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Shiiya N, Washiyama N, Takahashi D, Tsuda K, Ohashi Y, Natsume K, Hirano M. Surgical Approaches to Single-Stage Extended Aortic Repair from the Ascending to the Distal Descending Aorta. Ann Thorac Cardiovasc Surg 2023; 29:1-10. [PMID: 36104188 PMCID: PMC9939677 DOI: 10.5761/atcs.ra.22-00148] [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: 11/16/2022] Open
Abstract
Single-stage extended replacement from the ascending to the distal descending aorta or beyond is a formidable operation that should be preserved for those who have no other option or those who are physically fit, and should be performed in the experienced centers. Hybrid operations combining open surgical repair with thoracic endovascular aortic repair through a median sternotomy incision are preferable because these operations are less invasive than the extended open aortic repair and the risk of spinal cord ischemia is lower compared with the frozen elephant trunk operation. However, these operations are associated with the inherent demerits of endovascular aneurysm exclusion. When the underlying aortic pathology necessitates extended open aortic repair in a single stage, approaches such as the anterolateral partial sternotomy, straight incision with rib cross, and extended thoracotomy with sternal transection may be useful to provide sufficient exposure for both aortic reconstruction and organ protection, with less surgical stress to the patients.
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Affiliation(s)
- Norihiko Shiiya
- First Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan,Corresponding author: Norihiko Shiiya. First Department of Surgery, Hamamatsu University School of Medicine, 1-20-1, Handayama, Higashi-ku, Hamamatsu, Shizuoka 431-3192, Japan
| | - Naoki Washiyama
- First Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Daisuke Takahashi
- First Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Kazumasa Tsuda
- First Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Yuko Ohashi
- First Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Kayoko Natsume
- First Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Masahiro Hirano
- First Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
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Goto T, Koizumi J, Saiki H, Kin H. Distal arch replacement for aortic aneurysm associated with pseudocoarctation through the L-incision approach. Interact Cardiovasc Thorac Surg 2022; 35:6568020. [PMID: 35417001 PMCID: PMC9336573 DOI: 10.1093/icvts/ivac094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 03/16/2022] [Accepted: 04/11/2022] [Indexed: 11/13/2022] Open
Abstract
Abstract
We report the case of a 16-year-old boy in whom we successfully repaired a distal aortic arch aneurysm associated with pseudocoarctation using double aortic cannulation and antegrade selective cerebral perfusion through the L-incision approach. This approach provided excellent exposure from the ascending aorta to the descending aorta, which enabled total body perfusion. We avoided cardiac arrest and hypothermic circulatory arrest during the surgery. The L-incision approach could be a better alternative for aortic arch surgery in adolescents.
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Affiliation(s)
- Takuya Goto
- Department of Cardiovascular Surgery, Iwate Medical University , Morioka, Japan
| | - Junichi Koizumi
- Department of Cardiovascular Surgery, Iwate Medical University , Morioka, Japan
| | - Hirofumi Saiki
- Department of Pediatrics, Iwate Medical University , Morioka, Japan
| | - Hajime Kin
- Department of Cardiovascular Surgery, Iwate Medical University , Morioka, Japan
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Zhang H, Zhu K, Yang S, Zhai J, Zhou T, Sun X, Wang C. Bicuspid aortic valve with critical coarctation of the aorta: single- or two-stage operation? J Thorac Dis 2018; 10:4353-4359. [PMID: 30174883 DOI: 10.21037/jtd.2018.06.112] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background A bicuspid aortic valve (BAV) with critical coarctation of the aorta (CoA) is a rare but dangerous congenital cardiac malformation. The aim of this study was to compare the benefits of a single- versus two-stage operation for patients of BAV with CoA. Methods We retrospectively evaluated 20 patients of BAV and CoA who underwent surgery from 2000 to 2016 in our center. Eight patients underwent a single-stage procedure through a median sternotomy approach, while 12 patients underwent two-stage operation. Results The patients' baseline characteristics were similar between the two groups, and the overall mortality rate was 0%. No significant differences were found in the postoperative pressure gradient (P=0.64), use of implants (P=0.81), reoperation for bleeding, phrenic nerve injury, blood transfusion (P=1.00), or thromboembolic events between the two groups. However, patients in the single-stage group sustained less surgical trauma and ICU stay hours (P<0.01) than those in the two-stage group. Conclusions Performance of a single-stage operation was feasible for patients of BAV with CoA. It was a safe and optimal choice with less surgical trauma compared with a two-stage operation.
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Affiliation(s)
- Hongqiang Zhang
- Department of Cardiac Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China.,Shanghai Institute of Cardiovascular Disease, Shanghai 200032, China
| | - Kai Zhu
- Department of Cardiac Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China.,Shanghai Institute of Cardiovascular Disease, Shanghai 200032, China
| | - Shouguo Yang
- Department of Cardiac Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China.,Shanghai Institute of Cardiovascular Disease, Shanghai 200032, China
| | - Junyu Zhai
- Department of Cardiac Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China.,Shanghai Institute of Cardiovascular Disease, Shanghai 200032, China
| | - Tianyu Zhou
- Department of Cardiac Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China.,Shanghai Institute of Cardiovascular Disease, Shanghai 200032, China
| | - Xiaoning Sun
- Department of Cardiac Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China.,Shanghai Institute of Cardiovascular Disease, Shanghai 200032, China
| | - Chunsheng Wang
- Department of Cardiac Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China.,Shanghai Institute of Cardiovascular Disease, Shanghai 200032, China
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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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Yamane Y, Morimoto H, Mukai S. Single-Stage Repair of Thoracic Aortic Aneurysm through a Median Sternotomy in a Patient with Pseudocoarctation of the Aorta and Severe Aortic Valve Stenosis. Ann Vasc Dis 2015; 8:128-30. [PMID: 26131037 DOI: 10.3400/avd.cr.15-00024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Accepted: 04/14/2015] [Indexed: 11/13/2022] Open
Abstract
Pseudocoarctation of the aorta is a rare anomaly and considered a benign condition. Pseudocoarctation of the aorta has been associated with aneurysm formation in the thoracic aorta, which may cause sudden rupture or dissection. Thus, the presence of an aneurysm in combination with pseudocoarctation of the aorta is thought to be an indication for surgery. We present a case of pseudocoarctation of the aorta associated with thoracic aortic aneurysm and severe aortic valve stenosis with a bicuspid aortic valve. In our case, single-stage repair was performed through a median sternotomy using our "pleural-window approach."
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Affiliation(s)
- Yoshitaka Yamane
- Department of Cardiovascular Surgery, Fukuyama Cardiovascular Hospital, Fukuyama, Hiroshima, Japan
| | - Hironobu Morimoto
- Department of Cardiovascular Surgery, Fukuyama Cardiovascular Hospital, Fukuyama, Hiroshima, Japan
| | - Shogo Mukai
- Department of Cardiovascular Surgery, Fukuyama Cardiovascular Hospital, Fukuyama, Hiroshima, Japan
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