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Takeuchi Y, Suzuki R, Kurazumi H, Nawata R, Yokoyama T, Tsubone S, Matsuno Y, Mikamo A, Hamano K. Fate of dissected arch vessels by adventitial inversion technique for acute type A aortic dissection repair. Interact Cardiovasc Thorac Surg 2022; 35:6618531. [PMID: 35758613 PMCID: PMC9270857 DOI: 10.1093/icvts/ivac185] [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: 06/03/2022] [Accepted: 06/24/2022] [Indexed: 11/13/2022] Open
Abstract
Abstract
OBJECTIVES
The adventitial inversion technique is used widely for aortic reconstruction for acute type A aortic dissection, as it easily controls the bleeding at anastomotic sites and closes the patent false lumen. However, this technique for arch vessel reconstruction has not been previously reported. Therefore, we applied the adventitial inversion technique for dissected arch vessel reconstruction to close the patent false lumen.
METHODS
Among 57 consecutive patients who underwent emergency surgical treatment for acute type A aortic dissection from July 2006 to July 2012, the adventitial inversion technique for the dissected arch vessels was performed in 26 patients (42 arch vessel stumps). The patency and morphologic change of the false lumen of the arch vessels were evaluated using contrast-enhanced computed tomography.
RESULTS
Overall, 2 hospital deaths were recorded, and the hospital mortality rate was 4%. No postoperative cerebral strokes and reoperations due to bleeding occurred. Follow-up by contrast-enhanced computed tomography was completed in 24 patients (37 stumps) with a mean duration of 99 ± 35 months. The postoperative closure rate of the false lumen after adventitial inversion was 86%, which was higher than when adventitial inversion was not used. No adverse events including stroke occurred during follow-up period.
CONCLUSIONS
This technique facilitates the closure of the false lumen of dissected arch vessels and might improve clinical outcomes.
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Affiliation(s)
- Yuriko Takeuchi
- Department of Surgery and Clinical Science, Yamaguchi University Graduate School of Medicine , Ube, Yamaguchi, Japan
| | - Ryo Suzuki
- Department of Surgery and Clinical Science, Yamaguchi University Graduate School of Medicine , Ube, Yamaguchi, Japan
| | - Hiroshi Kurazumi
- Department of Surgery and Clinical Science, Yamaguchi University Graduate School of Medicine , Ube, Yamaguchi, Japan
| | - Ryosuke Nawata
- Department of Surgery and Clinical Science, Yamaguchi University Graduate School of Medicine , Ube, Yamaguchi, Japan
| | - Toshiki Yokoyama
- Department of Surgery and Clinical Science, Yamaguchi University Graduate School of Medicine , Ube, Yamaguchi, Japan
| | - Sarii Tsubone
- Department of Surgery and Clinical Science, Yamaguchi University Graduate School of Medicine , Ube, Yamaguchi, Japan
| | - Yutaro Matsuno
- Department of Surgery and Clinical Science, Yamaguchi University Graduate School of Medicine , Ube, Yamaguchi, Japan
| | - Akihito Mikamo
- Department of Surgery and Clinical Science, Yamaguchi University Graduate School of Medicine , Ube, Yamaguchi, Japan
| | - Kimikazu Hamano
- Department of Surgery and Clinical Science, Yamaguchi University Graduate School of Medicine , Ube, Yamaguchi, Japan
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Uchida K, Minami T, Cho T, Yasuda S, Kasama K, Suzuki S, Masuda M, Imoto K, Karube N, Goda M, Matsuki Y, Nemoto H, Izubuchi R, Kobayashi Y, Matsumoto A. Results of ascending aortic and arch replacement for type A aortic dissection. J Thorac Cardiovasc Surg 2021; 162:1025-1031. [DOI: 10.1016/j.jtcvs.2020.02.087] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 02/11/2020] [Accepted: 02/13/2020] [Indexed: 10/24/2022]
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Cho T, Uchida K, Kasama K, Machida D, Minami T, Yasuda S, Matsuki Y, Suzuki S, Masuda M. Brachiocephalic artery dissection is a marker of stroke after acute type A aortic dissection repair. J Card Surg 2021; 36:902-908. [PMID: 33442891 DOI: 10.1111/jocs.15322] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 12/16/2020] [Accepted: 12/18/2020] [Indexed: 01/02/2023]
Abstract
OBJECTIVE Postoperative stroke is a serious unsolved complication after acute type A aortic dissection (ATAAD) repair. We investigated the incidence and risk factors of stroke, and hypothesized that dissection of supra-aortic vessels is an important risk factor of this morbidity. METHODS Between 2012 and 2019, 202 (56% men, median age 68 years) patients with ATAAD underwent surgical repair. Clinical data, image findings, method of circulatory support, and repair technique were retrospectively investigated to explore the risk factor of postoperative stroke. RESULTS Of the 202 patients, operative mortality was 6% and the incidence of postoperative stroke was 12% (n = 25). Brachiocephalic artery (BCA) dissection was associated with a higher risk of stroke (odds ratio, 3.89; 95% confidence interval, 1.104-13.780; p = .035) having no relation to the presence or absence of left common carotid artery dissection. Preoperative malperfusion syndrome, circulatory arrest time, isolated cerebral perfusion time, repair technique (total arch replacement), and femoral artery perfusion alone were not related to the incident rate of postoperative stroke. Stroke occurred in both hemispheres, regardless of the laterality of carotid artery dissection. CONCLUSION BCA dissection was an independent risk factor of stroke after ATAAD repair.
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Affiliation(s)
- Tomoki Cho
- Department of Cardiovascular Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Keiji Uchida
- Department of Cardiovascular Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Keiichiro Kasama
- Department of Cardiovascular Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Daisuke Machida
- Department of Surgery, Yokohama City University, Yokohama, Japan
| | - Tomoyuki Minami
- Department of Cardiovascular Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Shota Yasuda
- Department of Cardiovascular Center, Yokohama City University Medical Center, Yokohama, Japan
| | | | - Shinichi Suzuki
- Department of Surgery, Yokohama City University, Yokohama, Japan
| | - Munetaka Masuda
- Department of Cardiovascular Center, Yokohama City University Medical Center, Yokohama, Japan.,Department of Surgery, Yokohama City University, Yokohama, Japan
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Panagouli E, Antonopoulos I, Tsoucalas G, Samolis A, Venieratos D, Troupis T. Morphometry of the Brachiocephalic Artery: A Cadaveric Anatomical Study. Cureus 2020; 12:e9897. [PMID: 32968563 PMCID: PMC7505533 DOI: 10.7759/cureus.9897] [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: 11/30/2022] Open
Abstract
Introduction The brachiocephalic artery (BCA) is the largest branch that arises from the aortic arch, which varies in length. The present study focuses on BCA length and its probable correlation with height and torso length. Methods The BCA length (from the artery’s origin to the arcus aortae), the length of the torso, and height were measured in 76 embalmed adult human cadavers of Caucasian (Hellenic) origin. Results A total of 74 arteries were measured (36 females and 38 males). The mean length was found to be 3.82 cm (SD=±0.947, SE=0.110). In male cadavers, the mean BCA length was 3.94 cm (SD=±0.980, SE=0.159) and in females, it was found to be 3.69 cm (SD=±0.905, SE=0.151). No statistically significant difference was found (p=0.248, p>0.05) The mean torso length was 62.27 cm (SD=±4.325, SE=0.496) and the mean height was 155.3 cm (SD=±10.124, SE=1.161). The BCA length was correlated with body height and torso length in both sexes. A statistically significant correlation was found only between BCA length and body height in male cadavers (r=0.267, p=0.021). Conclusion The morphometric characteristics of the BCA are of great importance in a number of surgical procedures, such as stenting and catheterization in cases of aneurysms. One statistically significant correlation was observed in our study, which could be considered an important finding, as it could lead to the plausible assumption that greater height leads to the formation of larger arteries.
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Affiliation(s)
- Eleni Panagouli
- Department of Anatomy, Medical School, National and Kapodistrian University of Athens, Athens, GRC
| | - Ioannis Antonopoulos
- Department of Anatomy, Medical School, National and Kapodistrian University of Athens, Athens, GRC
| | - Gregory Tsoucalas
- Department of Anatomy, Medical School, Democritus University of Thrace, Alexandroupolis, GRC
| | - Alexandros Samolis
- Department of Anatomy, Medical School, National and Kapodistrian University of Athens, Athens, GRC
| | - Dionysios Venieratos
- Department of Anatomy, Medical School, National and Kapodistrian University of Athens, Athens, GRC
| | - Theodore Troupis
- Department of Anatomy, Medical School, National and Kapodistrian University of Athens, Athens, GRC
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Rhee R, Gupta A, Vechvitvarakul S, Hoque M, Ruggiero M, Shih M, Youdelman B, Drapkin J, Shin M, Jacob T. Risk factors predictive of unfavorable distal aortic remodeling after surgical repair of type A thoracic aortic dissection. THE JOURNAL OF CARDIOVASCULAR SURGERY 2020; 61:323-331. [DOI: 10.23736/s0021-9509.19.10784-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Heo W, Song SW, Lee KH, Kim TH, Baek MY, Yoo KJ, Cho BK. Residual Arch Tears and Major Adverse Events After Acute DeBakey Type I Aortic Dissection Repair. Ann Thorac Surg 2018; 106:1079-1086. [DOI: 10.1016/j.athoracsur.2018.05.067] [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: 01/30/2018] [Revised: 04/17/2018] [Accepted: 05/18/2018] [Indexed: 10/28/2022]
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Aftab M, Cleveland JC, Reece TB. Noteworthy Literature Published in 2016 for Cardiac Surgery. Semin Cardiothorac Vasc Anesth 2017; 21:30-35. [PMID: 28134010 DOI: 10.1177/1089253216688694] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Cardiac surgical care of patients continued to evolve rapidly in 2016. In this article, 3 topics of considerable change are discussed based on recent publications. The first topic reviews the potential risks and benefits of newly instituted low-risk percutaneous aortic valve replacement. The second topic reviews the increasing utilization of more extensive arch replacements in acute type A dissection. The final topic reviews current trends and justification for changes in patterns of use of cardioplegia options. The topics discussed are contemporary issues facing cardiac surgery, so they should serve to address the reasoning for changes in contemporary practice in 2016.
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