However, in-hospital mortality, and spinal cord ischemia were not significantly different among the two groups (before PSM: p = 0.068 and p = 0.211, respectively; after PSM: p = 0.303 and p = 0.314, respectively). The cumulative all-cause death and aorta-related death showed no significant differences between the two groups (before PSM: p = 0.709 and p = 0.734, respectively; after PSM: p = 0.888 and p = 0.731, respectively). However, aortic reintervention rates were higher in the TEVAR group than in the open repair group before and after PSM (p = 0.006 and p = 0.013, respectively). CONCLUSION The TEVAR group was superior in short-term recovery outcomes but had higher reintervention rates compared to the open repair group. However, there were no significant differences in long-term survival between the two groups.
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Affiliation(s)
- Shin-Ah Son
- Trauma Center, Department of Thoracic and Cardiovascular Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, Republic of Korea
| | - Hanna Jung
- Department of Thoracic and Cardiovascular Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, 130 Dongdeok-ro, Jung-gu, Daegu, Republic of Korea
| | - Joon Yong Cho
- Department of Thoracic and Cardiovascular Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, 130 Dongdeok-ro, Jung-gu, Daegu, Republic of Korea.
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Leong BDK, Joseph FS. Total Percutaneous Femoral Approach for Branched Custom-Made Device Endovascular Repair of Thoracoabdominal Aneurysm. Ann Vasc Dis 2020; 13:347-350. [PMID: 33384745 PMCID: PMC7751077 DOI: 10.3400/avd.cr.20-00080] [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: 11/18/2022] Open
Abstract
Thoracoabdominal aortic aneurysm (TAAA) is a challenging vascular condition to manage. Traditionally, open surgical repair has been the standard of treatment. Endovascular repair for TAAA has gained much popularity because it is a minimally invasive approach that results in better mortality and morbidity profiles. We report a case of TAAA successfully treated with a custom-made multi-branch device through a total femoral approach with the use of a steerable sheath for branch cannulation and deployment of bridging stents to targeted visceral vessels. This approach avoided complications related to upper extremity access, such as stroke, and allowed shorter operative time with better workstation ergonomics.
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Affiliation(s)
- Benjamin Dak Keung Leong
- CardioVascular & Lung Centre, Gleneagles Hospital.,Unit of Vascular Surgery, Queen Elizabeth Hospital
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Papadimas E, Tan YK, Qi Q, Ng JJ, Kofidis T, Teoh K, Sorokin V, Choong AMTL. Left heart bypass versus circulatory arrest for open repair of thoracoabdominal aortic pathologies. ANZ J Surg 2020; 90:2434-2440. [DOI: 10.1111/ans.16287] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Revised: 08/10/2020] [Accepted: 08/15/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Evangelos Papadimas
- Department of Cardiac Thoracic and Vascular Surgery National University Heart Centre Singapore
| | | | - Qian Qi
- Department of Cardiac Thoracic and Vascular Surgery National University Heart Centre Singapore
| | - Jun Jie Ng
- Department of Cardiac Thoracic and Vascular Surgery National University Heart Centre Singapore
| | - Theo Kofidis
- Department of Cardiac Thoracic and Vascular Surgery National University Heart Centre Singapore
| | - Kristine Teoh
- Department of Cardiac Thoracic and Vascular Surgery National University Heart Centre Singapore
| | - Vitaly Sorokin
- Department of Cardiac Thoracic and Vascular Surgery National University Heart Centre Singapore
- Yong Loo Lin School of Medicine Singapore
| | - Andrew M. T. L. Choong
- Department of Cardiac Thoracic and Vascular Surgery National University Heart Centre Singapore
- Cardiovascular Research Institute National University of Singapore Singapore
- Department of Surgery Yong Loo Lin School of Medicine, National University of Singapore Singapore
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25
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Palmier M, Bubenheim M, Chiche L, Chaufour X, Koskas F, Fadel E, Magnan PE, Ducasse E, Chakfe N, Steinmetz E, Dusseaux MM, Ricco JB, Plissonnier D. Protocol of supra-visceral aortic ischemic preconditioning for open surgical repair of thoracoabdominal aortic aneurysm : The EPICATA study (Evaluation of the Efficacy of Ischemic PreConditioning on morbidity and mortality in open ThoracoAbdominal Aortic surgery). BMC Surg 2020; 20:193. [PMID: 32854681 PMCID: PMC7457237 DOI: 10.1186/s12893-020-00851-3] [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: 04/17/2020] [Accepted: 08/19/2020] [Indexed: 11/25/2022] Open
Abstract
Background Open surgical repair (OSR) for thoracoabdominal aortic aneurysms (TAA) is associated with a high pulmonary and renal morbidity rate. Ischemic preconditioning (IPC) is a mechanism of protection against the deleterious effects of ischemia-reperfusion. To our knowledge IPC has never been tested during OSR for TAA. Methods The primary objective of the study is to evaluate the efficacy of IPC during OSR for TAA with respect to acute kidney injury (AKI) according to KDIGO and pneumonia/prolonged ventilation-time during the first 8 postoperative days. The secondary objectives are to compare both arms with respect to cardiac complications within 48 h, renal and pulmonary complications within 21 days and mortality at 60 days. To assess the efficacy of IPC with respect to pulmonary and renal morbidity, a cox model for competing risks will be used. Assuming that the event occurs among 36% of the patients when no IPC is performed, the allocation of 55 patients to each arm should allow detecting a hazard ratio of at least 2.75 with a power of 80% when admitting 5% for an error of first kind. This means that 110 patients, enrolled in this multicenter study, may be randomised within 36 months of the first randomization. Randomization will be performed to allocate patients either to surgery with preconditioning before aortic cross clamping (Arm 1) or to surgery without preconditioning before aortic cross clamping (Arm 2). Randomization takes place during the intervention after intravenous injection of heparin, or after the start of femoral assistance. The procedure for IPC will be a supra-visceral thoracic aortic cross clamping for 5 min followed by an unclamping period of 5 min. This procedure will be repeated twice before starting thoracic aortic cross clamping needed to perform surgery. Conclusions Our hypothesis is that ischemic preconditioning could reduce clinical morbidity and the incidence of lung damage associated with supra-visceral aortic clamping. Trial registration EPICATAStudy registered in ClinicalTrial.gov / number: NCT03718312 on Oct.24.2018 URL number
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Affiliation(s)
- Mickael Palmier
- Department of vascular surgery and Inserm U1096, Rouen University Hospital, 1 rue de Germont, 76031, Rouen Cedex, France
| | - Mickael Bubenheim
- Department of Clinical research and Innovation, Rouen University Hospital, Rouen, France
| | - Laurent Chiche
- Department of vascular surgery, Pitié-Salpétrière University Hospital, Paris, France
| | - Xavier Chaufour
- Department of vascular surgery, Rangueil University Hospital, Toulouse, France
| | - Fabien Koskas
- Department of vascular surgery, Pitié-Salpétrière University Hospital, Paris, France
| | - Elie Fadel
- Centre Chirurgical Marie Lannelongue, Le Plessis Robinson, France
| | | | - Eric Ducasse
- Department of vascular surgery, Pellegrin University Hospital, Bordeaux, France
| | - Nabil Chakfe
- Department of vascular surgery, Nouvel Hopital Civil, University of Strasbourg, Strasbourg, France
| | - Eric Steinmetz
- Department of vascular surgery, Dijon University Hospital, Dijon, France
| | | | - Jean Baptiste Ricco
- Department of Clinical Research and Innovation, University Hospital, Poitiers, France
| | - Didier Plissonnier
- Department of vascular surgery and Inserm U1096, Rouen University Hospital, 1 rue de Germont, 76031, Rouen Cedex, France.
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Mid-Term Results of Thoracic Endovascular Aneurysm Repair with Intentional Celiac Artery Coverage for Crawford Type I Thoracoabdominal Aortic Aneurysms with the TX2 Distal Component Endograft. Ann Vasc Surg 2020; 66:193-199. [DOI: 10.1016/j.avsg.2019.11.030] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 11/14/2019] [Accepted: 11/18/2019] [Indexed: 11/22/2022]
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Verstraeten A, Meester J, Peeters S, Mortier G, Loeys B. Chondrodysplasias and Aneurysmal Thoracic Aortopathy: An Emerging Tale of Molecular Intersection. Trends Mol Med 2020; 26:783-795. [PMID: 32507656 DOI: 10.1016/j.molmed.2020.05.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Revised: 04/03/2020] [Accepted: 05/13/2020] [Indexed: 12/16/2022]
Abstract
Although at first glance chondrodysplasia and aneurysmal thoracic aortopathy seem oddly dissimilar, recent lines of evidences indicate that they share molecular similarities. Chondrodysplasias are a group of skeletal disorders characterized by genetic defects in hyaline cartilage. Aneurysmal thoracic aortopathy is the pathological enlargement of the thoracic aorta due to wall weakness, along with its ensuing life-threatening complications (i.e., aortic dissection and/or rupture). Extracellular matrix dysregulation, abnormal TGF-β signaling, and, to a more limited extent, endoplasmic reticulum stress emerge as common disease processes. In this review we provide a comprehensive overview of the genetic and pathomechanistic overlap as well as of how these commonalities can guide treatment strategies for both disease entities.
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Affiliation(s)
- Aline Verstraeten
- Centre of Medical Genetics, Faculty of Medicine and Health Sciences, University of Antwerp and Antwerp University Hospital, Antwerp, Belgium. @uantwerpen.be
| | - Josephina Meester
- Centre of Medical Genetics, Faculty of Medicine and Health Sciences, University of Antwerp and Antwerp University Hospital, Antwerp, Belgium
| | - Silke Peeters
- Centre of Medical Genetics, Faculty of Medicine and Health Sciences, University of Antwerp and Antwerp University Hospital, Antwerp, Belgium
| | - Geert Mortier
- Centre of Medical Genetics, Faculty of Medicine and Health Sciences, University of Antwerp and Antwerp University Hospital, Antwerp, Belgium
| | - Bart Loeys
- Centre of Medical Genetics, Faculty of Medicine and Health Sciences, University of Antwerp and Antwerp University Hospital, Antwerp, Belgium; Department of Human Genetics, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
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Acute Insulin Resistance and Rapid Alterations in Neuronal Derived Blood Exosome Concentration After Branched Endovascular Aortic Aneurysm Repair. Eur J Vasc Endovasc Surg 2020; 59:457-463. [DOI: 10.1016/j.ejvs.2019.10.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Revised: 09/26/2019] [Accepted: 10/11/2019] [Indexed: 12/23/2022]
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Faure EM, El Batti S, Sutter W, Bel A, Julia P, Achouh P, Alsac JM. Stent-assisted balloon dilatation of chronic aortic dissection. J Thorac Cardiovasc Surg 2020; 162:1467-1473. [DOI: 10.1016/j.jtcvs.2020.01.081] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 01/06/2020] [Accepted: 01/27/2020] [Indexed: 11/30/2022]
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Review: perspectives on renal and visceral protection during thoracoabdominal aortic aneurysm repair. Indian J Thorac Cardiovasc Surg 2019; 35:179-185. [PMID: 33061084 DOI: 10.1007/s12055-018-0757-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 10/04/2018] [Accepted: 10/07/2018] [Indexed: 10/27/2022] Open
Abstract
Open repair of a thoracoabdominal aortic aneurysm (TAAA) is an extensive operation and associated with significant perioperative morbidities and mortality, in large part due to distal aortic ischemia secondary to aortic cross-clamping that is necessitated during repair. Distal aortic ischemia may manifest as complications of the kidneys and viscera. Postoperative renal complications range from temporarily elevated levels of creatinine resulting from impaired kidney function to acute renal failure necessitating dialysis that may persist after hospital discharge. Continued advances in the management and adjuncts associated with TAAA repair since the groundbreaking era of E.S. Crawford have led to improved postoperative outcomes following surgery, but the dramatic improvements seen in reducing rates of spinal cord deficits, mesenteric ischemia and other serious postoperative complications have not been seen in contemporary rates of postoperative renal failure. We provide an overview of the various surgical techniques and adjuncts as they relate to the management of visceral and renal ischemia.
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31
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Shimamura J, Oshima S, Ozaki K, Sakurai S, Hirai Y, Hirokami T, Fujikawa T, Ozaki A, Yamamoto S. Open Thoracoabdominal Aortic Aneurysm Repair: Contemporary Outcomes for 393 Elective Cases. Ann Thorac Surg 2019; 107:1326-1332. [DOI: 10.1016/j.athoracsur.2018.11.021] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 10/14/2018] [Accepted: 11/12/2018] [Indexed: 10/27/2022]
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Walker J, Kaushik S, Hoffman M, Gasper W, Hiramoto J, Reilly L, Chuter T. Long-term durability of multibranched endovascular repair of thoracoabdominal and pararenal aortic aneurysms. J Vasc Surg 2019; 69:341-347. [PMID: 30683193 DOI: 10.1016/j.jvs.2018.04.074] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 04/09/2018] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The objective of this study was to assess the durability of multibranched endovascular repair of thoracoabdominal aortic aneurysms (TAAAs) and pararenal aortic aneurysms by examining the rates of late-occurring (beyond 30 days) complications. METHODS There were 146 patients who underwent endovascular TAAA repair using a stent graft, with a total of 538 caudally oriented self-expanding branches. Four patients died in the perioperative period and were excluded, leaving 142 patients (mean age, 73 ± 8 years; 35 [24.7%] women). Follow-up included clinical examination and computed tomography angiography at 1 month, 6 months, and 12 months and yearly thereafter. RESULTS Mean aneurysm diameter was 67 ± 9 mm. Sixty-seven TAAAs (47.2%) were Crawford type I, II, III, or V; 75 (52.8%) were type IV or pararenal. Three patients (2.1%) died >30 days after operation from perioperative complications. During a mean follow-up of 36 months (±28 months), there were four additional aneurysm-related deaths: one (0.7%) as a result of aneurysm rupture in the presence of untreatable type I endoleak, one (0.7%) after conversion to open repair for stent graft infection, one (0.7%) after occlusion of superior mesenteric artery and celiac branches, and one (0.7%) due to bilateral renal branch occlusion. There was one additional open conversion for stent graft infection (0.7%). Nineteen patients (13.3%) underwent 20 reinterventions for late-occurring complications, including 11 (7.7%) for renal branch occlusion or stenosis, 1 (0.7%) for mesenteric branch stenosis, 4 (2.8%) for graft limb occlusion, 1 (0.7%) for type IB endoleak (distal stent graft migration), and 1 (0.7%) for type III endoleak (fabric erosion); 2 (1.4%) open conversions were performed for stent graft infection. There were no late type IA endoleaks. By Kaplan-Meier analysis, freedom from aneurysm-related death was 91.1% and freedom from aneurysm-related death or reintervention was 76.8% at 5 years. The 5-year overall survival rate of 49.1% reflects the high rate of cardiopulmonary comorbidity. Although renal branch occlusion (23 occlusions of 256 renal branches [8.9%]) was the most common late complication, only five patients required permanent dialysis. CONCLUSIONS Total endovascular repair of TAAAs and pararenal aortic aneurysms using axially oriented cuffs is safe, effective, and durable in the long term.
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Affiliation(s)
- Joy Walker
- Department of Vascular and Endovascular Surgery, University of California, San Francisco, Calif.
| | - Smita Kaushik
- Department of Vascular and Endovascular Surgery, University of California, San Francisco, Calif
| | - Megan Hoffman
- Department of Vascular and Endovascular Surgery, University of California, San Francisco, Calif
| | - Warren Gasper
- Department of Vascular and Endovascular Surgery, University of California, San Francisco, Calif
| | - Jade Hiramoto
- Department of Vascular and Endovascular Surgery, University of California, San Francisco, Calif
| | - Linda Reilly
- Department of Vascular and Endovascular Surgery, University of California, San Francisco, Calif
| | - Timothy Chuter
- Department of Vascular and Endovascular Surgery, University of California, San Francisco, Calif
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Siy AB, Rendell VR, Winslow ER. Analysis of National Presentations of Surgical Case Series Discussions: What Matters to Surgeons? J Surg Res 2019; 238:240-247. [PMID: 30776743 DOI: 10.1016/j.jss.2019.01.037] [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: 09/14/2018] [Revised: 12/05/2018] [Accepted: 01/11/2019] [Indexed: 11/10/2022]
Abstract
BACKGROUND Although the surgical case series is a useful study design for surgical disciplines, elements of its presentation have not been standardized with a widely accepted reporting guideline. Hence, case series may not include all components necessary for surgeons to best interpret their results. We aimed to determine core elements of case series through qualitative analysis of discussions after presentations at national meetings. METHODS Case series with accompanying discussions in three high-impact journals from 2010 to 2015 were analyzed with conventional content analysis. All interrogative sentences were selected for analysis and were classified by a redundant iterative process into descriptive categories and subcategories. RESULTS Two hundred twenty-one case series were identified, 56 of which included discussion transcripts. Four hundred seventy six unique interrogatives were classified into 4 categories and 13 subcategories. The main categories identified were "Application of Results to Patient Care," "Clarification of Study Methodology," "Facilitation of Author Insight," and "Request for Additional Study-Specific Data." The most frequent subcategories of inquiry pertained to the changes to current standard of care, clarification of study variables, and subgroup data and outcomes. CONCLUSIONS We determined major themes of inquiry that reflected core elements surgeons use to evaluate case series for relevance and applicability to their own practice. Discussants frequently questioned how the study's results changed the author's standard of care. Specifically encouraging surgical case series authors to comment on changes they made to their practice as a result of their findings would allow the surgical audience to quickly assess potential clinical applicability.
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Affiliation(s)
- Alexander B Siy
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Victoria R Rendell
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Emily R Winslow
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.
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Latt KK, Moiseev AA, Chernaya NR, Vasilyev KN, Bayandin NL, Stupin VA. IMMEDIATE AND LONGTERM RESULTS OF ENDOVASCULAR STENT-GRAFTING IN DISSECTIONS AND ATHEROSCLEROTIC ANEURYSMS OF THORACIC AORTA. ACTA ACUST UNITED AC 2018. [DOI: 10.21518/2307-1109-2018-2-135-140] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Objective: to analyze the results of endovascular stent-graftingin dissections and atherosclerotic aneurysms of descending part of thoracic aorta.Material and method: in this analysis includes 28 patients with dissections and atherosclerotic aneurysms of descending part of thoracic aorta. Acute aortic dissection type 3 was occurred in 10 patients and two of them were complicated with rupture into the left pleural cavity. 10 patients with chronic aortic dissection type bunderwent operations and one of them was complicated with rupture into the left pleural cavity. Among 8 operated patients due to chronic aneurysms of descending part of thoracic aorta, 4 patients were manifested with symptoms of hemothorax. In 3 patients with aortic dissection type 1 in long-term period, endovascular stent-grafting was performed concerning with the dilatation of descending thoracic aorta and patent false lumen. During in-hospital and long-term periods immediate clinical results, serious clinical complications and long-term survival were compared.Results: technical success of endovascular stent-grafting was achieved in 100 % of cases. In-hospital mortality was 4 (14,2 %) and 30-day mortality was 3 (10,7 %). Events of paraplegia, TIA (Transient Ischemic Attack), prosthetic infection were not found in our research. Two clinical occurrences of vascular approach site complication were found; one case of endoleak type 1 and stent-graft dislocation which required repeated endovascular stent-grafting and one case of endoleak type 2 which was performed subclaviancarotid bypass and ligation of left subclavian artery. Prolong intubation was needed in 5 patients (18,5 %).conclusion: Endovascular stent-grafting in dissections and atherosclerotic aneurysms of descending part of thoracic aorta contributes good immediate clinical results associating with less quantity of serious complications.
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Affiliation(s)
- Kyaw K. Latt
- Russian National Research Medical University named after N. I. Pirogov
| | - Alexey A. Moiseev
- Russian National Research Medical University named after N. I. Pirogov
| | | | | | | | - Viktor A. Stupin
- Russian National Research Medical University named after N. I. Pirogov
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Choong AMTL, Wee IJY, Almond M, Muratani M, Kovari F, Russai R, Jenkins MP. A Systematic Review of the Use of Biochemical Markers in the Assessment of Spinal Cord Ischemia in Thoracoabdominal Aortic Aneurysm Repair. Vasc Endovascular Surg 2018; 53:230-241. [DOI: 10.1177/1538574418814612] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Introduction: Despite advances in perioperative critical care and surgical technique, spinal cord ischemia remains a devastating complication of thoracic and thoracoabdominal aortic aneurysm repair. Biochemical markers present in peripheral blood and cerebrospinal fluid (CSF) may be useful in assessing spinal cord injury. We systematically analyze and report the role of all reported biochemical markers that have been used in assessing and diagnosing spinal cord ischemia in thoracic and thoracoabdominal aortic aneurysm repair. Methods: Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines were used for this review. Published literature was searched to identify all studies reporting on the use of biochemical markers in thoracoabdominal aortic aneurysm repair in the assessment of spinal cord ischemia. Marker-specific and patient-specific data were extracted from all studies and where possible, subgroup analysis was performed on marker-specific data sets. Results: Fourteen studies of 321 patients undergoing thoracic and thoracoabdominal aortic aneurysm repair were eligible for further analysis. Seven distinct biochemical markers were used in both CSF and blood samples: S100B proteins (S100B), neurone-specific enolase, lactate dehydrogenase, glial fibrillary acidic protein (GFAp), neurofilament triplet protein (NFL) and Tau protein, and glucose. There was substantial evidence demonstrating the heightened levels of S100, NFL, and GFAp in CSF in patients with spinal cord ischemia. There is however, wide variability in the correlation of the same 6 biochemical markers in peripheral blood and spinal cord ischemia. Conclusions: In patients with spinal cord injury, dramatic rises occur with S100B, NFL, and GFAp in CSF. However, further work is needed if biochemical markers are to impact on the future of thoracoabdominal aortic aneurysm repair.
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Affiliation(s)
- Andrew M. T. L. Choong
- SingVaSC, Singapore Vascular Surgical Collaborative, Singapore
- Cardiovascular Research Institute, National University of Singapore, Singapore
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Vascular Surgery, National University Heart Centre, Singapore
| | - Ian J. Y. Wee
- SingVaSC, Singapore Vascular Surgical Collaborative, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Mark Almond
- SingVaSC, Singapore Vascular Surgical Collaborative, Singapore
| | - Masafumi Muratani
- SingVaSC, Singapore Vascular Surgical Collaborative, Singapore
- Department of Genome Biology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Ferenc Kovari
- SingVaSC, Singapore Vascular Surgical Collaborative, Singapore
- Department of Anaesthetics and Intensive Care, North Middlesex University Hospital, London, United Kingdom
| | - Rita Russai
- SingVaSC, Singapore Vascular Surgical Collaborative, Singapore
- Department of Anaesthetics, London North West Healthcare NHS Trust, Middlesex, United Kingdom
| | - Michael P. Jenkins
- Imperial Vascular Unit, St Mary’s Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
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Wipper S, Kölbel T, Sandhu HK, Manzoni D, Duprée A, Estrera AL, Safi H, Miller CC, Tsilimparis N, Debus ES. Impact of hybrid thoracoabdominal aortic repair on visceral and spinal cord perfusion: The new and improved SPIDER-graft. J Thorac Cardiovasc Surg 2018; 158:692-701. [PMID: 30745044 DOI: 10.1016/j.jtcvs.2018.11.133] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 11/02/2018] [Accepted: 11/10/2018] [Indexed: 11/15/2022]
Abstract
OBJECTIVES SPIDER-graft for thoracoabdominal aortic aneurysm repair avoiding thoracotomy and extracorporeal circulation was modified, enabling reimplantation of lumbar arteries to prevent spinal cord ischemia and compared with open aortic repair (control) in a pig model. METHODS Graft implantation was performed in 7 pigs per group (75-85 kg). For SPIDER-graft (groups I and II), the infra-diaphragmatic aorta was exposed through retroperitoneal access. The right iliac branch was first temporarily anastomosed end-to-side to the distal aorta maintaining periprocedural retrograde visceral perfusion. SPIDER-graft was deployed in the descending thoracic aorta via the celiac artery ostium. The celiac, superior mesenteric, and renal arteries were successively connected to the corresponding side branches of the graft. In group II, the lumbar arteries were reimplanted into the former access branch. For control, complete thoracoabdominal exposure of the aorta was required. After crossclamping, proximal anastomosis was performed, and the celiac artery, superior mesenteric artery, renal arteries, and iliac arteries were reattached. Technical feasibility, ischemic times, blood flow, and visceral and spinal cord perfusion in the related organs were evaluated before implantation and 3 and 6 hours after implantation using transit-time flow measurement and fluorescent microspheres. RESULTS Technical success was achieved in all animals in all groups. Total aortic clamping time and selective ischemic times of related organs were significantly longer during open aortic repair compared with groups I and II (P < .0001). Fluorescent microspheres confirmed best spinal cord perfusion in group II. CONCLUSIONS SPIDER-graft reduced ischemic time, avoided extracorporeal circulation and thoracotomy, and improved spinal cord perfusion during thoracoabdominal aortic aneurysm repair in a pig model.
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Affiliation(s)
- Sabine Wipper
- Department of Vascular Medicine, University Heart Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Tilo Kölbel
- Department of Vascular Medicine, University Heart Center Hamburg-Eppendorf, Hamburg, Germany
| | - Harleen K Sandhu
- Department of Cardiothoracic and Vascular Surgery, McGovern Medical School, UTHealth, Houston, Tex
| | - Daniel Manzoni
- Department of Vascular Medicine, University Heart Center Hamburg-Eppendorf, Hamburg, Germany
| | - Anna Duprée
- Department of General and Visceral Surgery, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Anthony L Estrera
- Department of Cardiothoracic and Vascular Surgery, McGovern Medical School, UTHealth, Houston, Tex; Heart and Vascular Institute, Memorial Herman Hospital, Texas Medical Center, Houston, Tex
| | - Hazim Safi
- Department of Cardiothoracic and Vascular Surgery, McGovern Medical School, UTHealth, Houston, Tex; Heart and Vascular Institute, Memorial Herman Hospital, Texas Medical Center, Houston, Tex
| | - Charles C Miller
- Department of Cardiothoracic and Vascular Surgery, McGovern Medical School, UTHealth, Houston, Tex
| | - Nikolaos Tsilimparis
- Department of Vascular Medicine, University Heart Center Hamburg-Eppendorf, Hamburg, Germany
| | - E Sebastian Debus
- Department of Vascular Medicine, University Heart Center Hamburg-Eppendorf, Hamburg, Germany
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Open surgical thoracoabdominal aortic aneurysm repair: The Heidelberg experience. J Thorac Cardiovasc Surg 2018; 156:2067-2073. [DOI: 10.1016/j.jtcvs.2018.05.081] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 04/24/2018] [Accepted: 05/01/2018] [Indexed: 01/18/2023]
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Inhibition of MicroRNA-204 Conducts Neuroprotection Against Spinal Cord Ischemia. Ann Thorac Surg 2018; 107:76-83. [PMID: 30278168 DOI: 10.1016/j.athoracsur.2018.07.082] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2017] [Revised: 06/19/2018] [Accepted: 07/30/2018] [Indexed: 12/16/2022]
Abstract
BACKGROUND MicroRNA(miR)-204 is an autophagy- and apoptosis-related gene. Neuroprotection by the inhibition of miR-204 against spinal cord ischemia was evaluated, and the roles of neuronal autophagy and apoptosis were investigated. METHODS Spinal cord ischemia was conducted in rats by cross-clamping the descending aorta for 14 minutes. Inhibition of miR-204 was induced by intrathecal injection of lentivirus vectors containing antagomiR-204. Hind-limb motor function was assessed with the motor deficit index. Lumbar spinal cords were harvested for histologic examinations and terminal deoxynucleotidyl transferase-mediated dUTP-biotin nick-end labeling staining. Autophagy was evaluated by the LC3-II/LC3-I ratio and beclin-1 expression. Expressions of LC3-I, LC3-II, beclin-1, B-cell lymphoma-2 (BCL-2), caspase-3, and miR-204 were measured by Western blot and quantitative real-time polymerase chain reaction. Autophagy was blocked by 3-methyladenine. RESULTS Transient ischemia enhanced miR-204 expression and the LC3-II/LC3-I ratio and downregulated BCL-2 expression in spinal cords in a time-dependent manner. AntagomiR-204 significantly reduced expressions of miR-204 and caspase-3, dramatically upregulated expressions of beclin-1 and BCL-2 and the LC3-II/LC3-I ratio in spinal cords after reperfusion. Compared with controls, inhibition of miR-204 markedly decreased the motor deficit index scores at 6, 12, 24, and 48 hours after reperfusion; increased the number of viable motor neurons; and decreased the number of apoptotic neurons. 3-Methyladenine completely abolished enhancements of the LC3-II/LC3-I ratio and beclin-1 expression induced by antagomiR-204 and inhibited the protective effect on hind-limb motor function. CONCLUSIONS Inhibition of miR-204 exerts spinal cord protection against ischemia-reperfusion injury, possibly via promotion of autophagy and antiapoptotic effects.
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Li Z, Yin H, Wang M, Wu R, Liu C, Yao C, Chang G. Octopus Endograft Technique to Treat a Ruptured Thoracoabdominal Aortic Aneurysm. J Endovasc Ther 2018; 25:237-241. [PMID: 29552983 DOI: 10.1177/1526602818761663] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Zilun Li
- Division of Vascular Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Henghui Yin
- Division of Interventional Radiology and Vascular Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Mian Wang
- Division of Vascular Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Ridong Wu
- Division of Vascular Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Chenshu Liu
- Division of Vascular Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Chen Yao
- Division of Vascular Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Guangqi Chang
- Division of Vascular Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
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Waked K, Schepens M. State-of the-art review on the renal and visceral protection during open thoracoabdominal aortic aneurysm repair. J Vis Surg 2018; 4:31. [PMID: 29552513 DOI: 10.21037/jovs.2018.01.12] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Accepted: 01/10/2018] [Indexed: 12/13/2022]
Abstract
During open thoracoabdominal aortic aneurysm repair (OTAAAR), there is an inevitable organ ischemic period that occurs when the abdominal arteries are being reattached to the aortic graft. Despite various protective techniques, the incidence of renal and visceral complications remains substantial. This state-of-the-art review gives an overview of the current and most evidence-based organ protection methods during OTAAAR, based on the most recent publications and personal experience. An electronic search was performed in four medical databases, using the following MeSH terms: thoracoabdominal aneurysm, TAAAR, visceral protection, renal protection, kidney, perfusion, and intestines. Every publication type was considered. The literature search was ended on August 31st, 2017. The left heart bypass (LHB) is currently the most frequent adjunct to provide distal aortic perfusion (DAP) during aortic clamping. Together with systemic hypothermia, it forms the cornerstone in organ protection during aortic clamping. Further renal protection can be obtained by selective renal perfusion (SRP) with cold blood or cold crystalloid solution, the latter enriched with mannitol. The perfusion should be administered in a volume- and pressure-controlled way and, if possible, by use of a pulsatile pump. Selective visceral perfusion (SVP) is not routinely used, as it does not provide adequate blood flow for visceral protection. The best way to protect the intestines is by minimizing the ischemic time. The preservation of renal and visceral function after OTAAAR can only be obtained with specific strategies before, during, and after the operation. This involves a series of measures, including selective digestive decontamination (SDD), avoidance of nephrotoxic drugs, minimizing the renal and intestinal ischemic time, systemic cooling, avoidance of hemodynamic instability, and regional protective perfusion of the kidneys. Future innovations in catheters, cardiac bypass flow types, mechanical components, hybrid vascular grafts, and pharmaceutical protection measures will hopefully further reduce organ complications.
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Affiliation(s)
- Karl Waked
- Department of Cardiovascular Surgery, AZ Sint Jan Hospital, Brugge, Belgium
| | - Marc Schepens
- Department of Cardiovascular Surgery, AZ Sint Jan Hospital, Brugge, Belgium
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Elhelali A, Hynes N, Devane D, Sultan S, Kavanagh EP, Morris L, Veerasingam D, Jordan F. Hybrid repair versus conventional open repair for thoracic aortic arch aneurysms. Cochrane Database Syst Rev 2018. [DOI: 10.1002/14651858.cd012923] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Affiliation(s)
- Ala Elhelali
- Galway-Mayo Institute of Technology; Mechanical and Industrial Engineering; Dublin Road Galway Ireland
| | - Niamh Hynes
- The Galway Clinic; Department of Vascular and Endovascular Surgery; Doughiska Galway Ireland
| | - Declan Devane
- National University of Ireland Galway; School of Nursing and Midwifery; University Road Galway Ireland
| | - Sherif Sultan
- Galway University Hospital; Vascular Surgery; Newcastle Galway Ireland
| | - Edel P Kavanagh
- The Galway Clinic; Department of Vascular and Endovascular Surgery; Doughiska Galway Ireland
| | - Liam Morris
- Galway-Mayo Institute of Technology; Mechanical and Industrial Engineering; Dublin Road Galway Ireland
| | - Dave Veerasingam
- Galway University Hospital; Cardiothoracic Surgery; Newcastle Road Galway Ireland
| | - Fionnuala Jordan
- National University of Ireland Galway; School of Nursing and Midwifery; University Road Galway Ireland
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Open descending thoracic or thoracoabdominal aortic approaches for complications of endovascular aortic procedures: 19-year experience. J Thorac Cardiovasc Surg 2018; 155:10-18. [DOI: 10.1016/j.jtcvs.2017.08.023] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Revised: 07/20/2017] [Accepted: 08/11/2017] [Indexed: 11/19/2022]
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Debus ES, Kölbel T, Duprée A, Daum G, Sandhu HK, Manzoni D, Wipper SH. Feasibility Study of a Novel Thoraco-abdominal Aortic Hybrid Device (SPIDER-graft) in a Translational Pig Model. Eur J Vasc Endovasc Surg 2017; 55:196-205. [PMID: 29290476 DOI: 10.1016/j.ejvs.2017.11.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Accepted: 11/15/2017] [Indexed: 12/30/2022]
Abstract
BACKGROUND The hybrid SPIDER-graft consists of a proximal descending aortic stent graft and a conventional six branched Dacron graft for open abdominal aortic repair. Technical feasibility with regard to avoiding thoracotomy and extracorporeal circulation (ECC) during thoraco-abdominal aortic hybrid repair and peri-procedural safety of this novel device are unknown. MATERIAL AND METHODS This was a feasibility and safety study in domestic pigs (75-85 kg). The abdominal aorta including iliac bifurcation, left renal artery, and visceral arteries were exposed via retroperitoneal access. The right iliac branch was first temporarily anastomosed end to side to the distal aorta via partial clamping. During inflow reduction and infra-coeliac cross-clamping, the coeliac trunk (CT) was divided and the proximal stent graft portion of the SPIDER-graft was deployed into the descending aorta via the CT ostium. Retrograde visceral and antegrade aorto-iliac blood flow was maintained via the iliac side branch. The visceral, renal, and iliac arteries were sequentially anastomosed, finally replacing the first iliac end to side anastomosis. Technical success, blood flow, periods of ischaemia, and peri-procedural complications were evaluated after intra-operative completion angiography and post-operative computed tomography angiography. RESULTS Six animals underwent successful thoracic stent graft deployment and distal open reconstruction without peri-operative death. The median thoracic graft implantation time was 4.5 min, and the median ischaemia times before reperfusion were 10 min for the CT, 8 min for the superior mesenteric artery, 13 min for the right renal artery, and 22 min for the left renal artery. Angiography demonstrated appropriate graft implantation and blood flow measurements confirmed sufficient blood flow through all side branches. CONCLUSION In this translational pig model, thoraco-abdominal hybrid repair using the novel SPIDER-graft was successful in avoiding thoracotomy and ECC. Technical feasibility and safety appear promising, but need to be reassessed in humans.
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Affiliation(s)
- Eike S Debus
- Department for Vascular Medicine, University Heart Centre, University Hospital Eppendorf, Hamburg, Germany.
| | - Tilo Kölbel
- Department for Vascular Medicine, University Heart Centre, University Hospital Eppendorf, Hamburg, Germany
| | - Anna Duprée
- Department of General and Visceral Surgery, University Hospital Hamburg Eppendorf, Hamburg, Germany
| | - Günter Daum
- Department for Vascular Medicine, University Heart Centre, University Hospital Eppendorf, Hamburg, Germany
| | - Harleen K Sandhu
- Department of Cardiothoracic and Vascular Surgery, McGovern Medical School at UTHealth, Houston, TX, USA
| | - Daniel Manzoni
- Department for Vascular Medicine, University Heart Centre, University Hospital Eppendorf, Hamburg, Germany
| | - Sabine H Wipper
- Department for Vascular Medicine, University Heart Centre, University Hospital Eppendorf, Hamburg, Germany
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Wang H, Wagner M, Benrashid E, Keenan J, Wang A, Ranney D, Yerokun B, Gaca JG, McCann RL, Hughes GC. Outcomes of Reoperation After Acute Type A Aortic Dissection: Implications for Index Repair Strategy. J Am Heart Assoc 2017; 6:e006376. [PMID: 28974497 PMCID: PMC5721847 DOI: 10.1161/jaha.117.006376] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Accepted: 07/28/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND The optimal surgical approach for management of acute type A aortic dissection remains controversial. This study aimed to assess outcomes of reoperation after acute type A dissection repair to help guide decision making around index operative strategy. METHODS AND RESULTS All aortic reoperations (n=129) at a single referral institution from August 2005 to April 2016 after prior acute type A dissection repair were reviewed. The primary outcome was 30-day or in-hospital mortality. Secondary outcomes included organ-specific morbidity and 1- and 5-year outcomes as estimated using the Kaplan-Meier method. The majority of initial reoperations were proximal aortic (aortic valve, aortic root, or ascending) or aortic arch procedures (62.5%, n=55); most initial reoperations were performed in the elective setting (83.1%, n=74). Additional nonstaged second or more reoperations were required in 21 patients (23.6%) after the initial reoperation, during a median follow-up of 2.5 years after the initial reoperation. Thirty-day or in-hospital mortality for all reoperations was 7.0% (elective: 6.3%; nonelective: 11.1%) with acceptable rates of organ-specific morbidity, given the procedural complexity. One- and 5-year overall survival after initial reoperation was 85.9% and 64.9%, respectively, with aorta-specific survival of 88% at 5 years. CONCLUSIONS Reoperation after acute type A aortic dissection repair is associated with low rates of mortality and morbidity. These data support more limited index repair for acute type A dissection, especially for patients undergoing index repair in lower volume centers without expertise in extensive repair, because reoperations, if needed, can be performed safely in referral aortic centers.
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Affiliation(s)
- Hanghang Wang
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, NC
| | - Matthew Wagner
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, NC
| | - Ehsan Benrashid
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, NC
| | - Jeffrey Keenan
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, NC
| | - Alice Wang
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, NC
| | - David Ranney
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, NC
| | - Babatunde Yerokun
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, NC
| | - Jeffrey G Gaca
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, NC
| | - Richard L McCann
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, NC
| | - G Chad Hughes
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, NC
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Hobbs RD, Wallen TJ, Komlo CM, Moeller PJ, Pochettino A, Bavaria JE, Vallabhajosyula P. Central cannulation strategy for extent I thoracoabdominal aneurysm repair of chronic type B aortic dissection. J Card Surg 2017; 32:494-499. [DOI: 10.1111/jocs.13171] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Reilly D. Hobbs
- Department of Cardiovascular Surgery; Hospital of the University of Pennsylvania; Philadelphia Pennsylvania
| | - Tyler J. Wallen
- Department of Cardiovascular Surgery; Hospital of the University of Pennsylvania; Philadelphia Pennsylvania
| | - Caroline M. Komlo
- Department of Cardiovascular Surgery; Hospital of the University of Pennsylvania; Philadelphia Pennsylvania
| | - Patrick J. Moeller
- Department of Cardiovascular Surgery; Hospital of the University of Pennsylvania; Philadelphia Pennsylvania
| | - Alberto Pochettino
- Department of Cardiovascular Surgery; The Mayo Clinic; Rochester Minnesota
| | - Joseph E. Bavaria
- Department of Cardiovascular Surgery; Hospital of the University of Pennsylvania; Philadelphia Pennsylvania
| | - Prashanth Vallabhajosyula
- Department of Cardiovascular Surgery; Hospital of the University of Pennsylvania; Philadelphia Pennsylvania
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Moreno Bermudez K, Arias Páez C, Bautista Vacca C. Abordaje híbrido de la disfunción aórtica: a propósito de 2 casos y revisión de la literatura. ANGIOLOGIA 2017. [DOI: 10.1016/j.angio.2016.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Repair of Thoracoabdominal Aortic Aneurysm with Thrombosed Infrarenal Component: A Modified Hybrid Technique without Aortic Cross Clamping. Case Rep Med 2017. [PMID: 28642793 PMCID: PMC5470002 DOI: 10.1155/2017/7432032] [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: 12/03/2022] Open
Abstract
The authors report the successful repair of a Crawford type III thoracoabdominal aortic aneurysm (TAAA) with a thrombosed infrarenal component using a modified hybrid technique without aortic clamping in a high-risk patient. A 64-year-old male with a history of hypertension, diabetes, and severe chronic obstructive pulmonary disease presented with acute on chronic backache and bilateral short distance claudication. A computerized tomography scan demonstrated a large, nonleaking Crawford type III TAAA with thrombosed infrarenal component of the aneurysm. In addition, both common iliac arteries were occluded with the chronic thrombus. A single-stage, modified hybrid procedure involving an aortobifemoral bypass without aortic clamping, debranching of right renal, superior mesenteric, and celiac arteries as well as an endovascular repair of the thoracic aneurysm was performed. Unfortunately, despite a technically sound repair, the patient died postoperatively from a massive pulmonary embolism. TAAA with a thrombosed infrarenal aorta and bilateral common iliac arteries can be repaired using a single-stage modified hybrid procedure without aortic clamping in high-risk patients who cannot tolerate thoracotomy and aortic cross clamping.
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Liu K, Yan L, Jiang X, Yu Y, Liu H, Gu T, Shi E. Acquired inhibition of microRNA-124 protects against spinal cord ischemia-reperfusion injury partially through a mitophagy-dependent pathway. J Thorac Cardiovasc Surg 2017. [PMID: 28623098 DOI: 10.1016/j.jtcvs.2017.05.046] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Mitophagy results in selective clearance of damaged mitochondria. We investigated whether mitophagy was involved in the neuroprotection by inhibiting microRNA (miRNA)-124 on ischemic spinal cords. METHODS Inhibition of miRNA-124 was conducted by intrathecal injection of lentivirus vectors containing antagomiR-124. Spinal cord ischemia was induced in rats by crossclamping the descending aorta just distal to the left subclavian artery for 14 minutes. Hind-limb motor function was assessed with the motor deficit index (MDI). Lumbar spinal cords were harvested for ultrastructural, histologic examinations, and terminal deoxynucleotidyl transferase-mediated dUTP-biotin nick-end labeling staining. Mitophagy was evaluated by expressions of beclin-1 and LC3-II in mitochondria. Expressions of inhibitory member of the apoptosis-stimulating proteins of p53 family, p53, beclin-1, LC3-II, and miRNA-124 were measured by Western blot and quantitative real-time polymerase chain reaction. Mitophagy was inhibited by the antagonist of 3-methyladenine. RESULTS Compared with control animals, antagomiR-124 significantly inhibited expressions of miRNA-124 (P < .01) and p53 (P < .05) and enhanced expressions of inhibitory member of the apoptosis-stimulating proteins of p53 family, becline-1 and LC3-II (P < .01, respectively) in spinal cords. MDI at 6, 12, 24, and 48 hours after reperfusion were markedly lower in antagomiR-124 group (P < .01, vs control group, respectively). More motor neurons and less apoptotic cells were detected in lumbar spinal cords of antagomiR-124 group (P < .01 vs control group). Administration of 3-methyladenine completely abolished enhancements of mitochondrial becline-1 and LC3-II by antagomiR-124 (P < .01 vs antagomiR-124 group) and partially inhibited effects of antagomiR-124 on MDI, number of motor neurons, and apoptotic cells (P < .01 or < .05 vs control group and antagomiR-124 group, respectively). CONCLUSIONS Inhibition of miRNA-124 exerts neuroprotection on spinal cords against ischemia-reperfusion injury, possibly by induction of mitophagy and antiapoptotic effects.
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Affiliation(s)
- Kun Liu
- Department of Cardiac Surgery, First Affiliated Hospital, China Medical University, Shenyang, People's Republic of China
| | - Lihui Yan
- Department of Anesthesiology, Liaoning Cancer Hospital and Institute, Shenyang, People's Republic of China; Department of Anesthesiology, First Affiliated Hospital, China Medical University, Shenyang, People's Republic of China
| | - Xiaojing Jiang
- Department of Anesthesiology, First Affiliated Hospital, China Medical University, Shenyang, People's Republic of China
| | - Yang Yu
- Department of Cardiac Surgery, First Affiliated Hospital, China Medical University, Shenyang, People's Republic of China
| | - Hongbo Liu
- Department of Health Statistics, School of Public Health, China Medical University, Shenyang, People's Republic of China
| | - Tianxiang Gu
- Department of Cardiac Surgery, First Affiliated Hospital, China Medical University, Shenyang, People's Republic of China
| | - Enyi Shi
- Department of Cardiac Surgery, First Affiliated Hospital, China Medical University, Shenyang, People's Republic of China.
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Wahlgren CM, Blohmé L, Günther A, Nilsson L, Olsson C. Outcomes of Left Heart Bypass Versus Circulatory Arrest in Elective Open Surgical Descending and Thoraco-abdominal Aortic Repair. Eur J Vasc Endovasc Surg 2017; 53:672-678. [DOI: 10.1016/j.ejvs.2017.02.027] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Accepted: 02/23/2017] [Indexed: 11/28/2022]
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von Aspern K, Bakhtiary F, Misfeld M, Mohr FW, Etz CD. Paraspinale Nahinfrarotspektroskopie zur indirekten Überwachung der Rückenmarkoxygenierung. GEFASSCHIRURGIE 2017. [DOI: 10.1007/s00772-017-0244-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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