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Dada RS, Kakuturu J, Cook C, Toker A, Ellison M. Descending Thoracic Aorta Replacement in the Setting of Coexisting Aortobronchial and Aortoesophageal Fistula Formation After Open Thoracic Aortic Graft Placement and Subsequent Endovascular Aortic Repair. J Cardiothorac Vasc Anesth 2024; 38:499-504. [PMID: 38071146 DOI: 10.1053/j.jvca.2023.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 10/15/2023] [Accepted: 11/01/2023] [Indexed: 01/27/2024]
Affiliation(s)
- Rachel S Dada
- Department of Anesthesiology, West Virginia University, Morgantown, WV.
| | - Jahnavi Kakuturu
- Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, WV
| | - Chris Cook
- Division of Cardiothoracic Surgery, Sentara Heart Hospital, Norfolk, VA
| | - Alper Toker
- Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, WV
| | - Matthew Ellison
- Division of Cardiovascular and Thoracic Anesthesiology, Department of Anesthesiology, West Virginia University, Morgantown, WV
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2
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Lee YP, Ozaki K, Oshima S, Hirokami T. Aortoesophageal fistula treated using one-stage total reconstruction: a case report from a high-volume center. J Cardiothorac Surg 2023; 18:329. [PMID: 37964318 PMCID: PMC10647152 DOI: 10.1186/s13019-023-02438-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 11/04/2023] [Indexed: 11/16/2023] Open
Abstract
BACKGROUND Aortoesophageal fistula (AEF) is a rare but typically life-threatening condition. Although several treatment strategies exist, including conservative treatment with intraluminal stent graft and open thoracic aortic replacement, the overall outcome remains poor, ranging from 16 to 39%. Furthermore, esophageal reconstruction methods vary between hospitals. Herein, we report a case of aortoesophageal fistula treated using one-stage total reconstruction. CASE PRESENTATION This case involved a 58-year-old woman who developed acute type A aortic dissection and underwent successful total arch replacement at the other hospital. However, she developed AEF 1 year later and underwent urgent thoracic endovascular aortic repair, which eventually failed. We performed thoracic aortic replacement, total esophagectomy, gastric tube reconstruction, and omental flap in a one-stage operation. The patient was extubated the next day and transferred to the general ward on postoperative day 3. Computed tomography revealed favorable results. CONCLUSIONS For postoperative AEF, dedicated debridement with reconstruction is more effective than conservative treatment. In an experienced center, post-procedure-related AEF can be easily treated using one-stage reconstruction.
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Affiliation(s)
- Yi-Ping Lee
- Kawasaki Aortic Center, Kawasaki Saiwai Hospital, Kawasaki, Japan.
- Division of Thoracic and Cardiovascular Surgery, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan.
| | - Kensuke Ozaki
- Kawasaki Aortic Center, Kawasaki Saiwai Hospital, Kawasaki, Japan
| | - Susumu Oshima
- Kawasaki Aortic Center, Kawasaki Saiwai Hospital, Kawasaki, Japan
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3
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Huang L, Chen X, Hu Q, Luo F, Hu J, Duan L, Wang E, Ye Z, Zhang C. The application of modular multifunctional left heart bypass circuit system integrated with ultrafiltration in thoracoabdominal aortic aneurysm repair. Front Cardiovasc Med 2022; 9:944287. [PMID: 36211541 PMCID: PMC9534546 DOI: 10.3389/fcvm.2022.944287] [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: 05/15/2022] [Accepted: 08/23/2022] [Indexed: 11/13/2022] Open
Abstract
Open thoracoabdominal aortic aneurysm (TAAA) repair is a complex and challenging operation with a high incidence of serious complications, and high perioperative mortality and morbidity. Left heart bypass (LHB) is a circulatory support system used to perfuse the distal aorta during TAAA operation, and the advantages of LHB include guaranteeing distal perfusion, reducing the use of heparin, and diminishing the risk of bleeding and postoperative neurological deficits. In China, the circuit for TAAA repair is deficient, and far from the perfusion requirements. We designed a modular multifunctional LHB circuit for TAAA repair. The modular circuit consisted of cannulation pipelines, functional consumables connection pipelines, and accessory pipelines. The accessory pipelines make up lines for selective visceral perfusion and kidney perfusion, suckers and rapid infusion. The circuit can be assembled according to surgical requirements. The ultrafilter and heat exchanger are integrated into the circuit to fulfill the basic demands of LHB. The LHB circuit also has pipelines for selective visceral perfusion to the celiac artery and superior mesenteric artery and renal perfusion pipelines. Meanwhile, the reserved pipelines facilitate the quick switch from LHB to conventional cardiopulmonary bypass (CPB). The reserved pipelines reduce the time of reassembling the CPB circuit. Moreover, the rapid infusion was integrated into the LHB circuit, which can rapid infusion when massive hemorrhage during the open procedures such as exposure and reconstruction of the aorta. The ultrafiltration can diminish the consequent hemodilution of hemorrhage and rapid infusion. A hemoperfusion cartridge also can be added to reduce the systemic inflammatory during operation. The circuit can meet the needs of LHB and quickly switch to conventional CPB. No oxygenator was required during LHB, which reduce the use of heparin and reduce the risk of bleeding. The heat exchanger contributes to temperature regulation; ultrafiltration, arterial filter, and rapid-infusion facilitated the blood volume management and are useful to maintain hemodynamic stability. This circuit made the assembly of the LHB circuit more easily, and more efficient, which may contribute to the TAAA repair operation performed in lower volume centers easily. 26 patients who received TAAA repair under the modular multifunctional LHB from January 2018-March 2022 were analyzed, and we achieved acceptable clinical outcomes. The in-hospital mortality and 30-day postoperative mortality were 15.4%, and the postoperative incidences of paraparesis (4%), stroke (4%), and AKI need hemodialysis (12%) were not particularly high, based on the limited patients sample size in short research period duration.
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Affiliation(s)
- Lingjin Huang
- Department of Cardiovascular Surgery, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Xuliang Chen
- Department of Cardiovascular Surgery, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Qinghua Hu
- Department of Cardiovascular Surgery, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Fanyan Luo
- Department of Cardiovascular Surgery, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Jiajia Hu
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
- Department of Anesthesiology, Xiangya Hospital, Central South University, Changsha, China
| | - Lian Duan
- Department of Cardiovascular Surgery, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - E. Wang
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
- Department of Anesthesiology, Xiangya Hospital, Central South University, Changsha, China
| | - Zhi Ye
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
- Department of Anesthesiology, Xiangya Hospital, Central South University, Changsha, China
| | - Chengliang Zhang
- Department of Cardiovascular Surgery, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
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4
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Yamane Y, Oshima S, Ishiko K, Okiyama M, Hirokami T, Hirai Y, Sakurai S, Ozaki K, Yoshimura K, Takahashi S, Yamamoto S. Descending thoracic aortic repair outcomes for chronic aortic dissection: a single-centre experience. Interact Cardiovasc Thorac Surg 2022; 35:6697888. [PMID: 36102809 PMCID: PMC9519091 DOI: 10.1093/icvts/ivac233] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 08/31/2022] [Accepted: 09/13/2022] [Indexed: 11/14/2022] Open
Affiliation(s)
- Yoshitaka Yamane
- Kawasaki Aortic Center, Kawasaki Saiwai Hospital , Kawasaki, Japan
| | - Susumu Oshima
- Kawasaki Aortic Center, Kawasaki Saiwai Hospital , Kawasaki, Japan
| | - Kazumasa Ishiko
- Kawasaki Aortic Center, Kawasaki Saiwai Hospital , Kawasaki, Japan
| | - Makoto Okiyama
- Kawasaki Aortic Center, Kawasaki Saiwai Hospital , Kawasaki, Japan
| | | | - Yuki Hirai
- Kawasaki Aortic Center, Kawasaki Saiwai Hospital , Kawasaki, Japan
| | - Shigeru Sakurai
- Kawasaki Aortic Center, Kawasaki Saiwai Hospital , Kawasaki, Japan
| | - Kensuke Ozaki
- Kawasaki Aortic Center, Kawasaki Saiwai Hospital , Kawasaki, Japan
| | - Kenichi Yoshimura
- Department of Biostatistics, Medical Center for Translational and Clinical Research, Hiroshima University Hospital , Hiroshima, Japan
| | - Shinya Takahashi
- Department of Surgery, Graduate School of Biomedical and Health Science, Hiroshima University , Hiroshima, Japan
| | - Shin Yamamoto
- Kawasaki Aortic Center, Kawasaki Saiwai Hospital , Kawasaki, Japan
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5
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Fujikawa T, Chow SCY, Ho JYK, Wong RHL. Open conversion with Crawford extent 3 thoracoabdominal aortic replacement after candy-plug implantation. J Card Surg 2022; 37:2152-2154. [PMID: 35451125 DOI: 10.1111/jocs.16540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 04/09/2022] [Accepted: 04/11/2022] [Indexed: 11/26/2022]
Abstract
A patient who underwent candy-plug insertion in the year 2016 developed type 1B endoleak with rapid enlargement of distal descending thoracic aortic aneurysm in the year 2021 despite the initial successful false lumen occlusion and thrombosis. Open conversion with Crawford extent 3 thoracoabdominal aortic replacement was performed successfully and the patient was discharged home without any major complications.
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Affiliation(s)
- Takuya Fujikawa
- Department of Surgery, Division of Cardiothoracic Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, New Territories Hong Kong, China, Hong Kong SAR
| | - Simon C Y Chow
- Department of Surgery, Division of Cardiothoracic Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, New Territories Hong Kong, China, Hong Kong SAR
| | - Jacky Y K Ho
- Department of Surgery, Division of Cardiothoracic Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, New Territories Hong Kong, China, Hong Kong SAR
| | - Randolph H L Wong
- Department of Surgery, Division of Cardiothoracic Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, New Territories Hong Kong, China, Hong Kong SAR
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Rusch R, Hoffmann G, Cremer J, Berndt R. Repair of the descending thoracic aorta using minimally invasive endoscopic Robot-assisted surgery: a feasibility study with the DaVinci XI system in a cadaver model. Eur J Cardiothorac Surg 2021; 61:1440-1442. [PMID: 34432002 PMCID: PMC9154338 DOI: 10.1093/ejcts/ezab400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 06/23/2021] [Accepted: 07/22/2021] [Indexed: 11/24/2022] Open
Abstract
Development of minimally invasive techniques has led to the clinical routine application of Robot-assisted surgery. Here, we demonstrate for the first time Robotic-assisted surgery (DaVinci XI) of the descending thoracic aorta in a Thiel cadaver model and discuss its potential value in the endovascular era.
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Affiliation(s)
- René Rusch
- Clinic of Cardiovascular Surgery, University Hospital of Schleswig-Holstein, Kiel, Germany.,Kurt-Semm-Center for Laparoscopic and Robot-Assisted Surgery, University Hospital of Schleswig-Holstein, Kiel, Germany
| | - Grischa Hoffmann
- Clinic of Cardiovascular Surgery, University Hospital of Schleswig-Holstein, Kiel, Germany.,Kurt-Semm-Center for Laparoscopic and Robot-Assisted Surgery, University Hospital of Schleswig-Holstein, Kiel, Germany
| | - Jochen Cremer
- Clinic of Cardiovascular Surgery, University Hospital of Schleswig-Holstein, Kiel, Germany.,Kurt-Semm-Center for Laparoscopic and Robot-Assisted Surgery, University Hospital of Schleswig-Holstein, Kiel, Germany
| | - Rouven Berndt
- Clinic of Cardiovascular Surgery, University Hospital of Schleswig-Holstein, Kiel, Germany.,Kurt-Semm-Center for Laparoscopic and Robot-Assisted Surgery, University Hospital of Schleswig-Holstein, Kiel, Germany
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7
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Rhee Y, Kim JB. Miniaccess open repair of descending thoracic aorta. JTCVS Tech 2021; 8:27-30. [PMID: 34401800 PMCID: PMC8350782 DOI: 10.1016/j.xjtc.2021.03.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 03/30/2021] [Indexed: 11/28/2022] Open
Affiliation(s)
- Younju Rhee
- Department of Thoracic and Cardiovascular Surgery, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, South Korea
| | - Joon Bum Kim
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
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Fujikawa T, Chow SCY, Chang ATC, Wong RHL. Open descending aortic replacement in a patient with a fractured Djumbodis™ dissection system. Eur J Cardiothorac Surg 2020; 58:199-201. [DOI: 10.1093/ejcts/ezz367] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 12/02/2019] [Accepted: 12/11/2019] [Indexed: 11/12/2022] Open
Abstract
Abstract
The Djumbodis™ dissection system was introduced as an alternative to aortic arch replacement in acute type A aortic dissection involving the arch. In our own experience, some patients with Djumbodis implantation developed distal aortic arch and descending aortic aneurysm during subsequent follow-up and required additional interventions. However, as there is a high incidence of fracture associated with the Djumbodis system, further endovascular interventions are not feasible. We report a case of successful open descending aortic replacement in a patient with a fractured Djumbodis stent system.
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Affiliation(s)
- Takuya Fujikawa
- Division of Cardiothoracic Surgery, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong
| | - Simon C Y Chow
- Division of Cardiothoracic Surgery, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong
| | - Aliss T C Chang
- Division of Cardiothoracic Surgery, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong
| | - Randolph H L Wong
- Division of Cardiothoracic Surgery, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong
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9
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De Santo LS. Commentary: Open surgery for descending thoracic aortic disease: "Pride and prejudice". J Thorac Cardiovasc Surg 2018; 157:2175-2176. [PMID: 30249341 DOI: 10.1016/j.jtcvs.2018.08.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Accepted: 08/24/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Luca Salvatore De Santo
- University of Foggia, Foggia, Italy; Casa di Cura Montevergine, Cardiac Surgery Unit, GVM Care and Research, Mercogliano, Avellino, Italy.
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