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Kudo T, Kuratani T, Sawa Y, Miyagawa S. Assessment of the Effectiveness of Zone 1-Landing Hybrid TEVAR by Comparing Its Outcomes with Those of Zone 2-Landing Hybrid TEVAR. J Clin Med 2023; 12:5326. [PMID: 37629368 PMCID: PMC10455504 DOI: 10.3390/jcm12165326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 08/09/2023] [Accepted: 08/14/2023] [Indexed: 08/27/2023] Open
Abstract
Background: Hybrid thoracic endovascular aortic repair (TEVAR) without median sternotomy is increasingly being performed in high-risk patients with aortic arch disease. The outcomes of hybrid TEVAR were reported to be worse with a more proximal landing zone. This study aims to clarify the effectiveness of zone 1-landing hybrid TEVAR by comparing the outcomes of zone 2-landing hybrid TEVAR. Methods: From April 2008 to October 2020, 213 patients (zone 1: zone 1-landing hybrid TEVAR, n = 82, 38.5%; zone 2: zone 2-landing hybrid TEVAR, n = 131, 61.5%) were enrolled (median age, 72 years; interquartile range [IQR], 65-78 years), with a median follow-up period of 6.0 years (IQR, 2.8-9.7 years). Results: The mean logistic EuroSCORE was 20.9 ± 14.8%: the logistic EuroSCORE of the zone 1 group (23.3 ± 16.1) was significantly higher than that of the zone 2 group (19.3 ± 12.4%, p = 0.045). The operative time and hospital stay of the zone 1 group were significantly longer than those of the zone 2 group. On the other hand, the in-hospital and late outcomes did not differ significantly between the two groups. There were no significant differences in cumulative survival (66.8% vs. 78.0% at 10 years, Log-rank p = 0.074), aorta-related death-free rates (97.6% vs. 99.2% at 10 years, Log-rank p = 0.312), and aortic event-free rates (81.4% vs. 87.9% at 10 years, Log-rank p = 0.257). Conclusions: Zone 1- and 2-landing hybrid TEVAR outcomes were satisfactory. Despite the high procedural difficulty and surgical risk, the outcomes of zone 1-landing hybrid TEVAR were equal to those of zone 2-landing hybrid TEVAR. If the surgical risk is high, zone 1-landing hybrid TEVAR should not be avoided.
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Affiliation(s)
- Tomoaki Kudo
- Department of Cardiovascular Surgery, Graduate School of Medicine, Osaka University, Suita 565-0871, Osaka, Japan
| | - Toru Kuratani
- Department of Minimally Invasive Cardiovascular Medicine, Graduate School of Medicine, Osaka University, Suita 565-0871, Osaka, Japan
| | - Yoshiki Sawa
- Department of Cardiovascular Surgery, Graduate School of Medicine, Osaka University, Suita 565-0871, Osaka, Japan
| | - Shigeru Miyagawa
- Department of Cardiovascular Surgery, Graduate School of Medicine, Osaka University, Suita 565-0871, Osaka, Japan
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Kitada Y, Okamura H, Kimura N, Yamaguchi A. Association between frailty and long-term outcomes among patients undergoing thoracic aortic surgery via median sternotomy. Gen Thorac Cardiovasc Surg 2023; 71:232-239. [PMID: 35999411 DOI: 10.1007/s11748-022-01865-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 08/07/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Preoperative assessment of frailty is important for predicting postoperative outcomes. This study investigated the association between frailty and late outcomes among patients who underwent thoracic aortic surgery via median sternotomy. METHODS A total of 1010 patients underwent thoracic aortic surgery via median sternotomy between April 2008 and December 2016. Patients < 65 years of age, those who underwent urgent or emergent surgery, and those with incomplete data were excluded; as such, 374 patients were ultimately included in the present study. Frailty was evaluated using an index comprising history of dementia, body mass index < 18.5 kg/m2, and hypoalbuminemia. A frailty score from 0 to 3 was determined by assigning 1 point for each criterion met. Frailty was defined as a score ≥ 1. Patients were categorized into of 2 groups: frail (n = 52) and non-frail (n = 322). The mean follow-up was 6.1 ± 3.1 years. RESULTS Overall in-hospital mortality did not differ between the frail and non-frail groups. However, the incidence of re-exploration for bleeding and discharge to a health care facility was higher in the frail group than in the non-frail group. Multivariable analysis revealed that preoperative frailty was an independent predictor of late mortality during follow-up [hazard ratio 3.71 (95% confidence interval 2.16-6.37); P < 0.001]. CONCLUSION Preoperative frailty was associated with late mortality after thoracic aortic surgery. Assessment of preoperative frailty using a simple frailty index may be useful in the decision-making process for elderly patients.
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Affiliation(s)
- Yuichiro Kitada
- Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama-shi, Saitama, 330-8503, Japan
| | - Homare Okamura
- Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama-shi, Saitama, 330-8503, Japan.
| | - Naoyuki Kimura
- Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama-shi, Saitama, 330-8503, Japan
| | - Atsushi Yamaguchi
- Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama-shi, Saitama, 330-8503, Japan
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Okada K. Total arch replacement: When and how? Asian Cardiovasc Thorac Ann 2023; 31:42-47. [PMID: 35509182 DOI: 10.1177/02184923211073374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Acute type A aortic dissection (ATAAD) is a life-threatening disease, which often causes cardiac tamponade, rupture, and malperfusion. ATAAD is associated with a high hospital mortality rate. Open aortic surgery for ATAAD is always required to save the patient, particularly elderly patients. Tear-oriented surgery is recommended as the frontline treatment for ATAAD, and hemiarch replacement (HAR) is sufficient because the primary entry is often observed in the ascending aorta (60%-70%). However, HAR has some drawbacks, such as new creation of an anastomotic entry and unfavorable distal aortic remodeling during long-term follow-up. Although total arch replacement (TAR) is a demanding procedure, it is another useful option for ATAAD. Proper patient selection for TAR is controversial. Standardized procedure for TAR, including the optimal brain protection methods and the use of excellent sealed vascular prosthetic grafts, has been established over the past decades. Therefore, TAR is increasingly being selected for HAR in patients who are young or have enlarged aortic arch, severely dissected supra-aortic arch vessels, or hereditary thoracic aortic disorders. The emerging technology of commercially available frozen elephant trunk accelerated the application of TAR, facilitates distal anastomosis, and improves distal aortic remodeling. Although further evidence is required, TAR could be the best choice for HAR for selected patients. Currently, appropriate selection of the surgical technique is important to maximize the benefits of open surgery for ATAAD.
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Affiliation(s)
- Kenji Okada
- Division of Cardiovascular Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
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Yamabe T, Zhao Y, Kurlansky PA, Patel V, George I, Smith CR, Takayama H. Extent of aortic replacement and operative outcome in open proximal thoracic aortic aneurysm repair. JTCVS OPEN 2022; 12:1-12. [PMID: 36590741 PMCID: PMC9801234 DOI: 10.1016/j.xjon.2022.07.013] [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: 04/28/2021] [Revised: 06/30/2022] [Accepted: 07/11/2022] [Indexed: 01/04/2023]
Abstract
Objectives There are few data to delineate the risk differences among open aortic procedures. We aimed to investigate the influence of the procedural types on the outcomes of proximal thoracic aortic aneurysm repair. Methods Among 1900 patients who underwent aortic replacement in our institution between 2005 and 2019, 1132 patients with aortic aneurysm who underwent a graft replacement of proximal thoracic aorta were retrospectively reviewed. Patients were divided into 4 groups based on the extent of the aortic replacement: isolated ascending aortic replacement (n = 52); ascending aortic replacement with distal extension with hemiarch, partial arch, or total arch replacement (n = 126); ascending aortic replacement with proximal extension with aortic valve or root replacement (n = 620); and ascending aortic replacement with distal and proximal extension (n = 334). "Eventful recovery," defined as occurrence of any key complications, was used as the primary end point. Odds ratios for inability to achieve uneventful recovery in each procedure were calculated using ascending aortic replacement as a reference. Results Overall, in-hospital mortality and stroke occurred in 16 patients (1.4%) and 24 patients (2.1%). Eventful recovery was observed in 19.7% of patients: 11.5% in those with ascending aortic replacement, 36.5% in those with partial arch or total arch replacement, 16.6% in those with proximal extension with aortic valve or root replacement, and 20.4% in those with distal and proximal extension (P < .001). With ascending aortic replacement as the reference, a multivariable logistic regression revealed partial arch or total arch replacement (odds ratio, 10.0; 95% confidence interval, 1.8-189.5) was an independent risk factor of inability to achieve uneventful recovery. Conclusions Open proximal aneurysm repair in the contemporary era resulted in satisfactory in-hospital outcomes. Distal extension was associated with a higher risk for postoperative complications.
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Affiliation(s)
- Tsuyoshi Yamabe
- Division of Cardiothoracic and Vascular Surgery, New York Presbyterian Hospital, Columbia University Medical Center, New York, NY,Department of Cardiovascular Surgery, Shonan-Kamakura General Hospital, Kamakura, Kanagawa, Japan
| | - Yanling Zhao
- Division of Cardiothoracic and Vascular Surgery, New York Presbyterian Hospital, Columbia University Medical Center, New York, NY
| | - Paul A. Kurlansky
- Division of Cardiothoracic and Vascular Surgery, New York Presbyterian Hospital, Columbia University Medical Center, New York, NY
| | - Virendra Patel
- Division of Aortic Surgery, New York Presbyterian Hospital, Columbia University Medical Center, New York, NY
| | - Isaac George
- Division of Cardiothoracic and Vascular Surgery, New York Presbyterian Hospital, Columbia University Medical Center, New York, NY
| | - Craig R. Smith
- Division of Cardiothoracic and Vascular Surgery, New York Presbyterian Hospital, Columbia University Medical Center, New York, NY
| | - Hiroo Takayama
- Division of Cardiothoracic and Vascular Surgery, New York Presbyterian Hospital, Columbia University Medical Center, New York, NY,Address for reprints: Hiroo Takayama, MD, PhD, Division of Cardiothoracic and Vascular Surgery, New York Presbyterian Hospital, Columbia University Medical Center, 177 Fort Washington Ave, New York, NY 10032.
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Slisatkorn W, Sanphasitvong V, Luangthong N, Kaewsaengeak C. Tips and tricks in redo aortic surgery. Indian J Thorac Cardiovasc Surg 2022; 38:163-170. [PMID: 35463713 PMCID: PMC8980975 DOI: 10.1007/s12055-021-01322-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 12/15/2021] [Accepted: 12/20/2021] [Indexed: 11/25/2022] Open
Abstract
Redo aortic surgery is challenging, and the operative risk is higher than that in primary aortic surgery. Preoperative imaging is a crucial guide for a safe re-entry. Scrutinized preparing in cannulation and organ protection strategies have affected surgical outcomes. With comprehensive planning and meticulously executed surgery, mortality and morbidity can be acceptable. Supplementary Information The online version contains supplementary material available at 10.1007/s12055-021-01322-x.
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Affiliation(s)
- Worawong Slisatkorn
- Division of Cardio-Thoracic Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, Bangkok, 10700 Thailand
| | - Vutthipong Sanphasitvong
- Division of Cardio-Thoracic Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, Bangkok, 10700 Thailand
| | - Nutthawadee Luangthong
- Division of Cardio-Thoracic Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, Bangkok, 10700 Thailand
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Kishimoto Y, Yoshikawa Y, Morimoto K, Onohara T, Horie H, Kumagai K, Nii R, Nishimura M. Impact of frailty on early and mid-term outcomes of hybrid aortic arch repair. Surg Today 2022; 52:1194-1201. [PMID: 34984573 DOI: 10.1007/s00595-021-02443-x] [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: 05/12/2021] [Accepted: 11/22/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE The purpose of this study was to investigate the impact of frailty on the clinical outcomes of hybrid aortic arch repair with debranching of the supra-aortic arteries. METHODS Consecutive patients ≥ 75 years old who underwent hybrid aortic arch repair from January 2010 to December 2019 were retrospectively analyzed. Using the Canadian Study of Health and Aging (CSHA) scale, all patients with a CSHA scale score > 4 were defined as frail. The frail patients (FP) group and the non-frail patients (NFP) group were compared regarding the early and mid-term outcomes of hybrid aortic arch repair. RESULTS A total of 84 patients were included. The early postoperative results were not markedly different between the groups, except that the rate of transfer to a rehabilitation hospital was higher in the FP group than in the NFP group. The survival at 5 years was significantly lower in the FP group at 43.0% than in the NFP group at 67.7% (P = 0.015). However, the freedom from aorta-related death was not significantly different between the two groups. CONCLUSION Frailty did not affect the short-term outcomes of hybrid aortic arch repair; however, the mid-term outcomes, including the survival, of the frail patients were significantly worse than those of the non-frail patients, mostly because of non-aorta-related causes.
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Affiliation(s)
- Yuichiro Kishimoto
- Division of Cardiovascular Surgery, Tottori University School of Medicine, 36-1 Nishi-cho, Yonago, Tottori, 683-8504, Japan
| | - Yasushi Yoshikawa
- Division of Cardiovascular Surgery, Tottori University School of Medicine, 36-1 Nishi-cho, Yonago, Tottori, 683-8504, Japan.
| | - Kenichi Morimoto
- Division of Cardiovascular Surgery, Tottori University School of Medicine, 36-1 Nishi-cho, Yonago, Tottori, 683-8504, Japan
| | - Takeshi Onohara
- Division of Cardiovascular Surgery, Tottori University School of Medicine, 36-1 Nishi-cho, Yonago, Tottori, 683-8504, Japan
| | - Hiromu Horie
- Division of Cardiovascular Surgery, Tottori University School of Medicine, 36-1 Nishi-cho, Yonago, Tottori, 683-8504, Japan
| | - Kunitaka Kumagai
- Division of Cardiovascular Surgery, Tottori University School of Medicine, 36-1 Nishi-cho, Yonago, Tottori, 683-8504, Japan
| | - Rikuto Nii
- Division of Cardiovascular Surgery, Tottori University School of Medicine, 36-1 Nishi-cho, Yonago, Tottori, 683-8504, Japan
| | - Motonobu Nishimura
- Division of Cardiovascular Surgery, Tottori University School of Medicine, 36-1 Nishi-cho, Yonago, Tottori, 683-8504, Japan
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Bao X, Zhao Y, Li T, Wu M, Zeng Z, Gao M, Xu D, Feng J, Feng R. Chimney Graft Technique Combined With Embolization for Treating Ruptured Aortic Arch Lesions. Front Cardiovasc Med 2021; 8:711283. [PMID: 34671650 PMCID: PMC8520930 DOI: 10.3389/fcvm.2021.711283] [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: 06/15/2021] [Accepted: 09/03/2021] [Indexed: 11/13/2022] Open
Abstract
Background: This study aimed to share the experience in applying the chimney graft technique combined with embolization for treating aortic arch rupture under emergency conditions and evaluating early-term results in these patients. Methods: This study retrospectively included patients with ruptured aortic arch lesions who received the chimney graft technique combined with embolization between March 2016 and March 2021. The primary endpoint was a technical success, deemed as successful stent graft deployment to the planned location, patency of the target branch vessel, and absence of significant type I endoleak. The secondary endpoint was clinical success defined with the size of false lumen in follow-up remaining unchanged or decreasing over time, 30-day mortality, complication, and primary patency of chimney graft. Results: This study included 12 patients (age, 61 ± 12 years; male, 83%). Five patients (42%) received single chimney, one patient (8%) received double chimney, and six patients (50%) received triple chimney. Intraoperative type I endoleak occurred in six patients (50%) who underwent endovascular embolization in the primary operation. Post-operative type I endoleak, evaluated by computed tomography angiography examination following the primary operation, occurred in seven patients (58%), including one patient who received endovascular embolization two times. All patients with post-operative type I endoleak were successfully re-treated using coil and Onyx glue within 1 week, and the median length of stay was 22 ± 11 days (range: 7-44 days). Overall technical success was 100%. Eleven patients had completed their follow-up (median, 12 months, range: 1-34 months), and one patient was out of contact. The 30-day mortality was 9% (1/11, post-operative death of a patient with cerebral hemorrhage). No major complications and no chimney compression, migration, occlusion, or stenosis were recorded during follow-up. Seven patients (58%) have ≥6 months of clinical follow-up time with appropriate imaging. In four (57%) of these patients, diameter stabilization was detected, whereas three (43%) experienced significant reduction (≥5 mm). Conclusion: The patients in this study had satisfactory early-term outcomes. The chimney graft technique combined with coil and Onyx glue embolization may be a safe and effective treatment for ruptured aortic arch lesions under emergency conditions.
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Affiliation(s)
- Xianhao Bao
- Department of Vascular Surgery, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yuxi Zhao
- Department of Vascular Surgery, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Tao Li
- Department of Cardiovascular Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Mingwei Wu
- Department of Vascular Surgery, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhaoxiang Zeng
- Department of Vascular Surgery, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Minxin Gao
- Department of Vascular Surgery, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ding Xu
- Department of Vascular Surgery, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jiaxuan Feng
- Department of Vascular Surgery, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Rui Feng
- Department of Vascular Surgery, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Zhan Y, Kooperkamp H, Lofftus S, McGrath D, Kawabori M, Chen FY. Conventional open versus hybrid aortic arch repair: a meta-analysis of propensity-matched studies. J Thorac Dis 2021; 13:4714-4722. [PMID: 34527312 PMCID: PMC8411138 DOI: 10.21037/jtd-21-183] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 07/02/2021] [Indexed: 12/03/2022]
Abstract
Background Comparison of conventional (open) surgical versus hybrid aortic arch repair remains debatable. While the majority of previous comparative studies including meta-analyses contained primarily risk-unadjusted cohorts, those focusing on propensity-matched comparisons were limited by their small sample size. We aimed to compare outcomes of these two approaches through an up-to-date search and meta-analysis of the best evidence currently available in the literature. Methods The PubMed/MEDLINE, EMBASE, and Cochrane library from inception to September 2019 were searched to identify articles reporting propensity-score matching data on open versus hybrid aortic arch repair. Patients’ baseline characteristics and clinical outcomes were extracted from the articles and pooled for analysis. Heterogeneity and biases were assessed among the included studies. Results Five studies, including a total of 378 patients (189 pairs), were included in the study. The two groups were similar in patients’ baseline characteristics. Stroke rate favoured the open group [2.1% versus 14.3%, OR 0.18 (0.07, 0.46), P=0.0004, I2=0%]. There was no significant difference between the two groups with regard to paraplegia. The hybrid group had numerically higher short-term mortality, but lower rate of acute renal failure requiring dialysis. There was a statistically significant difference between the mid-term survivals of the open and hybrid groups, with lower pooled mortality seen for the open group at 1-year and 2-years (P=0.02). Conclusions Open and hybrid repairs do not offer equivalent outcomes. Compared with hybrid aortic arch repair, conventional surgical aortic repair could be associated with favourable outcomes including postoperative stroke. Hybrid repair does not appear to provide better survival. Operative approaches should be carefully selected in treating aortic arch pathology.
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Affiliation(s)
- Yong Zhan
- Division of Cardiac Surgery, Tufts Medical Center, Tufts University School of Medicine, Boston, MA, USA
| | - Hannah Kooperkamp
- Division of Cardiac Surgery, Tufts Medical Center, Tufts University School of Medicine, Boston, MA, USA
| | - Serena Lofftus
- Division of Cardiac Surgery, Tufts Medical Center, Tufts University School of Medicine, Boston, MA, USA
| | - Daniel McGrath
- Division of Cardiac Surgery, Tufts Medical Center, Tufts University School of Medicine, Boston, MA, USA
| | - Masashi Kawabori
- Division of Cardiac Surgery, Tufts Medical Center, Tufts University School of Medicine, Boston, MA, USA
| | - Frederick Y Chen
- Division of Cardiac Surgery, Tufts Medical Center, Tufts University School of Medicine, Boston, MA, USA
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Gomibuchi T, Seto T, Naito K, Chino S, Mikoshiba T, Komatsu M, Tanaka H, Ichimura H, Yamamoto T, Nakahara K, Ohashi N, Fuke M, Wada Y, Okada K. Strategies to improve outcomes for acute type A aortic dissection with cerebral malperfusion. Eur J Cardiothorac Surg 2021; 59:666-673. [PMID: 33253365 DOI: 10.1093/ejcts/ezaa376] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 09/10/2020] [Accepted: 09/11/2020] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES We aimed to identify predictors of postoperative permanent neurological deficits (PNDs) and evaluate the early management of cerebral perfusion in patients undergoing surgical repair of acute type A aortic dissection with cerebral malperfusion. METHODS Between October 2009 and September 2018, a total of 197 patients with acute type A aortic dissection underwent aortic replacement. Of these, 42 (21.3%) patients had an imaging cerebral malperfusion (ICM). ICM was assessed preoperatively, which also revealed whether dissected supra-aortic branch vessels were occluded or narrowed by a thrombosed false lumen. After September 2017, early reperfusion and extra-anatomic revascularization were performed in cases with ICM. RESULTS Hospital mortality rates for cases with ICM were 4.8% (2/42). Before September 2017, PND were observed in 6 patients (54.5%) with preoperative neurological symptoms (n = 11), and 7 patients (33.3%) without neurological symptoms (n = 21) in patients with ICM. Occlusion or severe stenosis of supra-aortic branch vessels (odds ratio, 7.66; P < 0.001), regardless of preoperative clinical neurological symptoms, was a risk factor for PND. After September 2017, 7 of 10 patients with ICM underwent early reperfusion and extra-anatomic revascularization. PND did not occur in any of these 7 patients. CONCLUSIONS Occlusion or severe stenosis of supra-aortic branch vessels is a predictor of PND risk in patients undergoing surgery for acute type A aortic dissection. Early reperfusion and extra-anatomic revascularization may reduce the risk of neurological complications in patients with ICM, with or without neurological symptoms.
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Affiliation(s)
- Toshihito Gomibuchi
- Division of Cardiovascular Surgery, Department of Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Tatsuichiro Seto
- Division of Cardiovascular Surgery, Department of Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Kazuki Naito
- Division of Cardiovascular Surgery, Department of Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Shuji Chino
- Division of Cardiovascular Surgery, Department of Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Toru Mikoshiba
- Division of Cardiovascular Surgery, Department of Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Masaki Komatsu
- Division of Cardiovascular Surgery, Department of Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Haruki Tanaka
- Division of Cardiovascular Surgery, Department of Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Hajime Ichimura
- Division of Cardiovascular Surgery, Department of Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Takateru Yamamoto
- Division of Cardiovascular Surgery, Department of Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Ko Nakahara
- Division of Cardiovascular Surgery, Department of Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Noburo Ohashi
- Division of Cardiovascular Surgery, Department of Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Megumi Fuke
- Division of Cardiovascular Surgery, Department of Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Yuko Wada
- Division of Cardiovascular Surgery, Department of Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Kenji Okada
- Division of Cardiovascular Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
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Imamura Y, Kowatari R, Saito Y, Goto T, Daitoku K, Kondo N, Minakawa M, Fukuda I. Directing a dispersion cannula tip toward the aortic root during thoracic aortic arch surgery does not adversely affect cardiac function. Perfusion 2021; 37:598-604. [PMID: 33960221 DOI: 10.1177/02676591211014816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Neurologic complications of open thoracic aortic surgery are devastating problems in patients with severely diseased aortas. This study aimed to clarify whether directing the aortic cannula tip toward the aortic root affects the postoperative cardiac function in patients undergoing open thoracic aortic surgery. METHODS A total of 16 patients who underwent total or partial arch replacement between January 2014 and April 2019 were enrolled and divided into two groups. Ascending aorta perfusion was performed by placing the cannula tip toward the aortic root (reversed direction group, seven patients) or toward the aortic arch (standard direction group, nine patients). Intraoperative and perioperative data, including mortality, morbidity, and postoperative cardiac function, were compared between the groups. RESULTS There were no hospital deaths or stroke events in either group. The aortic cross-clamping time was 102.4 ± 20.3 minutes in the reversed direction group and 87.1 ± 9.9 minutes in the standard direction group (p = 0.049). Furthermore, the intubation time was 28.4 ± 12.9 hours in the reversed direction group and 12.4 ± 6.8 hours in the standard direction group (p = 0.022). Both times were significantly longer in the reverse direction group. Postoperative serum creatine kinase-MB levels were significantly lower in the reversed direction group (6.2 ± 3.3 U/L vs 13.3 ± 4.8 U/L, respectively, p = 0.006). The cardiac output and cardiac index did not significantly differ. CONCLUSIONS Directing the aortic cannula tip toward the aortic root does not adversely affect the postoperative cardiac function after aortic arch surgery.
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Affiliation(s)
- Yuki Imamura
- Department of Thoracic and Cardiovascular Surgery, Hirosaki University School of Medicine, Hirosaki, Aomori, Japan
| | - Ryosuke Kowatari
- Department of Thoracic and Cardiovascular Surgery, Hirosaki University School of Medicine, Hirosaki, Aomori, Japan
| | - Yoshiaki Saito
- Department of Thoracic and Cardiovascular Surgery, Hirosaki University School of Medicine, Hirosaki, Aomori, Japan
| | - Takeshi Goto
- Department of Clinical Engineering, Hirosaki University School of Medicine and Hospital, Hirosaki, Aomori, Japan
| | - Kazuyuki Daitoku
- Department of Thoracic and Cardiovascular Surgery, Hirosaki University School of Medicine, Hirosaki, Aomori, Japan
| | - Norihiro Kondo
- Department of Thoracic and Cardiovascular Surgery, Hirosaki University School of Medicine, Hirosaki, Aomori, Japan
| | - Masahito Minakawa
- Department of Thoracic and Cardiovascular Surgery, Hirosaki University School of Medicine, Hirosaki, Aomori, Japan
| | - Ikuo Fukuda
- Department of Thoracic and Cardiovascular Surgery, Hirosaki University School of Medicine, Hirosaki, Aomori, Japan
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Zhu C, Piao H, Wang Y, Li B, Zhang Y, Xu J, Wang T, Zhu Z, Xu R, Li D, Liu K. A New Aortic Arch Inclusion Technique with Frozen Elephant Trunk for Aortic Arch Aneurysm Treatment. Int Heart J 2020; 61:1229-1235. [PMID: 33116020 DOI: 10.1536/ihj.20-069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Various surgical techniques have been proposed for treating aortic arch aneurysm (AAA); however, the optimal treatment has not been well defined. This study introduces a new aortic arch inclusion technique with frozen elephant trunk (FET) for AAA treatment.A retrospective analysis was performed among 22 patients for AAA surgical treatment between March 2010 and March 2019. Patients were classified into Z1, Z2, and Z3 groups based on the origins of aneurysms. A stent graft with a 10 cm stented graft and 5-9 cm proximal vascular prosthesis was released into the descending thoracic aorta as FET through an incision in the aortic arch. The proximal vascular prosthesis was retracted into the aortic arch, trimmed to expose the orifices of the brachiocephalic vessels, and sutured inside the aortic arch using the inclusion technique. The proximal sealing location of the vascular graft was tailored to cover the origins of aneurysms.There was no 30-day mortality. No patient had postoperative stroke or paraplegia. Complete aneurysm thrombosis was achieved in all patients. One patient died of severe respiratory tract stenosis 3 months postoperatively. All other 21 patients were alive during 53.3 ± 36.5-month follow-up. Computed tomography angiography was obtained in 15 patients during follow-up. Endoleak was observed in one patient, and the other 14 patients were free from aneurysm-related or graft-related complications during follow-up.The aortic arch inclusion technique with FET provides an alternative technique in treating AAA with satisfactory mid-term follow-up results. A larger patient population with long-term follow-up results is warranted.
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Affiliation(s)
- Cuilin Zhu
- Department of Cardiovascular Surgery, The Second Hospital of Jilin University
| | - Hulin Piao
- Department of Cardiovascular Surgery, The Second Hospital of Jilin University
| | - Yong Wang
- Department of Cardiovascular Surgery, The Second Hospital of Jilin University
| | - Bo Li
- Department of Cardiovascular Surgery, The Second Hospital of Jilin University
| | - Yixin Zhang
- Department of Cardiovascular Surgery, The Second Hospital of Jilin University
| | - Jinyu Xu
- Department of Cardiovascular Surgery, The Second Hospital of Jilin University
| | - Tiance Wang
- Department of Cardiovascular Surgery, The Second Hospital of Jilin University
| | - Zhicheng Zhu
- Department of Cardiovascular Surgery, The Second Hospital of Jilin University
| | - Rihao Xu
- Department of Cardiovascular Surgery, The Second Hospital of Jilin University
| | - Dan Li
- Department of Cardiovascular Surgery, The Second Hospital of Jilin University
| | - Kexiang Liu
- Department of Cardiovascular Surgery, The Second Hospital of Jilin University
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Is Hybrid Repair for an Entire Shaggy Aorta Feasible? Heart Lung Circ 2020; 30:765-772. [PMID: 33139174 DOI: 10.1016/j.hlc.2020.09.923] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 09/13/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE This paper reviewed clinical experiences to evaluate the feasibility of a surgical strategy for an entire shaggy aorta. METHODS Fifty-two (52) surgeries (47 men, average age 72±7 years) were performed for an entire shaggy aorta at the current institution from 2002-2017. Open surgery was performed in 30 cases, including total arch replacement in 12, extended aortic arch replacement via L-shaped thoracotomy in 10 and median sternotomy combined with left thoracotomy in two, and thoracoabdominal aortic replacement in six. Hybrid procedures were performed in 22 cases: type I hybrid arch repair in six, type II hybrid arch repair in seven and type III hybrid arch repair in nine. RESULTS Hospital mortality was significantly higher with a hybrid repair: surgical, one case (3%); hybrid, six cases (27%), (p=0.0125). Stroke occurred at relatively high rates in both groups: surgical, seven cases (23%); hybrid, six cases (27%) (p=0.75). Spinal cord injury was significantly higher in hybrid repair: surgical, one case (3%); hybrid, seven cases (32%), (p=0.004). Open surgery revealed a better long-term survival rate than the hybrid procedure at 5 and 10 years: surgical, 82%, 65.7%; hybrid, 53%, 35.1%, respectively (p=0.0452). The rate of freedom from aortic events was significantly better with open surgery than a hybrid procedure at 5 and 10 years: surgical, 96%, 85%; hybrid, 83%, 41.3%, respectively (p=0.0082). CONCLUSIONS Surgery for an entire shaggy aorta was frequently associated with embolic complications such as stroke, paraplegia, renal failure, and bowel necrosis. However, open surgical repair may produce better early and late outcomes and freedom from aortic events compared with hybrid repair.
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Imasaka KI, Tomita Y, Morita S, Shiose A. Surgical outcome of elective total arch replacement with coronary artery bypass grafting. Indian J Thorac Cardiovasc Surg 2020; 36:572-579. [PMID: 33100618 DOI: 10.1007/s12055-020-01013-z] [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: 04/21/2020] [Revised: 07/02/2020] [Accepted: 07/07/2020] [Indexed: 11/24/2022] Open
Abstract
Purpose We aimed to compare the surgical outcome between total arch replacement with coronary bypass surgery and that without. Methods Between 2008 and 2016, 157 consecutive patients underwent total arch replacement with antegrade cerebral perfusion and moderate hypothermic circulatory arrest using the proximal first approach. They were divided into two groups: total arch replacement with coronary bypass surgery (group 1, n = 38) and that without (group 2, n = 119). Results Of the 38 patients in group 1, 37 (97%) were asymptomatic. The left internal thoracic artery and saphenous vein were used in one (2.6%) and 38 (100%) patients, respectively. The mean number of coronary anastomoses was 1.5 ± 1.0. In-hospital mortality rate was 3.8%. Cardiopulmonary bypass time and operation time in group 1 were significantly longer than those in group 2 (336 ± 52 min vs. 276 ± 38 min, P < 0.0001 and 702 ± 122 min vs. 619 ± 94 min, P < 0.0001, respectively). No differences in in-hospital mortality and perioperative myocardial infarction were found between the groups (5.3% vs. 3.4%, P = 0.633 and 0% vs. 1.7%, P = 1.000, respectively). In the multivariate analysis, age (odds ratio, 1.208; 95% confidence interval, 1.041-1.497; P = 0.008) and cardiopulmonary bypass time (odds ratio, 1.019; 95% confidence interval, 1.001-1.041; P = 0.041) were significant determinants of in-hospital mortality. Conclusions Although prolonged cardiopulmonary bypass time was a significant determinant of in-hospital mortality, total arch replacement with coronary bypass surgery could be safely performed with favorable outcomes.
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Affiliation(s)
- Ken-Ichi Imasaka
- Department of Cardiovascular Surgery, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan.,Department of Cardiovascular Surgery, Shimonoseki City Hospital, 1-13-1 Koyocho, Shimonoseki, 750-8520 Japan
| | - Yukihiro Tomita
- Department of Cardiovascular Surgery, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - Shigeki Morita
- Department of Cardiovascular Surgery, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - Akira Shiose
- Department of Cardiovascular Surgery, Faculty of Medicine, Kyushu University Graduate School of Medicine, Fukuoka, Japan
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Serra R, Bracale UM, Jiritano F, Ielapi N, Licastro N, Provenzano M, Andreucci M, Pingitore A, de Franciscis S, Mastroroberto P, Serraino GF. The Shaggy Aorta Syndrome: An Updated Review. Ann Vasc Surg 2020; 70:528-541. [PMID: 32800889 DOI: 10.1016/j.avsg.2020.08.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 08/04/2020] [Accepted: 08/05/2020] [Indexed: 01/16/2023]
Abstract
BACKGROUND Shaggy aorta (SA) depicts the severe aortic surface degeneration, extremely friable, and likely to cause spontaneous peripheral and visceral embolization or during catheterization, aortic manipulation, surgery, or minimally invasive procedures. This study aims to provide the most accurate and up-to-date information on this disease. METHODS Potentially eligible studies to be included were identified by searching the following databases: CENTRAL Library, ClinicalTrials.gov, MEDLINE, and CINAHL, using a combination of subject headings and text words to identify relevant studies: (Shaggy aorta) OR (aortic embolization) OR (aortic embolism) OR (aortic thrombus) OR (aortic plaque). From a total of 29,111 abstracts, and after applying inclusion and exclusion criteria, we considered 60 studies for inclusion in this review. RESULTS Appropriate measurement and assessment of the aortic wall are pivotal in the modern era, in particular when percutaneous procedures are performed, as SA has been identified as an independent risk factor for spinal cord injury, mesenteric embolization, and cerebral infarction after endovascular aortic repair. Furthermore, SA increases the rate of cerebral complications during transcatheter aortic valve implantation. CONCLUSIONS In conclusion, prompt diagnosis of SA syndrome and appropriate guidelines on the management of these conditions may help physicians to better assess the patient risk and to minimize the dreadful-related complications.
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Affiliation(s)
- Raffaele Serra
- Interuniversity Center of Phlebolymphology (CIFL). International Research and Educational Program in Clinical and Experimental Biotechnology" at the Department of Medical and Surgical Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy; Department of Medical and Surgical Sciences, University of Catanzaro, Catanzaro, Italy.
| | | | - Federica Jiritano
- Department of Experimental and Clinical Medicine, University of Catanzaro, Catanzaro, Italy
| | - Nicola Ielapi
- Interuniversity Center of Phlebolymphology (CIFL). International Research and Educational Program in Clinical and Experimental Biotechnology" at the Department of Medical and Surgical Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy; Sapienza" University of Rome, Department of Public Health and Infectious Disease, Roma, Italy
| | - Noemi Licastro
- Department of Medical and Surgical Sciences, University of Catanzaro, Catanzaro, Italy; Department of Public Health, University of Naples "Federico II", Naples, Italy
| | - Michele Provenzano
- Department of Health Sciences, University of Catanzaro, Catanzaro, Italy
| | - Michele Andreucci
- Department of Health Sciences, University of Catanzaro, Catanzaro, Italy
| | - Armando Pingitore
- Department of Radiology, Pugliese-Ciaccio Hospital of Catanzaro, Catanzaro, Italy
| | - Stefano de Franciscis
- Interuniversity Center of Phlebolymphology (CIFL). International Research and Educational Program in Clinical and Experimental Biotechnology" at the Department of Medical and Surgical Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy; Department of Medical and Surgical Sciences, University of Catanzaro, Catanzaro, Italy
| | - Pasquale Mastroroberto
- Department of Experimental and Clinical Medicine, University of Catanzaro, Catanzaro, Italy
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Ikeno Y, Yokawa K, Yamanaka K, Inoue T, Tanaka H, Okada K, Okita Y. Total arch replacement in octogenarians and nonagenarians: A single-center 18-year experience. J Thorac Cardiovasc Surg 2020; 160:346-356.e1. [DOI: 10.1016/j.jtcvs.2019.07.092] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 06/18/2019] [Accepted: 07/12/2019] [Indexed: 12/19/2022]
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Axillary artery cannulation reduces early embolic stroke and mortality after open arch repair with circulatory arrest. J Thorac Cardiovasc Surg 2020; 159:772-778.e4. [DOI: 10.1016/j.jtcvs.2019.02.112] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 02/13/2019] [Accepted: 02/24/2019] [Indexed: 01/16/2023]
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17
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Wang X, Yang F, Zhu J, Liu Y, Sun L, Hou X. Aortic arch surgery with hypothermic circulatory arrest and unilateral antegrade cerebral perfusion: Perioperative outcomes. J Thorac Cardiovasc Surg 2020; 159:374-387.e4. [DOI: 10.1016/j.jtcvs.2019.01.127] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Revised: 01/24/2019] [Accepted: 01/31/2019] [Indexed: 01/16/2023]
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18
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Debranching thoracic endovascular aortic repair for distal aortic arch aneurysm in elderly patients aged over 75 years old. J Cardiothorac Surg 2020; 15:13. [PMID: 31924243 PMCID: PMC6954511 DOI: 10.1186/s13019-020-1047-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Accepted: 01/02/2020] [Indexed: 11/26/2022] Open
Abstract
Background We examined the outcome of debranching thoracic endovascular aortic repair (d-TEVAR) without sternotomy for distal aortic arch aneurysm in patients aged ≥75 years. Methods Patients who underwent d-TEVAR or TAR for aortic arch aneurysm between 2008 and 2015 at our hospital and aged ≥75 years were included. Age, sex, left ventricular ejection fraction, preoperative creatinine level, diabetes, cerebrovascular disease, and chronic obstructive pulmonary disease were matched using PS. Results Among 74 patients (d-TEVAR: 51, TAR: 23), 17 patients in each group were matched. No difference in surgical outcome was detected between the d-TEVAR and TAR groups, including 30-day death (0% vs. 0%), hospital death (5.8% vs. 0%: p = 0.31) and incidence of cerebral infarction (5.8% vs. 7.6%: p = 0.27) as well as the long-term outcomes of 5-year survival (92.8% vs. 74.8%: p = 0.30) and 5-year aorta-related event-free rate (88.2% vs. 100%: p = 0.15). Average duration of ICU stay (1.3 ± 1.1 days vs. 5.6 ± 1.3 days: p = 0.025) and hospital stay (16.5 ± 5.2 days vs. 37.7 ± 19.6 days: p = 0.017) were significantly shorter in the d-TEVAR group. Conclusion Our results indicated that d-TEVAR is less invasive without affecting long-term outcome up to 5 years. Although the number of the patients included in the study was small, debranching TEVAR could be one of the treatments of the choice in the elderly, especially with comorbidities.
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Ryomoto M, Tanaka H, Mitsuno M, Yamamura M, Sekiya N, Uemura H, Sato A, Ueda D. A Novel Approach to Prevent Perioperative Stroke in Patients Undergoing Debranching Thoracic Endovascular Aortic Repair with a Mini-Cardiopulmonary Bypass Support. Ann Vasc Surg 2019; 59:143-149. [DOI: 10.1016/j.avsg.2018.09.036] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 08/31/2018] [Accepted: 09/29/2018] [Indexed: 11/27/2022]
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20
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Impact of white matter changes on neurologic outcomes of total arch replacement using antegrade cerebral perfusion. J Thorac Cardiovasc Surg 2019; 157:1350-1357.e1. [DOI: 10.1016/j.jtcvs.2018.10.150] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 09/22/2018] [Accepted: 10/16/2018] [Indexed: 11/18/2022]
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Okita Y. Some Comments from the East on the European Association for Cardio-Thoracic Surgery (EACTS) & the European Society for Vascular Surgery (ESVS) Consensus Document for Treatment of Aortic Arch Pathologies. Eur J Vasc Endovasc Surg 2019; 57:161-162. [PMID: 30825977 DOI: 10.1016/j.ejvs.2019.01.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Yutaka Okita
- Cardio-Aortic Centre, Takatsuki General Hospital, Osaka, Japan.
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22
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Impact of Isolated Cerebral Perfusion Technique for Aortic Arch Aneurysm Repair in Elderly Patients. Ann Thorac Surg 2019; 107:533-538. [DOI: 10.1016/j.athoracsur.2018.08.049] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Revised: 07/13/2018] [Accepted: 08/20/2018] [Indexed: 11/23/2022]
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Ikeno Y, Yokawa K, Matsueda T, Yamanaka K, Inoue T, Tanaka H, Okita Y. Long-term outcomes of total arch replacement using a 4-branched graft. J Thorac Cardiovasc Surg 2019; 157:75-85.e3. [DOI: 10.1016/j.jtcvs.2018.09.118] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 09/01/2018] [Accepted: 09/04/2018] [Indexed: 10/28/2022]
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Gomibuchi T, Seto T, Komatsu M, Tanaka H, Ichimura H, Yamamoto T, Ohashi N, Wada Y, Okada K. Impact of Frailty on Outcomes in Acute Type A Aortic Dissection. Ann Thorac Surg 2018; 106:1349-1355. [DOI: 10.1016/j.athoracsur.2018.06.055] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Revised: 05/25/2018] [Accepted: 06/18/2018] [Indexed: 01/14/2023]
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Abstract
Although antegrade cerebral perfusion (ACP) is the predominant method of protecting the brain in patients undergoing total arch replacement, both deep hypothermic circulatory arrest and ACP provide excellent and comparable clinical outcomes with regard to mortality, stroke, and temporary neurological deficit rates.
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Affiliation(s)
- Yutaka Okita
- Division of Cardiovascular Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
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26
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Hiraoka A, Saito K, Chikazawa G, Totsugawa T, Tamura K, Ishida A, Sakaguchi T, Yoshitaka H. Modified predictive score based on frailty for mid-term outcomes in open total aortic arch surgery. Eur J Cardiothorac Surg 2018; 54:42-47. [DOI: 10.1093/ejcts/ezy001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Accepted: 12/25/2017] [Indexed: 12/25/2022] Open
Affiliation(s)
- Arudo Hiraoka
- Department of Cardiovascular Surgery, Sakakibara Heart Institute of Okayama, Okayama, Japan
| | - Kazuya Saito
- Department of Physical Therapy, Sakakibara Heart Institute of Okayama, Okayama, Japan
| | - Genta Chikazawa
- Department of Cardiovascular Surgery, Sakakibara Heart Institute of Okayama, Okayama, Japan
| | - Toshinori Totsugawa
- Department of Cardiovascular Surgery, Sakakibara Heart Institute of Okayama, Okayama, Japan
| | - Kentaro Tamura
- Department of Cardiovascular Surgery, Sakakibara Heart Institute of Okayama, Okayama, Japan
| | - Atsuhisa Ishida
- Department of Cardiovascular Surgery, Sakakibara Heart Institute of Okayama, Okayama, Japan
| | - Taichi Sakaguchi
- Department of Cardiovascular Surgery, Sakakibara Heart Institute of Okayama, Okayama, Japan
| | - Hidenori Yoshitaka
- Department of Cardiovascular Surgery, Sakakibara Heart Institute of Okayama, Okayama, Japan
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27
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Ikeno Y, Koide Y, Abe N, Matsueda T, Izawa N, Yamazato T, Miyahara S, Nomura Y, Sato S, Takahashi H, Inoue T, Matsumori M, Tanaka H, Ishihara S, Nakayama S, Sugimoto K, Okita Y. Impact of sarcopenia on the outcomes of elective total arch replacement in the elderly†. Eur J Cardiothorac Surg 2017; 51:1135-1141. [DOI: 10.1093/ejcts/ezx050] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Accepted: 01/30/2017] [Indexed: 01/06/2023] Open
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Yoshitake A, Okamoto K, Yamazaki M, Kimura N, Hirano A, Iida Y, Abe T, Shimizu H. Comparison of aortic arch repair using the endovascular technique, total arch replacement and staged surgery†. Eur J Cardiothorac Surg 2017; 51:1142-1148. [DOI: 10.1093/ejcts/ezx028] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2016] [Accepted: 01/10/2017] [Indexed: 11/12/2022] Open
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Hiraoka A, Chikazawa G, Totsugawa T, Tamura K, Ishida A, Sakaguchi T, Yoshitaka H. Objective analysis of midterm outcomes of conventional and hybrid aortic arch repair by propensity-score matching. J Thorac Cardiovasc Surg 2017; 154:100-106.e1. [PMID: 28314530 DOI: 10.1016/j.jtcvs.2016.12.060] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Revised: 11/18/2016] [Accepted: 12/12/2016] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The aim of this study is to evaluate the objective outcomes of conventional total aortic arch repair (CTAR) and hybrid arch repair by using propensity-score matching to reduce selection bias. METHODS Between January 2006 and April 2016, 470 consecutive patients underwent isolated aortic arch repair (excluding hemiarch or partial arch reconstruction, and cases with concomitant cardiac surgeries) at a single cardiovascular institute. We categorized 337 total aortic arch repair with antegrade cerebral perfusion under circulatory arrest as the CTAR group and 58 hybrid aortic arch repair (HAR) with thoracic endovascular aortic repair as the HAR group. Seventy-five patients with scheduled and staged thoracic endovascular aortic repair after total aortic arch repair with elephant trunk were excluded. Then, we compared early and midterm outcomes between the propensity-matched group (43 CTAR vs HAR pairs). RESULTS There were no significant differences in 30-day and operative deaths between the CTAR and HAR groups (4.7% [2/43] vs 7.0% [3/43]; P = .4142 and 11.6% [5/43] vs 16.3% [7/43]; P = .5637). Although there were no significant differences in the incidences of other major complications, permanent stroke was observed more frequently in the HAR group (0% [0/43] vs 11.6% [5/43]; P = .0064) compared with the CTAR group. Matching analysis, however, revealed an equivalent 5-year survival rate between the CTAR and HAR groups (80.5% vs 59.9%; P = .1300). CONCLUSIONS Matching analysis revealed a significantly greater incidence of stroke in the HAR group but equivalent midterm outcomes in the hybrid group compared with the CTAR group.
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Affiliation(s)
- Arudo Hiraoka
- Department of Cardiovascular Surgery, The Sakakibara Heart Institute of Okayama, Japan.
| | - Genta Chikazawa
- Department of Cardiovascular Surgery, The Sakakibara Heart Institute of Okayama, Japan
| | - Toshinori Totsugawa
- Department of Cardiovascular Surgery, The Sakakibara Heart Institute of Okayama, Japan
| | - Kentaro Tamura
- Department of Cardiovascular Surgery, The Sakakibara Heart Institute of Okayama, Japan
| | - Atsuhisa Ishida
- Department of Cardiovascular Surgery, The Sakakibara Heart Institute of Okayama, Japan
| | - Taichi Sakaguchi
- Department of Cardiovascular Surgery, The Sakakibara Heart Institute of Okayama, Japan
| | - Hidenori Yoshitaka
- Department of Cardiovascular Surgery, The Sakakibara Heart Institute of Okayama, Japan
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Yamanaka K, Komiya T, Tsuneyoshi H, Shimamoto T. Outcomes of Concomitant Total Aortic Arch Replacement with Coronary Artery Bypass Grafting. Ann Thorac Cardiovasc Surg 2016; 22:251-7. [PMID: 27237968 DOI: 10.5761/atcs.oa.16-00056] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE Total aortic arch replacement is a highly invasive procedure. Here, we have investigated patient outcomes following total aortic arch replacement with or without coronary artery bypass grafting. METHODS One hundred and eighty-one patients underwent total aortic arch replacement without coronary artery bypass grafting, and 65 underwent with coronary artery bypass grafting. We compared preoperative, operative, and postoperative factors and analyzed survival outcomes. We used univariate and multivariate analyses to determine factors associated with long-term mortality. RESULTS Cardiopulmonary bypass and surgical times were significantly longer in the concomitant total aortic arch replacement with coronary artery bypass grafting group. Hospital mortality was 3.3% in the total aortic arch replacement group and 7.7% in the concomitant total aortic arch replacement with coronary artery bypass grafting group. Perioperative myocardial infarction was not seen in either group. There were no significant differences in mortality between the groups. Multivariate analysis revealed preoperative age, ischemic heart disease, and estimated glemerular filtration rate (eGFR) as risk factors affecting long-term mortality, whereas concomitant total aortic arch replacement with coronary artery bypass grafting was not a risk factor. CONCLUSION Although patients' backgrounds should be considered, total aortic arch replacement can be concomitantly performed with coronary artery bypass grafting surgery without additional mortality risk.
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Affiliation(s)
- Ken Yamanaka
- Department of Cardiovascular Surgery, Kurashiki Central Hospital, Kurashiki, Okayama, Japan
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Omura A, Miyahara S, Yamanaka K, Sakamoto T, Matsumori M, Okada K, Okita Y. Early and late outcomes of repaired acute DeBakey type I aortic dissection after graft replacement. J Thorac Cardiovasc Surg 2016; 151:341-8. [DOI: 10.1016/j.jtcvs.2015.03.068] [Citation(s) in RCA: 79] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Revised: 02/08/2015] [Accepted: 03/07/2015] [Indexed: 10/23/2022]
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Oda T, Minatoya K, Sasaki H, Tanaka H, Seike Y, Itonaga T, Inoue Y, Kobayashi J. Is Conventional Open Repair Still a Good Option for Aortic Arch Aneurysm in Patients of Advanced Age? Ann Thorac Surg 2016; 101:80-6. [DOI: 10.1016/j.athoracsur.2015.06.064] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Revised: 05/22/2015] [Accepted: 06/19/2015] [Indexed: 11/27/2022]
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Preventza O, Garcia A, Cooley DA, Haywood-Watson RJ, Simpson K, Bakaeen FG, Cornwell LD, Omer S, de la Cruz KI, Price MD, Rosengart TK, LeMaire SA, Coselli JS. Total aortic arch replacement: A comparative study of zone 0 hybrid arch exclusion versus traditional open repair. J Thorac Cardiovasc Surg 2015; 150:1591-8; discussion 1598-600. [DOI: 10.1016/j.jtcvs.2015.08.117] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Revised: 08/11/2015] [Accepted: 08/22/2015] [Indexed: 10/23/2022]
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Kurimoto Y, Maruyama R, Ujihira K, Nishioka N, Hasegawa K, Iba Y, Hatta E, Yamada A, Nakanishi K. Thoracic Endovascular Aortic Repair for Challenging Aortic Arch Diseases Using Fenestrated Stent Grafts From Zone 0. Ann Thorac Surg 2015; 100:24-32; discussion 32-3. [DOI: 10.1016/j.athoracsur.2015.01.071] [Citation(s) in RCA: 69] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Revised: 01/06/2015] [Accepted: 01/16/2015] [Indexed: 11/30/2022]
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Matalanis G, Perera NK, Galvin SD. Aortic arch replacement without circulatory arrest or deep hypothermia: The “branch-first” technique. J Thorac Cardiovasc Surg 2015; 149:S76-82. [DOI: 10.1016/j.jtcvs.2014.07.100] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Revised: 07/03/2014] [Accepted: 07/21/2014] [Indexed: 11/30/2022]
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A study of brain protection during total arch replacement comparing antegrade cerebral perfusion versus hypothermic circulatory arrest, with or without retrograde cerebral perfusion: Analysis based on the Japan Adult Cardiovascular Surgery Database. J Thorac Cardiovasc Surg 2015; 149:S65-73. [DOI: 10.1016/j.jtcvs.2014.08.070] [Citation(s) in RCA: 92] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2014] [Revised: 08/14/2014] [Accepted: 08/20/2014] [Indexed: 11/24/2022]
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Clinical outcomes of different approaches to aortic arch disease. J Vasc Surg 2015; 61:88-95. [DOI: 10.1016/j.jvs.2014.06.121] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2014] [Accepted: 06/24/2014] [Indexed: 11/18/2022]
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Influences of Chronic Obstructive Pulmonary Disease on Outcomes of Total Arch Replacement. Ann Thorac Surg 2015; 99:72-8. [DOI: 10.1016/j.athoracsur.2014.08.031] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2014] [Revised: 08/05/2014] [Accepted: 08/15/2014] [Indexed: 11/17/2022]
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Di Eusanio M, Berretta P, Cefarelli M, Castrovinci S, Folesani G, Alfonsi J, Pantaleo A, Murana G, Di Bartolomeo R. Long-term outcomes after aortic arch surgery: results of a study involving 623 patients. Eur J Cardiothorac Surg 2014; 48:483-90. [DOI: 10.1093/ejcts/ezu468] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2014] [Accepted: 11/04/2014] [Indexed: 11/12/2022] Open
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Minami H, Miyahara S, Okada K, Matsumori M, Kano H, Inoue T, Sakamoto T, Okita Y. Clinical outcomes of combined aortic root reimplantation technique and total arch replacement. Eur J Cardiothorac Surg 2014; 48:152-7. [PMID: 25354747 DOI: 10.1093/ejcts/ezu387] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Accepted: 09/04/2014] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVES The goal of this study was to evaluate early and late outcomes of combined valve-sparing aortic root replacement and total arch replacement (TAR). METHODS From October 1999 to May 2014, 195 patients underwent valve-sparing operations using the David reimplantation technique. Thirty-one patients underwent combined TAR for aortic regurgitation (AR) with extended aortic aneurysm from the aortic root to the aortic arch. Aetiologies included acute type A aortic dissection in 12 cases, chronic aortic dissection in 8 cases and non-dissecting aneurysm in 11 cases. There were 9 patients with Marfan syndrome. The preoperative severity of AR was mild in 4, moderate in 16 and severe in 11. Even though half of those were emergent operations for acute aortic dissection, preoperative haemodynamic conditions were stable in all patients. RESULTS No hospital deaths occurred. Postoperative complications included prolonged mechanical ventilation (>48 h) in 1 case and re-exploration for bleeding in 2 cases. Other complications, such as neurological dysfunction or low cardiac output syndrome, were not observed. At hospital discharge, 2 patients had mild AR, 22 had trace AR and 7 had no AR. During follow-up, 2 patients had moderate AR, 7 had mild AR, 18 had trace AR and 3 had no AR. Follow-up was completed in 95.1% of patients, and the mean follow-up period was 60.5 ± 9.1 months. No late death and thromboembolic complication occurred during follow-up. One patient required reoperation for AR. Freedom from reoperation at 5 and 10 years was 100 ± 0 and 83.3 ± 3.5%, respectively. Freedom from moderate or severe AR at 3 and 5 years was 83.3 ± 3.5 and 83.3 ± 3.5%, respectively. CONCLUSIONS Early outcomes of combined aortic root reimplantation and TAR were satisfactory and provided excellent freedom from thromboembolic complication. The rate of freedom from reoperation during long-term follow-up was acceptable. Further follow-up is required to evaluate this procedure.
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Affiliation(s)
- Hitoshi Minami
- Department of Surgery, Division of Cardiovascular Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Shunsuke Miyahara
- Department of Surgery, Division of Cardiovascular Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Kenji Okada
- Department of Surgery, Division of Cardiovascular Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Masamichi Matsumori
- Department of Surgery, Division of Cardiovascular Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Hiroya Kano
- Department of Surgery, Division of Cardiovascular Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Takeshi Inoue
- Department of Surgery, Division of Cardiovascular Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Toshihito Sakamoto
- Department of Surgery, Division of Cardiovascular Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yutaka Okita
- Department of Surgery, Division of Cardiovascular Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
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Takashima N, Suzuki T, Asai T, Nota H, Ikegami H, Kinoshita T, Fujino S, Hosoba S. Outcome of total arch replacement with coronary artery bypass grafting. Eur J Cardiothorac Surg 2014; 47:990-4. [DOI: 10.1093/ejcts/ezu341] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Accepted: 07/21/2014] [Indexed: 11/12/2022] Open
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Nota H, Asai T, Suzuki T, Kinoshita T, Ikegami H, Takashima N. Risk factors for acute kidney injury in aortic arch surgery with selective cerebral perfusion and mild hypothermic lower body circulatory arrest. Interact Cardiovasc Thorac Surg 2014; 19:955-61. [DOI: 10.1093/icvts/ivu241] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Hiraoka A, Chikazawa G, Totsugawa T, Kuinose M, Tamura K, Sakaguchi T, Yoshitaka H. Open total aortic arch reconstruction for patients with advanced age in the era of endovascular repair. J Thorac Cardiovasc Surg 2014; 148:77-82. [DOI: 10.1016/j.jtcvs.2013.07.042] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2013] [Revised: 07/01/2013] [Accepted: 07/18/2013] [Indexed: 10/26/2022]
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Modified Elephant Trunk Technique in Distal Anastomosis With the Aid of Antegrade Selective Cerebral Perfusion for Total Arch Replacement. Ann Thorac Surg 2014; 97:1281-5. [DOI: 10.1016/j.athoracsur.2013.11.018] [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: 05/30/2013] [Revised: 10/05/2013] [Accepted: 11/11/2013] [Indexed: 11/18/2022]
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Efficacy of right axillary artery perfusion for antegrade cerebral perfusion in open total arch repair. J Vasc Surg 2014; 60:436-42. [PMID: 24680238 DOI: 10.1016/j.jvs.2014.02.049] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2014] [Accepted: 02/21/2014] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Right axillary artery (RAxA) perfusion was introduced for selective antegrade cerebral perfusion in total aortic arch repair to prevent cerebral embolism derived from arterial cannulation. However, the strategic benefits and long-term results regarding the cannulation site remain controversial. We retrospectively compared the outcomes between propensity score-matched patients with and without using RAxA cannulation. METHODS Between 2006 and 2012, 260 consecutive patients underwent total arch repair with antegrade cerebral perfusion and moderate hypothermia at a single institution. RAxA cannulation was added in 142 patients (54.6%), and 70 propensity score-matched pairs were obtained. RESULTS There were no significant differences in 30-day (2.9% [2 of 70] vs 5.7% [4 of 70]; P = .415 and in-hospital death (5.7% [4 of 70] vs 5.7% [4 of 70]; P = 1.000) between matched pairs. Although there was no significant difference in the occurrence of postoperative stroke (8.6% [6 of 70] vs 8.6% [6 of 70]; P = 1.000), the new rate of new occurrence of postoperative paraparesis was lower in patients with RAxA perfusion (0% [0 of 70] vs 4.3% [3 of 70]; P = .067). With a mean follow-up period of 1057 ± 686 days, the overall 5-year survival was 90.6% and was 89.6% for patients with RAxA perfusion. Thee difference in survival between patients with and without RAxA perfusion was not significant. CONCLUSIONS RAxA perfusion is a useful option for total aortic arch repair, and the midterm outcomes were satisfactory. However, RAxA perfusion did not completely prevent stroke in patients with an atherothrombotic aorta.
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Tanaka Y, Mikamo A, Suzuki R, Kurazumi H, Kudo T, Takahashi M, Ikenaga S, Shirasawa B, Hamano K. Mortality and morbidity after total aortic arch replacement. Ann Thorac Surg 2014; 97:1569-75. [PMID: 24629302 DOI: 10.1016/j.athoracsur.2014.01.014] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2013] [Revised: 12/26/2013] [Accepted: 01/06/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Total aortic arch replacement is associated with considerable mortality and morbidity. Although operative death is the most extreme adverse clinical end point, postoperative morbidity can also be devastating for survivors. METHODS We examined the short-term and long-term outcomes of 146 patients who underwent total aortic arch replacements between September 2003 and September 2011. RESULTS The overall in-hospital mortality was 4.8%, and major postoperative morbidity during hospitalization occurred in 29 patients (19.9%). Multivariate analyses demonstrated that risk factors for hospital death were left thoracotomy (odds ratio [OR], 51.92; p=0.01), high preoperative serum creatinine values (OR, 3.88; p=0.02), and intraoperative blood loss (OR, 1.01; p=0.04). Ruptured aorta (OR, 7.13; p=0.02) and previous myocardial infarction (OR, 5.13; p=0.04) were identified as independent risk factors for major postoperative morbidity. The postoperative survival of all patients at 5 years was 76.7%±5%. After hospital discharge, the standardized mortality ratios showed no significant difference between hospital survivors and a comparable Japanese population and were 1.09 (p=0.41) among patients without major morbidity and 1.82 (p=0.12) among those with major morbidity. The development of renal failure requiring hemodialysis increased the risk of long-term death (hazard ratio, 5.59; p=0.03), even among hospital survivors. CONCLUSIONS Our approach for total arch replacement resulted in low in-hospital mortality and morbidity. Long-term outcomes are stable in hospital survivors, especially in the absence of a postoperative requirement for dialysis.
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Affiliation(s)
- Yuya Tanaka
- Department of Surgery and Clinical Science, Division of Cardiac Surgery, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
| | - Akihito Mikamo
- Department of Surgery and Clinical Science, Division of Cardiac Surgery, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan.
| | - Ryo Suzuki
- Department of Surgery and Clinical Science, Division of Cardiac Surgery, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
| | - Hiroshi Kurazumi
- Department of Surgery and Clinical Science, Division of Cardiac Surgery, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
| | - Tomoaki Kudo
- Department of Surgery and Clinical Science, Division of Cardiac Surgery, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
| | - Masaya Takahashi
- Department of Surgery and Clinical Science, Division of Cardiac Surgery, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
| | - Shigeru Ikenaga
- Department of Surgery and Clinical Science, Division of Cardiac Surgery, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
| | - Bungo Shirasawa
- Department of Surgery and Clinical Science, Division of Cardiac Surgery, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
| | - Kimikazu Hamano
- Department of Surgery and Clinical Science, Division of Cardiac Surgery, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
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Kurazumi H, Mikamo A, Kudo T, Suzuki R, Takahashi M, Shirasawa B, Zempo N, Hamano K. Aortic arch surgery in octogenarians: is it justified? Eur J Cardiothorac Surg 2014; 46:672-7. [DOI: 10.1093/ejcts/ezu056] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Okada K, Yamanaka K, Sakamoto T, Inoue T, Matsumori M, Kawakami F, Okita Y. In situ total aortic arch replacement for infected distal aortic arch aneurysms with penetrating atherosclerotic ulcer. J Thorac Cardiovasc Surg 2014; 148:2096-100. [PMID: 24607377 DOI: 10.1016/j.jtcvs.2014.02.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2013] [Revised: 12/22/2013] [Accepted: 02/03/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND We present a series of patients who underwent in situ total aortic arch replacement for infected distal aortic arch aneurysms. METHODS Between 2002 and 2013, 9 patients with infected distal aortic arch aneurysms underwent total aortic arch replacement using antegrade selective cerebral perfusion. There were 4 male and 5 female patients with a mean age of 72.7±9.0 years. All patients had penetrating atherosclerotic ulcer in the distal aortic arch, which formed saccular aneurysms. Four patients had preoperative hoarseness. Maximum preoperative white blood cell count was 10,211±4375/μL, and mean serum C-reactive protein concentration was 12.7±7.2 mg/dL. Causative microorganisms were identified by blood culture or aortic wall culture and were as follows: Candida albicans, Pseudomonas aeruginosa, Edwardsiella tarda, Streptococcus dysgalactiae, Listeria monocytogenes, Staphylococcus aureus (2 cases), and unknown (2 cases). Radical debridement with in situ total aortic arch replacement was performed in all patients, followed by the omental flap grafting in 7 patients. All surgery was performed on an urgent or emergency basis. RESULTS Average cardiopulmonary bypass time and lower body circulatory arrest time were 199.7±50.7 minutes and 66.6±13.8 minutes, respectively. There was no in-hospital mortality, but 1 patient died of asphyxia 5 months after hospital discharge. Freedom from recurrence of infection was 100%. CONCLUSIONS Surgical treatment with the combination of radical debridement with in situ total aortic arch replacement using antegrade selective cerebral perfusion and omental flap grafting was a reliable procedure for the treatment of infected distal aortic arch aneurysms.
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Affiliation(s)
- Kenji Okada
- Division of Cardiovascular Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Katsuhiro Yamanaka
- Division of Cardiovascular Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Toshihito Sakamoto
- Division of Cardiovascular Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Takeshi Inoue
- Division of Cardiovascular Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Masamichi Matsumori
- Division of Cardiovascular Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Fumi Kawakami
- Department of Diagnostic Pathology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yutaka Okita
- Division of Cardiovascular Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan.
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Watanabe Y, Shimamura K, Shirakawa Y, Torikai K, Kuratani T, Sawa Y. A new staged hybrid total arch repair procedure using a branched proximal elephant trunk technique with implantation of stent grafts to the ascending aorta. J Vasc Surg 2013; 58:1700-4. [DOI: 10.1016/j.jvs.2013.05.044] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2013] [Revised: 03/19/2013] [Accepted: 05/10/2013] [Indexed: 11/24/2022]
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Hartert M, Abugameh A, Vahl CF. Herausforderung Porzellanaorta. ZEITSCHRIFT FUR HERZ THORAX UND GEFASSCHIRURGIE 2013. [DOI: 10.1007/s00398-013-1039-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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