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Mousavizadeh M, Bashir M, Jubouri M, Tan SZ, Borzeshi EZ, Ilkhani S, Banar S, Nakhaei P, Rezaei Y, Idhrees M, Hosseini S. Zone proximalization in frozen elephant trunk: what is the optimal zone for open intervention? A systematic review and meta-analysis. THE JOURNAL OF CARDIOVASCULAR SURGERY 2022; 63:265-274. [PMID: 35238527 DOI: 10.23736/s0021-9509.22.12292-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
INTRODUCTION The treatment of complex aortic lesions involving the ascending, arch, and proximal descending aorta, remains challenging for surgeons despite the evolution of surgical techniques and aortic prostheses over decades. The frozen elephant trunk (FET) approach offers a one-stage repair of this entity of aortic pathologies. The main scope of this systematic review and meta-analysis is to evaluate the clinical outcomes and effectiveness of FET. EVIDENCE ACQUISITION In a systematic review, multiple electronic databases including EMBASE, Scopus, and PubMed/MEDLINE were searched from inception to June 2021 to identify relevant studies reporting on outcomes of total arch replacement (TAR) with FET. EVIDENCE SYNTHESIS Eighty-five studies met inclusion criteria, encompassing 10960 patients. Meta-analysis was conducted using the R-studio (RStudio, Boston, MA, USA) and STATA software (StataCorp LLC, College Station, TX, USA). The pooled in-hospital mortality rate was 7% (95% CI 0.05-0.09; I2=76%) and 12% for renal failure (95% CI 0.09-0.15; I2=88%), while the rates for paraplegia and cerebrovascular accidents were 3% (95% CI 0.02-0.04; I2=0%) and 6% (95% CI 0.05-0.08; I2=73%), respectively. Lower heterogeneity was attained after the stratification by the aortic pathologies, except for the renal failure. The distal anastomosis of the stent in zone 2 was significantly correlated with a lower renal failure development compared to zone 3 (odds ratio 0.52; 95% CI 0.33-0.82; P=0.069; I2=0%). CONCLUSIONS Our results indicate that the morbidities and mortality following TAR with FET were acceptable. We also associated the distal anastomosis in zone 2 with fewer renal failure development compared to that in zone 3.
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Affiliation(s)
- Mostafa Mousavizadeh
- Heart Valve Disease Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Mohamad Bashir
- Heart Valve Disease Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran - .,Vascular and Endovascular Surgery, Health Education, and Improvement Wales (HEIW), Velindre University NHS Trust, Cardiff, UK.,Institute of Cardiac and Aortic Disorders (ICAD), SRM Institutes for Medical Science (SIMS Hospital), Chennai, Tamil Nadu, India
| | - Matti Jubouri
- Hull York Medical School, University of York, York, UK
| | - Sven Z Tan
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Elahe Z Borzeshi
- School of Public Health and Safety, Department of Epidemiology, Shahid Beheshti University of Medical Sciences Tehran, Iran
| | - Saba Ilkhani
- Department of Surgery and Vascular Surgery, Shohada Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sepideh Banar
- Heart Valve Disease Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Pooria Nakhaei
- Endocrinology and Metabolism Research Center (EMRC), Vali-Asr Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Yousef Rezaei
- Heart Valve Disease Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammed Idhrees
- Institute of Cardiac and Aortic Disorders (ICAD), SRM Institutes for Medical Science (SIMS Hospital), Chennai, Tamil Nadu, India
| | - Saeid Hosseini
- Heart Valve Disease Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
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Bashir M, Abo Aljadayel H, Mousavizadeh M, Daliri M, Rezaei Y, Tan SZ, Mohammed I, Hosseini S. Correlation of coagulopathy and frozen elephant trunk use in aortic arch surgery: A systematic review and meta-analysis. J Card Surg 2021; 36:4699-4714. [PMID: 34550616 DOI: 10.1111/jocs.16001] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 09/14/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND The advent of frozen elephant trunk (FET) for reconstruction of elective and nonelective aortic arch surgery has augmented the treatment of complex aortic pathologies in a single-stage operation. To date, no studies have been focused on the prevalence and predictors of coagulopathy potentiated by FET procedure. METHODS In a systematic review, we searched databases up to June 2020 to find studies reporting coagulopathy complications after FET procedure. A proportional meta-analysis was carried out using STATA software (StataCorp). RESULTS A total of 46 studies consisting of 6313 patients were eligible. The pooled estimation of reoperation for postoperative bleeding was 7% (95% confidence interval [CI:] 5-8; I2 = 84.73%; reported by 39 studies including 4796 patients). The mean volume of transfused packed blood cells and fresh frozen plasma was 1677 ml (95% CI: 1066.4-2287.6) and 1016.5 ml (95% CI: 450.7-1582.3). The subgroup by the stent type showed a decrease in the heterogeneity (I2 = 0.01%, I2 = 53.95%, I2 = 0.01%, and I2 = 54.41% for Thoraflex® Hybrid, E-vita®, Frozenix®, and Cronus®, respectively). The subgroup by the chronicity of operation resulted in less heterogeneity among patients undergoing elective compared with nonelective operation (I2 = 29.22% vs. I2 = 80.56% in nonelective). Meta-regression analysis showed that age and male gender significantly impacted on the reoperation for postoperative bleeding. CONCLUSIONS The FET procedure for arch replacement is associated with coagulopathy complications and the transfusion of blood products. Male, age, and selective choice of FET use were found to be the heterogeneity sources of reoperation for postoperative bleeding.
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Affiliation(s)
- Mohamad Bashir
- Heart Valve Disease Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran.,Institute of Cardiac and Aortic Disorders (ICAD), SRM Institutes for Medical Science (SIMS Hospital), Chennai, Tamil Nadu, India.,Vascular and Endovascular Surgery, Velindre University NHS Trust, Health & Education Improvement Wales (HEIW), Wales, UK
| | - Hadi Abo Aljadayel
- Heart Valve Disease Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Mostafa Mousavizadeh
- Heart Valve Disease Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Mahdi Daliri
- Heart Valve Disease Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Yousef Rezaei
- Heart Valve Disease Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Sven Zcp Tan
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Idhrees Mohammed
- Institute of Cardiac and Aortic Disorders (ICAD), SRM Institutes for Medical Science (SIMS Hospital), Chennai, Tamil Nadu, India
| | - Saeid Hosseini
- Heart Valve Disease Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
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Wang L, Li Y, Dun Y, Sun X. Risk factor analysis of clinical outcomes of total aortic arch replacement and frozen elephant trunk with aortic balloon occlusion. J Cardiothorac Surg 2021; 16:256. [PMID: 34496891 PMCID: PMC8425170 DOI: 10.1186/s13019-021-01643-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 08/29/2021] [Indexed: 11/30/2022] Open
Abstract
Background Total aortic arch replacement (TAR) with frozen elephant trunk (FET) requires hypothermic circulatory arrest (HCA) for 20 min, which increases the surgical risk. We invented an aortic balloon occlusion (ABO) technique that requires 5 min of HCA on average to perform TAR with FET and investigated the possible merit of this new method in this study. Methods This retrospective study included consecutive patients who underwent TAR and FET (consisting of 130 cases of ABO group and 230 cases of conventional group) in Fuwai Hospital between August 2017 and February 2019. In addition to the postoperative complications, the alterations of blood routine tests, alanine transaminase (ALT) and aspartate transaminase (AST) during in-hospital stay were also recorded. Results The 30-day mortality rates were similar between ABO group (4.6%) and conventional group (7.8%, P = 0.241). Multivariate analysis showed ABO reduced postoperative acute kidney injury (23.1% vs. 35.7%, P = 0.013) and hepatic injury (12.3% vs. 27.8%, P = 0.001), and maintained similar cost to patients (25.5 vs. 24.9 kUSD, P = 0.298). We also found that AST was high during intensive care unit (ICU) stay and recovered to normal before discharge, while ALT was not as high as AST in ICU but showed a rising tendency before discharge. The platelet count showed a rising tendency on postoperative day 3 and may exceed the preoperative value before discharge. Conclusions The ABO achieved the surgical goal of TAR with FET with an improved recovery process during the in-hospital stay. Supplementary Information The online version contains supplementary material available at 10.1186/s13019-021-01643-3.
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Affiliation(s)
- Luchen Wang
- Aortic and Vascular Surgery Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No.167 North Lishi Road, Xicheng District, Beijing, 100037, China
| | - Yunfeng Li
- Aortic and Vascular Surgery Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No.167 North Lishi Road, Xicheng District, Beijing, 100037, China
| | - Yaojun Dun
- Aortic and Vascular Surgery Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No.167 North Lishi Road, Xicheng District, Beijing, 100037, China
| | - Xiaogang Sun
- Aortic and Vascular Surgery Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No.167 North Lishi Road, Xicheng District, Beijing, 100037, China.
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Rezaei Y, Bashir M, Mousavizadeh M, Daliri M, Aljadayel HA, Mohammed I, Hosseini S. Frozen elephant trunk in total arch replacement: A systematic review and meta-analysis of outcomes and aortic proximalization. J Card Surg 2021; 36:1922-1934. [PMID: 33665866 DOI: 10.1111/jocs.15452] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 01/04/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIM OF THE STUDY The frozen elephant trunk (FET) procedure became a popular entity for utilization in aortic arch aneurysm disease. However, its proper mortality and morbidities as well as the predictors of outcomes are poorly identified. This systematic review and meta-analysis explore FET outcomes and its predictors with a focus on zone aortic proximalization. METHODS We searched PubMed/MEDLINE, EMBASE, and Scopus databases from their beginning to June 2020 to find studies reporting the outcomes of the FET procedure for the total arch replacement (TAR). RESULTS A total of 64 studies including 7967 patients were evaluated. The pooled estimates of cerebrovascular accidents, paraplegia, renal failure, and in-hospital mortality were 7.104 (95% confidence interval [CI], 5.691-8.661; I2 = 78.53%), 3.465 (95% CI, 2.852-4.136; I2 = 15.96), 14.969 (95% CI, 11.361-18.977; I2 = 91.26%), and 8.933 (95% CI, 7.128-10.919; I2 = 78.51%), respectively. Stratification by the geographical locations and by the aortic pathologies led to lower heterogeneity, but not for renal failure. The distal anastomosis in Zone 2 was associated with a lower rate of renal failure compared with Zone 3 (odds ratio, 0.54; 95% CI, 0.36-0.81; p = .003; I2 = 0%). CONCLUSIONS The FET procedure for TAR can be performed with acceptable mortality and morbidities among patients with complex aortic pathologies. Moreover, the distal anastomosis in Zone 2 was associated with lower renal failure compared to Zone 3.
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Affiliation(s)
- Yousef Rezaei
- Heart Valve Disease Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Mohamad Bashir
- Department of Vascular and Endovascular Surgery, Royal Blackburn Teaching Hospital, Blackburn, UK
| | - Mostafa Mousavizadeh
- Heart Valve Disease Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Mahdi Daliri
- Heart Valve Disease Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Hadi Abo Aljadayel
- Heart Valve Disease Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Idhrees Mohammed
- Institute of Cardiac and Aortic Disorders (ICAD), SRM Institutes for Medical Science (SIMS Hospital), Chennai, Tamil Nadu, India
| | - Saeid Hosseini
- Heart Valve Disease Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
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Hu Z, Wang Z, Chang J, Zhang M, Hu X, Ren Z, Li B, Hu R. Application of prosthesis eversion method for ascending aorta replacement guarantees better clinical outcomes of type A acute aortic dissection surgery. J Thorac Dis 2021; 13:533-540. [PMID: 33717526 PMCID: PMC7947529 DOI: 10.21037/jtd-20-2578] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background The advantages of prosthesis eversion method in patients diagnosed with Stanford type A acute aortic dissection (AAD) undergoing ascending aorta replacement (AAR) is unknown. This research is designed to explore it. Methods We retrospectively analyzed the data of a total of 283 patients diagnosed with type A aortic dissection that underwent surgery in Renmin Hospital of Wuhan University from March, 2006 to April, 2020. Eighty-eight patients underwent surgical repair with traditional continuous suture technique, and 195 patients received prosthesis eversion. Baseline data, intra-operative data and early-stage clinical results were collected and statistically analyzed. Results Baseline data were similar except for age, incidence of hyperlipidemia and taking ACEI/ARB drugs (P<0.05). Cardiopulmonary bypass time, cross-clamp time, circulation arrest time, hemostasis time and total operation time in the traditional method group were far longer than in the prothesis eversion group (P<0.01). The operative mortality was similar (P>0.01). Post-operatively, there was no statistically significant difference in the mean ventilation time, mortality, incidence of re-exploration, tracheostomy, paraplegia, long-term coma and stroke between the two groups (P>0.05). Patients in the traditional method group had a longer duration stay in ICU and hospital than patients in the prosthesis eversion group (P<0.05). Patients in the traditional method group received more red blood cells (RBC) (P<0.01), plasma (P<0.05), fibrinogen (P<0.01) and albumin (P<0.05) transfusions, and CoSeal™ surgical sealant (P<0.05) than patients in the prosthesis eversion group. Conclusions Our experience and statistical analysis showed prosthesis eversion method to have some advantage in reducing blood loss and improving clinical results compared with repair with continuous suture. This technique is both simple to learn and perform.
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Affiliation(s)
- Zhipeng Hu
- Department of Cardiovascular Surgery, Renmin Hospital of Wuhan University, Wuhan, China
| | - Zhiwei Wang
- Department of Cardiovascular Surgery, Renmin Hospital of Wuhan University, Wuhan, China
| | - Jinxing Chang
- Department of Cardiovascular Surgery, Renmin Hospital of Wuhan University, Wuhan, China
| | - Min Zhang
- Department of Cardiovascular Surgery, Renmin Hospital of Wuhan University, Wuhan, China
| | - Xiaoping Hu
- Department of Cardiovascular Surgery, Renmin Hospital of Wuhan University, Wuhan, China
| | - Zongli Ren
- Department of Cardiovascular Surgery, Renmin Hospital of Wuhan University, Wuhan, China
| | - Bowen Li
- Department of Cardiovascular Surgery, Renmin Hospital of Wuhan University, Wuhan, China
| | - Rui Hu
- Department of Cardiovascular Surgery, Renmin Hospital of Wuhan University, Wuhan, China
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Kuroda Y, Uchida T, Ohba E, Yamashita A, Nakai S, Kobayashi K, Ochiai T, Sadahiro M. Aortic remodelling effect of the frozen elephant trunk technique on Stanford type A acute aortic dissection. Interact Cardiovasc Thorac Surg 2021; 32:789-791. [PMID: 33479773 DOI: 10.1093/icvts/ivaa339] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 11/26/2020] [Accepted: 12/12/2020] [Indexed: 11/14/2022] Open
Abstract
Total arch replacement using the frozen elephant trunk procedure is performed for true lumen expansion of the descending aorta in patients with type A acute aortic dissection. However, the remodelling effect of the frozen elephant trunk on the dissected descending aorta is unclear. We aimed to evaluate the effect of the frozen elephant trunk on postoperative descending aortic remodelling after surgery. Between December 2012 and January 2020, we retrospectively investigated 24 patients who underwent total arch replacement using the frozen elephant trunk for type A acute aortic dissection. Remodelling of the descending aorta was evaluated using computed tomography. The aortic remodelling effect, based on aortic true lumen ratio, was determined for (i) DeBakey type (type I versus type III retrograde); (ii) thoracic endovascular aneurysm repair reintervention status (reintervention versus no reintervention); and (iii) stent length of the frozen elephant trunk (60 vs 90 mm). Postoperative true lumen ratio significantly increased in the type I dissection group. The true lumen ratio in the no-reintervention group, which had many patients with the type I dissection, significantly increased after the frozen elephant trunk. Aortic remodelling due to the frozen elephant trunk can be expected after type I acute aortic dissections.
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Affiliation(s)
- Yoshinori Kuroda
- Division of Cardiovascular Surgery, Department of Surgery II, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Tetsuro Uchida
- Division of Cardiovascular Surgery, Department of Surgery II, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Eiichi Ohba
- Division of Cardiovascular Surgery, Department of Surgery II, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Atsushi Yamashita
- Division of Cardiovascular Surgery, Department of Surgery II, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Shingo Nakai
- Division of Cardiovascular Surgery, Department of Surgery II, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Kimihiro Kobayashi
- Division of Cardiovascular Surgery, Department of Surgery II, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Tomonori Ochiai
- Division of Cardiovascular Surgery, Department of Surgery II, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Mitsuaki Sadahiro
- Division of Cardiovascular Surgery, Department of Surgery II, Yamagata University Faculty of Medicine, Yamagata, Japan
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Yu A, Zhang M, Wang Z, Hu Z, Hu R, Xiao Q. Elephant Trunk Stent Fenestration for Acute Type A Aortic Dissection. Ann Thorac Surg 2020; 112:747-754. [PMID: 33385366 DOI: 10.1016/j.athoracsur.2020.12.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 11/12/2020] [Accepted: 12/07/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND This study investigated the clinical outcomes of elephant trunk stent fenestration in patients with acute type A aortic dissection (ATAAD). METHODS From January 2009 to December 2019, 271 ATAAD patients were treated in the Department of Cardiovascular Surgery, Renmin Hospital of Wuhan University. Patients underwent deep hypothermia circulatory arrest with bilateral antegrade cerebral perfusion with total arch replacement and elephant trunk stent fenestration. Patient characteristics, perioperative findings, and follow-up results were analyzed retrospectively. RESULTS The average in-hospital mortality rate was 4.1%, the cardiopulmonary bypass time was 160.8 ± 60.4 minutes, the cross-clamp time was 91.1 ± 24.5 minutes, and the circulatory arrest time was 22.8 ± 5.5 minutes. The rate of reoperation for bleeding was 1.5%, and the pericardial mediastinal drainage volume was 312.0 ± 159.2 mL 24 hours after surgery. Follow-up data were available for 95.4% of patients. Endoleaks developed in 2 patients 3 years after surgery. The postoperative survival rate was 93.0% at 1 year, 89.3% at 5 years, and 81.7% at 10 years. CONCLUSIONS Elephant trunk stent fenestration can simplify reconstruction of the left subclavian artery in ATAAD patients and reduce surgical difficulty. Because the early postoperative outcomes and long-term results were satisfactory in our sample, this technique should be promoted for some patients with ATAAD.
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Affiliation(s)
- Anfeng Yu
- Department of Cardiovascular Surgery, Renmin Hospital of Wuhan University, Hubei, China; Cardiovascular Surgery Laboratory, Renmin Hospital of Wuhan University, Hubei, China; Central Laboratory, Renmin Hospital of Wuhan University, Hubei, China
| | - Min Zhang
- Department of Cardiovascular Surgery, Renmin Hospital of Wuhan University, Hubei, China; Cardiovascular Surgery Laboratory, Renmin Hospital of Wuhan University, Hubei, China; Central Laboratory, Renmin Hospital of Wuhan University, Hubei, China
| | - Zhiwei Wang
- Department of Cardiovascular Surgery, Renmin Hospital of Wuhan University, Hubei, China; Cardiovascular Surgery Laboratory, Renmin Hospital of Wuhan University, Hubei, China; Central Laboratory, Renmin Hospital of Wuhan University, Hubei, China.
| | - Zhipeng Hu
- Department of Cardiovascular Surgery, Renmin Hospital of Wuhan University, Hubei, China; Cardiovascular Surgery Laboratory, Renmin Hospital of Wuhan University, Hubei, China; Central Laboratory, Renmin Hospital of Wuhan University, Hubei, China
| | - Rui Hu
- Department of Cardiovascular Surgery, Renmin Hospital of Wuhan University, Hubei, China; Cardiovascular Surgery Laboratory, Renmin Hospital of Wuhan University, Hubei, China; Central Laboratory, Renmin Hospital of Wuhan University, Hubei, China
| | - Qiubei Xiao
- Department of Cardiovascular Surgery, Renmin Hospital of Wuhan University, Hubei, China; Cardiovascular Surgery Laboratory, Renmin Hospital of Wuhan University, Hubei, China; Central Laboratory, Renmin Hospital of Wuhan University, Hubei, China
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Pei X, Zhu SQ, Long X, Qiu BQ, Lin K, Lu F, Xu JJ, Wu YB. Modified Distal Aortic Arch Occlusion During Aortic Arch Replacement. Heart Lung Circ 2020; 29:e245-e252. [PMID: 32430219 DOI: 10.1016/j.hlc.2020.03.016] [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: 07/01/2019] [Revised: 02/12/2020] [Accepted: 03/11/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND Circulatory arrest has been identified as an independent risk factor related to postoperative mortality in patients with Stanford type A aortic dissection. This study described a modified technique for distal aortic arch occlusion that markedly shortened the circulatory arrest time. The early results are encouraging. METHODS From May 2016 to September 2018, 51 patients with Stanford type A aortic dissection underwent the modified procedure for aortic arch replacement. All operations were performed via transitory circulatory arrest by clamping the distal aorta between the left common carotid artery and the left subclavian artery. The in-hospital and follow-up data of the treated patients were investigated. RESULTS Successful repair of the involved vasculature was achieved in all patients. One (1) patient died due to postoperative aspiration and infection, and three patients required continuous renal replacement therapy due to poor preoperative renal function. The remaining patients were successfully discharged. The median average circulatory arrest time was 5.0 (3.0-6.0) minutes. No cases of tracheotomy, delayed closure, secondary thoracotomy, or other complications occurred. During the follow-up period of 2.4-18.6 months, the implanted grafts and stented elephant trunks were all fully open and not kinked. CONCLUSIONS A modified distal aortic arch occlusion can considerably shorten the duration of circulatory arrest. Current experience suggests that this approach can serve as a feasible alternative for patients during aortic arch replacement because of its simplicity and satisfactory clinical effects.
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Affiliation(s)
- Xu Pei
- Department of Cardiothoracic Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi Province, People's Republic of China
| | - Shu-Qiang Zhu
- Department of Cardiothoracic Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi Province, People's Republic of China
| | - Xiang Long
- Department of Cardiothoracic Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi Province, People's Republic of China
| | - Bai-Quan Qiu
- Department of Cardiothoracic Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi Province, People's Republic of China
| | - Kun Lin
- Department of Cardiothoracic Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi Province, People's Republic of China
| | - Feng Lu
- Department of Cardiothoracic Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi Province, People's Republic of China
| | - Jian-Jun Xu
- Department of Cardiothoracic Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi Province, People's Republic of China.
| | - Yong-Bing Wu
- Department of Cardiothoracic Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi Province, People's Republic of China.
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Li Y, Yan S, Lou S, Sun X. The strategy of cardiopulmonary bypass for total aortic arch replacement and the frozen elephant trunk technique with aortic balloon occlusion. J Int Med Res 2020; 48:300060520905410. [PMID: 32357091 PMCID: PMC7218955 DOI: 10.1177/0300060520905410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective To investigate the use of the aortic balloon occlusion technique to assist total aortic arch replacement (TAR) with frozen elephant trunk (FET) to shorten the lower body circulatory arrest (CA) time and raise the nadir temperature during cardiopulmonary bypass. Methods This retrospective study reviewed consecutive patients that underwent aortic balloon occlusion to assist TAR with FET and patients that received conventional TAR with FET procedures. Preoperative characteristics, perioperative characteristics and postoperative outcomes were compared between the two groups. Results The study included130 patients treated with aortic balloon occlusion and 230 patients treated with conventional TAR with FET. The 30-day mortality rate was similar between the aortic balloon occlusion and conventional groups (4.62% versus 7.83%, respectively). Multivariate analysis showed that aortic balloon occlusion reduced the incidence of acute kidney injury, hepatic injury and red blood cell transfusion. The application of aortic balloon occlusion reduced the mean ± SD CA time from 17.24 ± 4.36 min to 6.33 ± 5.74 min, with the target nadir nasal temperature being increased from 25°C to 28°C. Conclusion The aortic balloon occlusion technique achieved significant improvements in reducing complications, but this did not translate into lower 30-day mortality.
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Affiliation(s)
- Yunfeng Li
- Aortic and Vascular Surgery Centre, Fuwai Hospital, National Centre for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shujie Yan
- Department of Adult Cardiopulmonary Bypass, Fuwai Hospital, National Centre for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Song Lou
- Department of Adult Cardiopulmonary Bypass, Fuwai Hospital, National Centre for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiaogang Sun
- Aortic and Vascular Surgery Centre, Fuwai Hospital, National Centre for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Jiang H, Liu Y, Yang Z, Ge Y, Li L, Wang H. Total Arch Replacement via Single Upper-Hemisternotomy Approach in Patients With Type A Dissection. Ann Thorac Surg 2020; 109:1394-1399. [DOI: 10.1016/j.athoracsur.2019.08.095] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 08/05/2019] [Accepted: 08/26/2019] [Indexed: 11/30/2022]
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Ruan Y, Wang Z, Wu Z, Ren W, Ren Z, Yu A, Rahouma M. Painless retrograde type A aortic dissection followed conservative treatment of type B aortic dissection: a case report. BMC Cardiovasc Disord 2020; 20:17. [PMID: 31931757 PMCID: PMC6956508 DOI: 10.1186/s12872-020-01331-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 01/08/2020] [Indexed: 11/18/2022] Open
Abstract
Background Retrograde type A aortic dissection (RTAD) is a fatal aortic disease secondary to descending aortic dissection, and might be misdiagnosed due to its atypical symptoms lead to catastrophic outcomes. Case presentation We herein reported a case of a 40-year old Chinese non-comorbid man who received conservative treatment for acute type B aortic dissection and progressed to RTAD in a painless manner in a week. After open surgical aortic repair with stented elephant truck technique, the patient survived without obvious complication and cured with a satisfactory outcome in a half-year follow-up. Conclusion This case indicates that RTAD may present without typical symptoms, early diagnosis and open surgical procedure are imperative for treating RTAD.
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Affiliation(s)
- Yongle Ruan
- Department of Cardiovascular Surgery, Renmin Hospital of Wuhan University, Zhangzhidong Road, Wuhan, Hubei Province, 430060, People's Republic of China.,Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, NY, 10065, USA
| | - Zhiwei Wang
- Department of Cardiovascular Surgery, Renmin Hospital of Wuhan University, Zhangzhidong Road, Wuhan, Hubei Province, 430060, People's Republic of China.
| | - Zhiyong Wu
- Department of Cardiovascular Surgery, Renmin Hospital of Wuhan University, Zhangzhidong Road, Wuhan, Hubei Province, 430060, People's Republic of China
| | - Wei Ren
- Department of Cardiovascular Surgery, Renmin Hospital of Wuhan University, Zhangzhidong Road, Wuhan, Hubei Province, 430060, People's Republic of China
| | - Zongli Ren
- Department of Cardiovascular Surgery, Renmin Hospital of Wuhan University, Zhangzhidong Road, Wuhan, Hubei Province, 430060, People's Republic of China
| | - Anfeng Yu
- Department of Cardiovascular Surgery, Renmin Hospital of Wuhan University, Zhangzhidong Road, Wuhan, Hubei Province, 430060, People's Republic of China
| | - Mohamed Rahouma
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, NY, 10065, USA
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Li Y, Guo H, Shi Y, Liu Y, Sun X. Early outcome of aortic balloon occlusion during total aortic arch replacement with the frozen elephant trunk technique for aortic dissection. Interact Cardiovasc Thorac Surg 2020; 30:91-98. [PMID: 31670767 DOI: 10.1093/icvts/ivz229] [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: 01/14/2019] [Revised: 08/13/2019] [Accepted: 08/16/2019] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES The aim of this study was to propose and evaluate the new operative technique of aortic balloon occlusion in total aortic arch replacement (TAR) with the frozen elephant trunk that can significantly decrease the time of circulatory arrest and increase the hypothermic cardiopulmonary bypass (CPB) temperature. METHODS Between 2010 and 2018, 1335 patients with aortic dissection who underwent TAR with the frozen elephant trunk were included in the study. The newest 80 cases were treated with aortic balloon occlusion. To illustrate the difference with the new procedure, 1255 conventional TAR cases served as the historical control. Femoral and right axillary artery cannulations were used for CPB and antegrade selective cerebral perfusion. Circulatory arrest was implemented at the nasopharyngeal temperature of 28°C with continuous antegrade selective cerebral perfusion. After the stent graft was inserted into the true lumen of the descending aorta, the aortic balloon in a sheath was deployed into the stent graft and positioned at the metal part of the stent graft. When the balloon was inflated with enough saline to compress the stent graft, the sheath was simultaneously pressed by hand to properly fix the balloon and avoid displacement. Then femoral perfusion could be resumed. RESULTS The aortic balloon occlusion technique was successful in all patients, with the median duration of circulatory arrest being 5 (interquartile range 3-7) min. The 30-day mortality rate was 6.25% (5/80), whereas with the conventional method it was 9.40% (118/1255). The postoperative conscious revival (8.67 vs 11.40 h, P < 0.001) and mechanical ventilation times (19.70 vs 24.45 h, P = 0.02) were significantly shorter. Decreases in postoperative acute kidney injuries (13.75% vs 32.11%, P = 0.001) and liver injuries (8.75% vs 37.61%, P < 0.001) were also observed. The patients were transfused with lesser quantities of red blood cells, plasma and platelets. CONCLUSIONS The aortic balloon occlusion technique is a feasible way to shorten circulatory arrest significantly, to obviate the need for deep hypothermia in TAR with the frozen elephant trunk and to provide favourable protective effects on the central nervous, haematological and visceral systems. With these satisfactory results, this technique deserves further investigation.
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Affiliation(s)
- Yunfeng Li
- Aortic and Vascular Surgery Center, Fuwai Hospital, Beijing, China
| | - Hongwei Guo
- Aortic and Vascular Surgery Center, Fuwai Hospital, Beijing, China
| | - Yi Shi
- Aortic and Vascular Surgery Center, Fuwai Hospital, Beijing, China
| | - Yanxiang Liu
- Aortic and Vascular Surgery Center, Fuwai Hospital, Beijing, China
| | - Xiaogang Sun
- Aortic and Vascular Surgery Center, Fuwai Hospital, Beijing, China
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13
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Zhang H, Wu X, Fang G, Qiu Z, Chen LW. Is it justified to apply a modified Cabrol fistula in surgical repair of acute type A aortic dissection? J Thorac Cardiovasc Surg 2019; 158:1307-1314.e2. [PMID: 30737112 DOI: 10.1016/j.jtcvs.2018.12.082] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Revised: 11/25/2018] [Accepted: 12/25/2018] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Open repair of acute type A aortic dissection frequently results in oozing from the suture lines. A modified fistula technique was developed to rapidly control oozing and allow closing the chest immediately and safely. The efficiency of this modified fistula technique in surgical repair of acute type A aortic dissection was evaluated. METHODS This was a retrospective study. From January 2015 to December 2016, 172 patients with acute type A aortic dissection underwent emergency surgical repair in our center. Among them, 76 were treated with the modified Cabrol fistula technique (fistula group), and the others did not receive this modified technique (nonfistula group). The clinical data of all patients were retrospectively reviewed and analyzed. RESULTS The preoperative data, cardiopulmonary bypass time, aortic crossclamp time, selective cerebral perfusion, and lower body arrest time of the 2 groups were similar. The chest closure time was shorter in the fistula group. The postoperative drainage, amount of red blood cell transfusion, incidence of reopening for hemostasis, mechanical ventilation support time, duration of intensive care unit stay, incidence of postoperative dialysis, and 30-day mortality were significantly lower in the fistula group than in the nonfistula group. CONCLUSIONS During surgical repair of acute type A aortic dissection, a modified Cabral fistula technique can rapidly control oozing and effectively improve the short-term outcomes.
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Affiliation(s)
- Hui Zhang
- Department of Cardiac Surgery, Union Hospital, Fujian Medical University, Fuzhou, Fujian, China
| | - Xijie Wu
- Department of Cardiac Surgery, Union Hospital, Fujian Medical University, Fuzhou, Fujian, China
| | - Guanhua Fang
- Department of Cardiac Surgery, Union Hospital, Fujian Medical University, Fuzhou, Fujian, China
| | - Zhihuang Qiu
- Department of Cardiac Surgery, Union Hospital, Fujian Medical University, Fuzhou, Fujian, China
| | - Liang-Wan Chen
- Department of Cardiac Surgery, Union Hospital, Fujian Medical University, Fuzhou, Fujian, China.
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14
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Chen LW, Dai XF, Wu XJ, Liao DS, Hu YN, Zhang H, Dong Y. Ascending Aorta and Hemiarch Replacement Combined With Modified Triple-Branched Stent Graft Implantation for Repair of Acute DeBakey Type I Aortic Dissection. Ann Thorac Surg 2016; 103:595-601. [PMID: 27553503 DOI: 10.1016/j.athoracsur.2016.06.017] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Revised: 05/25/2016] [Accepted: 06/06/2016] [Indexed: 11/24/2022]
Abstract
BACKGROUND To simplify extensive repair of acute DeBakey type I aortic dissection, ascending aorta and hemiarch replacement combined with modified triple-branched stent graft implantation was developed. The descriptions and early results of this technique are reported. METHODS From August 2014 to September 2015, 116 patients with acute DeBakey type I aortic dissection underwent ascending aorta and hemiarch replacement combined with modified triple-branched stent graft implantation. Clinical data of all patients were retrospectively reviewed. Survivors were followed up prospectively by computed tomography angiography. RESULTS The cardiopulmonary bypass time was 131.5 ± 10.7 minutes, the aortic cross-clamp time was 50.0 ± 9.9 minutes, and the selective cerebral perfusion and lower body arrest time was 17.2 ± 2.2 minutes. The in-hospital mortality rate was 3.4%. Two patients were lost during follow-up. One patient died of a cerebrovascular accident 2 months after discharge, and another died of chronic renal failure 5 months after discharge. At the 3-month postoperative scans, complete thrombus formation of the false lumen around the implanted modified triple-branched stent graft occurred in all survivors, at the diaphragmatic level in 69.7% patients, and at the superior mesenteric arterial level in 8.3% patients. CONCLUSIONS Extensive thoracic aorta repair of acute type I aortic dissection can be performed simply by combining ascending aorta and hemiarch replacement with modified triple-branched stent graft implantation. This technique can reduce the risk and technical difficulty of extensive thoracic aorta repair to levels close to those seen with ascending aorta and hemiarch graft replacement with open distal anastomosis.
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Affiliation(s)
- Liang-Wan Chen
- Department of Cardiac Surgery, Union Hospital, Fujian Medical University, Fuzhou, Fujian, China.
| | - Xiao-Fu Dai
- Department of Cardiac Surgery, Union Hospital, Fujian Medical University, Fuzhou, Fujian, China
| | - Xi-Jie Wu
- Department of Cardiac Surgery, Union Hospital, Fujian Medical University, Fuzhou, Fujian, China
| | - Dong-Shan Liao
- Department of Cardiac Surgery, Union Hospital, Fujian Medical University, Fuzhou, Fujian, China
| | - Yun-Nan Hu
- Department of Cardiac Surgery, Union Hospital, Fujian Medical University, Fuzhou, Fujian, China
| | - Hui Zhang
- Department of Cardiac Surgery, Union Hospital, Fujian Medical University, Fuzhou, Fujian, China
| | - Yi Dong
- Department of Cardiac Surgery, Union Hospital, Fujian Medical University, Fuzhou, Fujian, China
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15
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Liu P, Chang Q, Qian X, Sun X, Yu C, Tian C, Li Y, Pei H. Early and mid-term results after hybrid total arch repair of DeBakey type I dissection without deep hypothermic circulatory arrest. Interact Cardiovasc Thorac Surg 2016; 23:608-15. [DOI: 10.1093/icvts/ivw192] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Accepted: 05/10/2016] [Indexed: 01/13/2023] Open
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16
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Ma WG, Zheng J, Sun LZ, Elefteriades JA. Open Stented Grafts for Frozen Elephant Trunk Technique: Technical Aspects and Current Outcomes. AORTA : OFFICIAL JOURNAL OF THE AORTIC INSTITUTE AT YALE-NEW HAVEN HOSPITAL 2015; 3:122-35. [PMID: 27069943 DOI: 10.12945/j.aorta.2015.14.062] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Accepted: 05/06/2015] [Indexed: 12/19/2022]
Abstract
With growing experience in patients with aneurysms and dissections in the arch and proximal descending aorta, the frozen elephant trunk (FET) technique has been shown to be safe and effective, and has achieved favorable short to mid-term outcomes. As the FET technique is gaining wider acceptance, there is a growing need for versatile, technically simple, and highly durable open stented grafts involving less complicated deployment mechanisms enabling use in various indications. This paper gives a brief review on the technical aspects and clinical outcomes of currently available open stented grafts used in the FET technique, including the E-vita Open Plus, Thoraflex Hybrid, Cronus, and J Graft. While none of these grafts can claim to be an ideal device, technology continues to improve towards this goal. As newer devices and systems are developed, more widespread use of the FET technique can be expected; such progress promises to improve the clinical outcomes and quality of life for patients with complex aortic diseases.
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Affiliation(s)
- Wei-Guo Ma
- Department of Cardiovascular Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, and Beijing Engineering Research Center of Vascular Prostheses, Beijing, China; Aortic Institute at Yale-New Haven, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Jun Zheng
- Department of Cardiovascular Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, and Beijing Engineering Research Center of Vascular Prostheses, Beijing, China
| | - Li-Zhong Sun
- Department of Cardiovascular Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, and Beijing Engineering Research Center of Vascular Prostheses, Beijing, China
| | - John A Elefteriades
- Aortic Institute at Yale-New Haven, Yale University School of Medicine, New Haven, Connecticut, USA
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Kimura N, Itoh S, Yuri K, Adachi K, Matsumoto H, Yamaguchi A, Adachi H. Reoperation for enlargement of the distal aorta after initial surgery for acute type A aortic dissection. J Thorac Cardiovasc Surg 2015; 149:S91-8.e1. [DOI: 10.1016/j.jtcvs.2014.08.008] [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: 04/22/2014] [Revised: 08/02/2014] [Accepted: 08/07/2014] [Indexed: 10/24/2022]
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