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Kreuzer M, Sames-Dolzer E, Klapper M, Tulzer A, Mair R, Seeber F, Gierlinger G, Saric D, Mair R. The anatomic repair of recurrent aortic arch obstruction in children and adolescents. JTCVS OPEN 2024; 19:215-222. [PMID: 39015463 PMCID: PMC11247212 DOI: 10.1016/j.xjon.2024.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 03/22/2024] [Accepted: 04/09/2024] [Indexed: 07/18/2024]
Abstract
Objective Surgery for recurrent aortic arch obstruction is highly challenging and publications are rare. The aim of this retrospective, single-center study was to evaluate mortality, complications, and reintervention rate after an anatomic repair. Methods Between 1999 and 2022, in total 946 operations on the aortic arch were performed at the Children's Heart Center Linz. In 39 cases, the indication was a recurrent or residual aortic arch obstruction or coarctation in a patient aged 18 years or younger. This is our study cohort. The aorta was reconstructed by a direct anastomosis/autograft in 20 patients, patch in 17 patients, and interposition graft in 2 adolescents. In 32 procedures, cardiopulmonary bypass with whole body perfusion was employed, in 4, antegrade cerebral perfusion was employed, in 2, a left heart bypass was employed, and in 1 no cardiopulmonary bypass was used. Results Median (Q1, Q3) age at operation was 253 days (100, 2198 days), weight 7.5 kg (4.5, 17.8 kg). Median cardiopulmonary bypass time was 177 minutes (115, 219 minutes), crossclamp time 73 minutes (49, 102 minutes). Three infants died during the hospital stay: 1 with Williams syndrome, 1 with hypoplastic left heart syndrome, and 1 with heterotaxia. There was no death due to an arch complication. The main complications were 1 neurologic injury after postoperative resuscitation (Williams syndrome) and 1 permanent recurrent laryngeal nerve paralysis. During the follow-up period of median 8.1 years (2.6, 12 years) 1 re-reintervention on the aortic arch was necessary. Conclusions Sophisticated reoperations on the aortic arch could be performed safely. In children, the growth potential of all segments of the aorta could be sustainably preserved by avoiding interposition or extra-anatomic bypass grafts.
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Affiliation(s)
- Michaela Kreuzer
- Division of Pediatric and Congenital Heart Surgery, Kepler University Hospital, Linz, Austria
- Medical Faculty, Johannes Kepler University Linz, Linz, Austria
| | - Eva Sames-Dolzer
- Division of Pediatric and Congenital Heart Surgery, Kepler University Hospital, Linz, Austria
- Medical Faculty, Johannes Kepler University Linz, Linz, Austria
| | - Melanie Klapper
- Division of Pediatric and Congenital Heart Surgery, Kepler University Hospital, Linz, Austria
| | - Andreas Tulzer
- Medical Faculty, Johannes Kepler University Linz, Linz, Austria
- Department of Pediatric Cardiology, Kepler University Hospital, Linz, Austria
| | - Roland Mair
- Division of Pediatric and Congenital Heart Surgery, Kepler University Hospital, Linz, Austria
| | - Fabian Seeber
- Division of Pediatric and Congenital Heart Surgery, Kepler University Hospital, Linz, Austria
| | - Gregor Gierlinger
- Division of Pediatric and Congenital Heart Surgery, Kepler University Hospital, Linz, Austria
- Medical Faculty, Johannes Kepler University Linz, Linz, Austria
| | - Dalibor Saric
- Department of Pediatric Cardiology, Klinički Bolnički Centar Zagreb, Zagreb, Croatia
| | - Rudolf Mair
- Division of Pediatric and Congenital Heart Surgery, Kepler University Hospital, Linz, Austria
- Medical Faculty, Johannes Kepler University Linz, Linz, Austria
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Couture T, Gaudric J, Davaine JM, Jayet J, Chiche L, Jarraya M, Koskas F. Results of cryopreserved arterial allograft replacement for thoracic and thoracoabdominal aortic infections. J Vasc Surg 2021; 73:626-634. [PMID: 33485491 DOI: 10.1016/j.jvs.2020.05.052] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 05/29/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Primary and secondary thoracic aortic infections are rare but associated with high morbidity and mortality. There is currently no consensus on their optimal treatment. Arterial allografts have been shown to be resistant to bacterial colonization. Complete excision of infected material, especially synthetic grafts, combined with in situ aortic repair is considered the best treatment of abdominal aortic infections. The aim of this study was to assess the management of thoracic and thoracoabdominal aortic infections using arterial allografts. METHODS Between January 2009 and December 2017, all patients with thoracic and thoracoabdominal aortic native or graft infections underwent complete excision of infected material and in situ arterial allografting. The end points were the early mortality and morbidity rates and early and late rates of reinfection, graft degeneration, and graft-related morbidity. RESULTS Thirty-five patients with a mean age of 65.6 ± 9.2 years were included. Twenty-one (60%) cases experienced graft infections and 14 (40%) experienced native aortic infections. Eight (22.8%) patients had visceral fistulas: 5 (14.4%) prosthetic-esophageal, 1 (2.8%) prosthetic-bronchial, 1 (2.8%) prosthetic-duodenal, and 1 (2.8%) native aortobronchial. In 12 (34.3%) cases, only the descending thoracic aorta was involved; in 23 (65.7%) cases, the thoracoabdominal aorta was involved. Fifteen (42.8%) patients died during the first month or before discharge: 5 of hemorrhage, 4 of multiorgan failure, 3 of ischemic colitis, 2 of pneumonia, and 1 of anastomotic disruption. Eleven (31.5%) patients required early revision surgery: 6 (17.1%) for nongraft-related hemorrhage, 3 (8.6%) for colectomy, 1 (2.9%) for proximal anastomotic disruption, and 1 (2.9%) for tamponade. One (2.9%) patient who died before discharge experienced paraplegia. One (2.9%) patient experienced stroke. Six (17.1%) patients required postoperative dialysis. Among them, four died before discharge. The mean length of stay in the intensive care unit was 11 ± 10.5 days; the mean length of hospital stay was 32 ± 14 days. During a mean follow-up of 32.3 ± 23.7 months, three allograft-related complications occurred in survivors (15% of late survivors): one proximal and one distal false aneurysm with no evidence of reinfection and one allograft-enteric fistula. The 1-year and 2-year survival rates were 49.3% and 42.5%, respectively. CONCLUSIONS Although rare, aortic infections are highly challenging. Surgical management includes complete excision of infected tissues or grafts. Allografts offer a promising solution to aortic graft infection because they appear to resist reinfection; however, the grafts must be observed indefinitely because of the risk of late graft complications.
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Affiliation(s)
- Thibault Couture
- Faculty of Medicine, Sorbonne University, Paris, France; Department of Vascular Surgery, Pitié-Salpêtrière University Hospital, Paris, France.
| | - Julien Gaudric
- Faculty of Medicine, Sorbonne University, Paris, France; Department of Vascular Surgery, Pitié-Salpêtrière University Hospital, Paris, France
| | - Jean-Michel Davaine
- Faculty of Medicine, Sorbonne University, Paris, France; Department of Vascular Surgery, Pitié-Salpêtrière University Hospital, Paris, France
| | - Jérémie Jayet
- Faculty of Medicine, Sorbonne University, Paris, France; Department of Vascular Surgery, Pitié-Salpêtrière University Hospital, Paris, France
| | - Laurent Chiche
- Faculty of Medicine, Sorbonne University, Paris, France; Department of Vascular Surgery, Pitié-Salpêtrière University Hospital, Paris, France
| | | | - Fabien Koskas
- Faculty of Medicine, Sorbonne University, Paris, France; Department of Vascular Surgery, Pitié-Salpêtrière University Hospital, Paris, France
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Endicott KM, Taylor B, Toursavadkohi S. Management of thoracic aortic graft infections. ITALIAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY 2020. [DOI: 10.23736/s1824-4777.19.01430-x] [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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4
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Federici D, Bichi S, Montesi G, Matiashvili D, Agostinis C, Morzenti C, Sironi S, Galletti L. Native Aortic Arch Interruption in Adulthood: Surgical Management. AORTA : OFFICIAL JOURNAL OF THE AORTIC INSTITUTE AT YALE-NEW HAVEN HOSPITAL 2019; 7:84-86. [PMID: 31614377 PMCID: PMC6794140 DOI: 10.1055/s-0039-1688957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Aortic coarctations in adults are mainly represented by recurrent critical narrowing at the site of previous surgical correction, or less frequently by native forms of complex obstructive malformations of the distal arch and isthmus. We present our experience with an unusual form of native adult aortic coarctation presenting as a complete interruption of the aortic arch.
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Affiliation(s)
- Duccio Federici
- Pediatric Cardiac Surgery, Ospedale del Cuore G. Pasquinucci, Monasterio Foundation, Massa, Italy
| | - Samuele Bichi
- Cardiac Surgery Unit, Department of Cardiovascular, "Papa Giovanni XXIII" Hospital, Bergamo, Italy
| | - Gianfranco Montesi
- Cardiac Surgery Unit, Department of Cardiothoracic and Vascular Surgery, "Santa Maria alle Scotte" Hospital, Siena, Italy
| | - David Matiashvili
- Cardiac Surgery Unit, Department of Cardiovascular, "Papa Giovanni XXIII" Hospital, Bergamo, Italy
| | - Cristina Agostinis
- Departement of Radiology, "Papa Giovanni XXIII" Hospital, Bergamo, Italy
| | - Cesare Morzenti
- Departement of Radiology, "Papa Giovanni XXIII" Hospital, Bergamo, Italy
| | - Sandro Sironi
- Departement of Radiology, "Papa Giovanni XXIII" Hospital, Bergamo, Italy
| | - Lorenzo Galletti
- Pediatric Cardiac Surgery, Ospedale Pediatrico Bambin Gesù, Roma
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5
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Extraanatomic Bypass of a Complex Adult Coarctation. Ann Thorac Surg 2018; 106:e151-e154. [DOI: 10.1016/j.athoracsur.2018.03.080] [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] [Received: 01/26/2018] [Revised: 03/25/2018] [Accepted: 03/29/2018] [Indexed: 11/17/2022]
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Kahlberg A, Melissano G, Mascia D, Loschi D, Grandi A, Chiesa R. How to best treat infectious complications of open and endovascular thoracic aortic repairs. Semin Vasc Surg 2017; 30:95-102. [PMID: 29248127 DOI: 10.1053/j.semvascsurg.2017.11.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Infectious complications of open and endovascular procedures for descending thoracic aortic disease are relatively rare, affecting 1% to 6% of treated patients. However, the number of thoracic aortic procedures, especially endovascular, is increasing continuously, and infectious complications involving the graft or endograft have been observed more frequently in recent years. Several causative factors may play a role in thoracic aortic prosthetic infections, including hematogenous seeding, local bacterial translocation, and iatrogenous contamination. In addition, the development of a fistula between the aortic graft and the esophagus or the bronchial tree is a common associated finding, representing a dramatic event that further increases mortality rates and requires multidisciplinary management. Treatment of these conditions is demanding, often including a number of pharmacological, surgical, and endovascular options. Because there are several different surgical strategies and timing modalities that are chosen according to the surgeon's experience, the results of different treatment options are difficult to summarize, and no consensus exists on a standardized paradigm of treatment. In this review, published reports regarding clinical outcomes related to thoracic graft and endograft infections are discussed, including our personal experience with surgical and endovascular management of this condition.
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Affiliation(s)
- Andrea Kahlberg
- Department of Vascular Surgery, Vita-Salute University School of Medicine, San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milano, Italy.
| | - Germano Melissano
- Department of Vascular Surgery, Vita-Salute University School of Medicine, San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milano, Italy
| | - Daniele Mascia
- Department of Vascular Surgery, Vita-Salute University School of Medicine, San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milano, Italy
| | - Diletta Loschi
- Department of Vascular Surgery, Vita-Salute University School of Medicine, San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milano, Italy
| | - Alessandro Grandi
- Department of Vascular Surgery, Vita-Salute University School of Medicine, San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milano, Italy
| | - Roberto Chiesa
- Department of Vascular Surgery, Vita-Salute University School of Medicine, San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milano, Italy
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Spratt JR, Shumway SJ. Historical perspectives of The American Association for Thoracic Surgery: Hartzell V. Schaff, MD. J Thorac Cardiovasc Surg 2017; 154:1-6. [PMID: 28366547 DOI: 10.1016/j.jtcvs.2017.02.043] [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: 02/12/2017] [Accepted: 02/28/2017] [Indexed: 10/20/2022]
Affiliation(s)
- John R Spratt
- Department of Surgery, University of Minnesota Medical School, Minneapolis, Minn
| | - Sara J Shumway
- Department of Surgery, University of Minnesota Medical School, Minneapolis, Minn.
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Charchyan ER, Belov YV, Skvortsov AA, Salagaev GI. [Simultaneous Bentall-de-Bono procedure and descending thoracic aortic bypass through median sternotomy]. Khirurgiia (Mosk) 2017:69-71. [PMID: 29186100 DOI: 10.17116/hirurgia20171169-71] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
- E R Charchyan
- Department of Aortic surgery, Petrovsky Russian Research Center of Surgery, Moscow, Russia
| | - Yu V Belov
- Department of Aortic surgery, Petrovsky Russian Research Center of Surgery, Moscow, Russia
| | - A A Skvortsov
- Department of Aortic surgery, Petrovsky Russian Research Center of Surgery, Moscow, Russia
| | - G I Salagaev
- Department of Aortic surgery, Petrovsky Russian Research Center of Surgery, Moscow, Russia
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Single center experience of aortic bypass graft for aortic arch obstruction in children. Heart Vessels 2016; 32:76-82. [PMID: 27120172 DOI: 10.1007/s00380-016-0842-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Accepted: 04/15/2016] [Indexed: 11/27/2022]
Abstract
The purpose of this study is to access the outcomes of aortic bypass graft placement in children. This is a retrospective review of all children having aortic bypass graft placement for aortic arch obstruction for the first time between 1982 and 2013 at a single institution. The actuarial survival and the freedom from aortic arch reoperation were calculated and compared between the groups. Seventy consecutive children underwent aortic bypass graft placements. The median age and body weight at the operation were 14 days and 3.6 kg. There were 7 early deaths, 6 late deaths, and 7 heart transplants during the median follow-up of 10.8 years (0.0-31.5 years). The actuarial transplant free survival was 64.7 % at 20 years and the freedom from aortic arch reoperation was 50.5 % at 10 years. Between the children younger than 1 year old and older than 1 year old, there were significant differences in actuarial transplant free survival (56.4 vs. 100 % at 15 years, p = 0.0042) and in the freedom from aortic arch reoperation (18.7 vs. 100 % at 10 years, p < 0.001). The children who received aortic bypass graft larger than 16 mm in size had no aortic arch reoperation at 15 years. The aortic bypass graft placement for aortic arch obstruction can be done with low mortality and morbidity for children who can receive bypass graft larger than 16 mm in size. However, it should be avoided for the neonates and infants except selected situations.
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Repair of primary or complicated aortic coarctation in the adult with cardiopulmonary bypass and hypothermic circulatory arrest. J Thorac Cardiovasc Surg 2015; 149:S83-5. [DOI: 10.1016/j.jtcvs.2014.07.071] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Accepted: 07/24/2014] [Indexed: 11/21/2022]
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11
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Mery CM, Khan MS, Guzmán-Pruneda FA, Verm R, Umakanthan R, Watrin CH, Adachi I, Heinle JS, McKenzie ED, Fraser CD. Contemporary Results of Surgical Repair of Recurrent Aortic Arch Obstruction. Ann Thorac Surg 2014; 98:133-40; discussion 140-1. [DOI: 10.1016/j.athoracsur.2014.01.065] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2013] [Revised: 01/10/2014] [Accepted: 01/29/2014] [Indexed: 10/25/2022]
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12
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Ascending-to-descending aortic bypass: a simple solution to a complex problem. Ann Thorac Surg 2014; 97:2041-7; discussion 2047-8. [PMID: 24725830 DOI: 10.1016/j.athoracsur.2014.02.030] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2013] [Revised: 01/16/2014] [Accepted: 02/04/2014] [Indexed: 01/01/2023]
Abstract
BACKGROUND Surgical correction of complex aortic coarctation can be associated with significant risks. Extraanatomic bypass may represent a safer alternative. METHODS Between January 1985 and December 2012, 80 consecutive patients with complex coarctation underwent ascending-to-descending aortic bypass through a median sternotomy. Patients were a median age of 42 years (range, 15 to 75 years), and 51 (64%) were males. Recurrent coarctation was present in 52 patients (65%), with 6 (8%) having undergone balloon dilatation. Uncontrolled hypertension was present in 63 patients (79%). The most common concomitant pathology was aortic valve stenosis in 21 patients (26%), subaortic stenosis in 10 (13%), and Shone complex in 4 (5%). RESULTS There were no early deaths. The most common concomitant procedures were aortic valve replacement, coronary artery bypass grafting, and resection of subaortic stenosis. The mean aortic cross-clamp and cardiopulmonary bypass times were 33 ± 40 and 106 ± 54 minutes, respectively. Morbidity included atrial fibrillation in 17 patients (21%) and reexploration for bleeding in 6 (8%). There was no paraplegia or stroke. Upper extremity blood pressure significantly improved (p < 0.001). Mean systolic blood pressure decreased from 153 ± 26 mm Hg preoperatively to 123 ± 15 mm Hg postoperatively. Mean follow-up was 7 ± 6 years (maximum, 22 years). Late deaths occurred in 5 patients (6%) and were not graft-related. Three patients (4%) required reoperation for repair of periprosthetic regurgitation in 2 and mitral valve replacement in 1. CONCLUSIONS The ascending-to-descending aortic bypass can be performed with low morbidity and mortality. It is an effective solution to complex aortic coarctation and represents a safe single-stage approach for patients with concomitant cardiac pathology.
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Hokenek F, Kinoglu B, Gursoy M, Gulcan F. eComment. Ascending-descending aortic bypass in patients with complex aortic coarctation. Interact Cardiovasc Thorac Surg 2013; 17:471-2. [PMID: 23956360 DOI: 10.1093/icvts/ivt338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Faruk Hokenek
- Department of Cardiovascular Surgery, Acibadem Bahcelievler Aile Hospital, Istanbul, Turkey
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Ugur M, Alp I, Arslan G, Temizkan V, Ucak A, Yilmaz AT. Four different strategies for repair of aortic coarctation accompanied by cardiac lesions. Interact Cardiovasc Thorac Surg 2013; 17:467-71. [PMID: 23744896 DOI: 10.1093/icvts/ivt242] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Coarctation accompanied by cardiac lesions is a complex clinical situation due to the presence of two different pathologies that necessitate surgical treatment. An individual strategy, according to the severity of the disease, is important to reduce perioperative mortality and morbidity. METHODS We report here on 25 patients with coarctation accompanied by cardiac lesions who were treated by various surgical approaches. Coarctation and associated disease were treated in 14 patients in a single stage by an ascending-to-descending bypass (n = 11) or by a hybrid procedure (n = 3). The remaining 11 patients underwent a two-stage operation for their treatment. Six of these 11 patients who had coronary artery disease or signs of congestive heart failure were first operated for their cardiac disease, whereas in the remaining five patients, who did not have any congestive signs, coarctation repair was performed first. RESULTS All the patients were male, between the ages of 20 and 24 years, except for one 45-year-old woman. The mean cross-clamp times, cardiopulmonary bypass times and operation times were 52 ± 14.5, 102.3 ± 28.5 and 174 ± 24.8 min in the extra-anatomical bypass group; 29.8 ± 11.7, 55.5 ± 17.6 and 116 ± 22 min in the two-stage groups and 49 ± 19.8, 63 ± 18.7 and 159 ± 21.3 min in the hybrid patients, respectively. One patient who underwent extra-anatomical bypass died on the 14th postoperative day. There were no events during the follow-up period for the other patients. Also, there were no gradients between the extremities and no graft-related complications. CONCLUSIONS As a consequence of the progress in the development of endovascular techniques, hybrid treatment is becoming a more popular option for the treatment of coarctation accompanied by cardiac diseases. Two-stage procedures and extra-anatomical bypass might be alternative techniques if endovascular procedures are contraindicated or failing.
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Affiliation(s)
- Murat Ugur
- Department of Cardiovascular Surgery, GATA Haydarpasa Training Hospital, Istanbul, Turkey.
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Brink J, Lee MGY, Konstantinov IE, Cheung MMH, Goh TH, Bennett M, Brizard CP, d'Udekem Y. Complications of extra-anatomic aortic bypass for complex coarctation and aortic arch hypoplasia. Ann Thorac Surg 2012. [PMID: 23201107 DOI: 10.1016/j.athoracsur.2012.09.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND We have adopted the extra-anatomic bypass graft as the procedure of choice for the treatment of coarctation and aortic arch hypoplasia in the adult-sized patient. However, we have experienced prolonged chest drainage and have decided to investigate this complication and the morbidity related to this procedure. METHODS Between 1996 and 2010, 15 extra-anatomic bypass grafts of the aorta were performed in 14 patients. Their hospital records and follow-up data were retrospectively reviewed and compared with those of 14 consecutive patients operated with other conventional techniques over the same time period. RESULTS There was no hospital mortality. After the extra-anatomic bypass procedure, patients had longer hospital stay because of prolonged pleural effusions. Four patients developed complications related to persistent effusions leading to reinterventions, which led to mediastinitis in 2 instances. At last follow-up, 2 of 14 patients with extra-anatomic bypass remained hypertensive, while 8 of the 14 patients who underwent other types of repair had arch obstruction, were hypertensive, or both. CONCLUSIONS In the adult-sized patient extra-anatomic bypass of the aortic arch relieves arch obstruction more effectively than conventional techniques. However, this technique is fraught with complications related to prolonged effusion drainage that may lead to mediastinitis and reintervention. Its indication should be weighted carefully.
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Affiliation(s)
- Johann Brink
- Department of Cardiac Surgery, The Royal Children's Hospital, Melbourne, Victoria, Australia
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Erkanli K, Onan B, Akt�rk IF, Bakir I. Surgical Repair for Isolated Aortic Interruption in a Young Adult. Heart Surg Forum 2012; 15:E289-91. [DOI: 10.1532/hsf98.20111192] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Interrupted aortic arch (IAA), a rare congenital malformation of the aortic arch, is defined as a loss of luminal continuity between the ascending and descending portions of the aorta. It is rarely diagnosed as an isolated anomaly in adulthood. Surgical repair is feasible through a sternotomy or thoracotomy incision. In this report, we describe the surgical repair of an isolated IAA in a 29-year-old patient by performing an ascending-to-descending aortic bypass via a sternotomy with cardiopulmonary bypass.
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Andersen ND, Hughes GC. Reply to the Editor. J Thorac Cardiovasc Surg 2012. [DOI: 10.1016/j.jtcvs.2012.03.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Burkhart HM, Connolly HM. Previous use of ascending-decending posterior pericardial bypass with valve-sparing aortic root replacement. J Thorac Cardiovasc Surg 2012; 144:280; author reply 280-1. [PMID: 22710047 DOI: 10.1016/j.jtcvs.2012.02.017] [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: 01/23/2012] [Accepted: 02/03/2012] [Indexed: 10/28/2022]
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Lu JC, Dorfman AL, Attili AK, Ghadimi Mahani M, Dillman JR, Agarwal PP. Evaluation with Cardiovascular MR Imaging of Baffles and Conduits Used in Palliation or Repair of Congenital Heart Disease. Radiographics 2012; 32:E107-27. [DOI: 10.1148/rg.323115096] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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21
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Said SM, Dearani JA, Burkhart HM, Schaff HV. Extra-anatomic Bypass Graft for Recurrent Aortic Arch Obstruction. ACTA ACUST UNITED AC 2012. [DOI: 10.1053/j.optechstcvs.2012.10.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Yu L, Shi E, Gu T. Single-stage repair of interrupted aortic arch with simultaneous coronary artery bypass grafting without cardiopulmonary bypass in an adult. Ann Thorac Surg 2011; 92:1110-3. [PMID: 21871311 DOI: 10.1016/j.athoracsur.2011.03.043] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2010] [Revised: 12/29/2010] [Accepted: 03/07/2011] [Indexed: 10/17/2022]
Abstract
Interrupted aortic arch is a rare congenital cardiac defect. There are extremely few cases in adults that are reported in the pertinent medical literature. However, single-stage repair of interrupted aortic arch combined with coronary artery disease has been rarely reported. We describe the management of interrupted aortic arch associated with coronary artery disease through single-stage surgical procedure without cardiopulmonary bypass in a 56-year-old woman. The vascular prosthesis was anastomosed between the aortic arch just distal to the origin of the left subclavian artery and the descending thoracic aorta. Then a venous bypass was subsequently formed between the left anterior descending coronary artery, the circumflex artery, and the descending aorta.
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Affiliation(s)
- Lei Yu
- Department of Cardiac Surgery, The First Affiliated Hospital of China Medical University, Shenyang, PR China
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Ogasawara T, Daitoku K, Taniguchi S, Suzuki Y, Fukuda I. Open Plugging and Extra-Anatomical Bypass for Iatrogenic Rupture of Coarctation of the Aorta. Ann Thorac Surg 2011; 92:1106-8. [DOI: 10.1016/j.athoracsur.2011.03.050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2010] [Revised: 03/02/2011] [Accepted: 03/08/2011] [Indexed: 10/17/2022]
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24
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Andersen ND, Williams JB, Harrison JK, Hughes GC. Ascending-descending aortic bypass with valve-sparing root replacement for coarctation with aortic root aneurysm. J Thorac Cardiovasc Surg 2011; 143:514-5. [PMID: 21864852 DOI: 10.1016/j.jtcvs.2011.07.047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2011] [Accepted: 07/22/2011] [Indexed: 10/17/2022]
Affiliation(s)
- Nicholas D Andersen
- Division of Thoracic and Cardiovascular Surgery, Duke University Medical Center, Durham, NC 27710, USA
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Sachithanandan A, Badmanaban B. eComment: Trans-pericardial extra-anatomic aortic bypass for coarctation of the aorta. Interact Cardiovasc Thorac Surg 2011; 13:100. [PMID: 21697404 DOI: 10.1510/icvts.2010.265264a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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26
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Singh VP, Gupta R, Mittal CM, Aggarwal M, Ralhan S, Aslam N, Sharma VK, Wander GS. Off pump extra-anatomic aortic bypass for Type B interrupted aortic arch. Indian J Thorac Cardiovasc Surg 2011. [DOI: 10.1007/s12055-011-0090-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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John AS, Schaff HV, Drew T, Warnes CA, Ammash N. Adult Presentation of Interrupted Aortic Arch: Case Presentation and a Review of the Medical Literature. CONGENIT HEART DIS 2011; 6:269-75. [PMID: 21435185 DOI: 10.1111/j.1747-0803.2011.00486.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Anitha S John
- Division of Cardiology, Children's National Medical Center, George Washington University, Washington, DC 20008, USA.
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Burkhart HM, Dearani JA, Connolly HM, Schaff HV. Ascending-descending posterior pericardial bypass of complex coarctation of the aorta. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 2011; 14:116-119. [PMID: 21444058 DOI: 10.1053/j.pcsu.2011.01.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Recurrent coarctation or complex aortic arch obstruction can present a surgical challenge. The ascending-descending posterior pericardial aortic bypass offers a safe, reproducible solution for the surgical treatment of complex or recurrent coarctation of the aorta and facilitates concomitant cardiac surgery.
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Affiliation(s)
- Harold M Burkhart
- Division of Cardiovascular Surgery, Mayo Clinic and Foundation, Rochester, MN, USA.
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29
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Brown ML, Burkhart HM, Connolly HM, Dearani JA, Hagler DJ, Schaff HV. Late outcomes of reintervention on the descending aorta after repair of aortic coarctation. Circulation 2010; 122:S81-4. [PMID: 20837930 DOI: 10.1161/circulationaha.109.925172] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND After repair of aortic coarctation, patients may develop restenosis, aneurysms, and pseudoaneurysms at the site of prior repair. We assessed the outcomes of late reintervention on the descending aorta after aortic coarctation repair. METHODS AND RESULTS From March 1954 to July 2008, 130 patients had operations or endovascular procedures on the descending aorta after previous coarctation repair. We excluded patients who had complex left-sided cardiac lesions or interrupted aortic arch. Mean age at reintervention was 32±24 years and 28% were female. The interval between coarctation repair and reintervention was 17±13 years. Seventy-four percent of patients had hypertension. Reasons for reintervention were restenosis (n=122 [94%]), aneurysm (n=4 [3%]), and pseudoaneurysm (n=4 [3%]). Ninety-five patients (73%) underwent operative procedures including an extra-anatomic conduit (n=41), patch repair (n=32), interposition graft (n=14), end-end anastomosis (n=6), and subclavian flap (n=2). Thirty-five patients underwent endovascular treatment (balloon dilatation, n=22 or stenting, n=13). There was no early mortality. In the surgical group, 5 patients required early reoperation for bleeding and 5 patients had early vocal cord paralysis. One patient in the endovascular group had aortic rupture at the time of intervention requiring urgent operation. Survival was 97% at 10 years. At 5 years, freedom from a second repeat procedure on the descending aorta was 96% in the surgical group and 72% in the endovascular group (P<0.001). Five years after reintervention, fewer patients required treatment for hypertension (57% versus 74%, P<0.001) and a median of 1 antihypertensive medication was prescribed compared with a median of 2 medications preintervention. CONCLUSIONS Operative and endovascular management of recoarctation can be performed safely with good late outcomes.
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Affiliation(s)
- Morgan L Brown
- Department of Anesthesiology and Pain Medicine, University of Alberta, Edmonton, Alberta, Canada
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Pereda D, Cartañá R, Sundt TM, Mestres CA. Seventeen-year follow-up after ascending-to-infrarenal aorta bypass for recurrent coarctation in an adult. J Vasc Surg 2010; 52:1362-4. [PMID: 20674249 DOI: 10.1016/j.jvs.2010.06.071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2010] [Revised: 06/02/2010] [Accepted: 06/04/2010] [Indexed: 10/19/2022]
Abstract
Anatomic repair of complex aortic coarctation is associated with significant mortality and morbidity, including paraplegia. Extra-anatomic bypass strategies have been developed to reduce these complications and allow the correction of any concomitant conditions during the same operation. We present the case of a woman with uncontrolled hypertension and preductal coarctation of the aorta diagnosed at age 22 who underwent an unsuccessful attempt at primary repair, followed by extra-anatomic bypass from the ascending-to-infrarenal aorta. The patient has remained normotensive, with no additional complications related to the disease or the procedure, during a follow-up of 17 years.
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Affiliation(s)
- Daniel Pereda
- Mayo Clinic, Division of Cardiovascular Surgery, Rochester, MN 55905, USA.
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Kim KH, Jo JK, Choi JB, Seo YH, Kim TY. Extraanatomic Aortic Bypass through a Median Sternotomy in a Patient with Coarctation of Aorta Associated with Annuloaortic Ectasia. THE KOREAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2010. [DOI: 10.5090/kjtcs.2010.43.3.308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Kyung Hwa Kim
- Department of Thoracic and Cardiovascular Surgery, Chonbuk National University Medical School
| | - Jung-Ku Jo
- Department of Thoracic and Cardiovascular Surgery, Chonbuk National University Medical School
| | - Jong-Bum Choi
- Department of Thoracic and Cardiovascular Surgery, Chonbuk National University Medical School
| | - Yeon-Ho Seo
- Department of Thoracic and Cardiovascular Surgery, Chonbuk National University Medical School
| | - Tae Yun Kim
- Department of Thoracic and Cardiovascular Surgery, Chonbuk National University Medical School
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Riesenman PJ, Farber MA. Management of a thoracic endograft infection through an ascending to descending extra-anatomic aortic bypass and endograft explantation. J Vasc Surg 2010; 51:207-9. [DOI: 10.1016/j.jvs.2009.07.097] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2009] [Revised: 07/23/2009] [Accepted: 07/23/2009] [Indexed: 10/20/2022]
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Coartación aórtica en el adulto. CIRUGIA CARDIOVASCULAR 2009. [DOI: 10.1016/s1134-0096(09)70134-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Gelpi G, Lemma M, Pettinari M, Vanelli P, Antona C. One-stage repair of aortic coarctation and ascending aortic aneurysm by extra-anatomic graft. J Cardiovasc Med (Hagerstown) 2009; 10:554-6. [PMID: 19474575 DOI: 10.2459/jcm.0b013e32832bc132] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The best surgical approach for patients presenting with coarctation of the aorta and additional surgical cardiovascular disorders is uncertain. We describe the case of a young man with an aneurysm of the ascending aorta and a bicuspid aortic valve with a moderate insufficiency associated with a coarctation of the aorta. The patient underwent a single-stage procedure where the ascending aorta was replaced, the aortic valve repaired and the coarctation bypassed with an extra-anatomic graft. In our opinion, ascending-to-descending extra-anatomic graft is a good solution to treat these complicated cases.
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Affiliation(s)
- Guido Gelpi
- Cardiovascular Division, L.Sacco Hospital, Milan, Italy.
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Alegria JR, Burkhart HM, Connolly HM. Coarctation of the aorta presenting as systemic hypertension in a young adult. ACTA ACUST UNITED AC 2008; 5:484-8. [DOI: 10.1038/ncpcardio1258] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2007] [Accepted: 01/24/2008] [Indexed: 11/09/2022]
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Off-pump extraanatomic aortic bypass for the treatment of complex aortic coarctation and hypoplastic aortic arch. Ann Thorac Surg 2008; 85:460-4. [PMID: 18222243 DOI: 10.1016/j.athoracsur.2007.10.063] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2007] [Revised: 10/17/2007] [Accepted: 10/18/2007] [Indexed: 10/22/2022]
Abstract
BACKGROUND Despite advances in surgical and interventional techniques, the optimal surgical treatment of severe aortic (re) coarctation and hypoplastic aortic arch is still controversial. Anatomic repair may require extensive dissection, cardiopulmonary bypass, and deep hypothermic circulatory arrest with their inherent risks. The aim of this study was to analyze the outcome of off-pump extraanatomic aortic bypass as a surgical alternative to local repair. METHODS From February 2000 to December 2005, ten consecutive patients (median age 20 years; range, 11 to 38 years) with severe aortic (re) coarctation (n = 4) and (or) hypoplastic aortic arch (n = 7) underwent off-pump extraanatomic aortic bypass through median sternotomy. All but three patients had undergone previous surgery for coarctation and angioplasty or stenting. Three patients underwent concomitant replacement of the ascending aorta because of an aneurysm using cardiopulmonary bypass. RESULTS Postoperative hospital course was uneventful in all patients. There was no perioperative mortality or significant morbidity. During a mean follow-up of 48 +/- 22 months no patient required additional procedures. All patients were free of symptoms; no patient showed signs of heart failure after follow-up. At last follow-up, no patient presented with claudication, nor any patient experienced orthostatic problems due to a steal phenomenon. During follow-up, hypertension resolved in all patients with residual mild hypertension in two patients. CONCLUSIONS Off-pump extraanatomic aortic bypass is an attractive treatment option for complex aortic (re) coarctation and hypoplastic aortic arch. Perioperative risks are minimized, hypertension is influenced favorably, and midterm survival is event-free.
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Coarctation and sternotomy. COR ET VASA 2008. [DOI: 10.33678/cor.2008.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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