1
|
Lok YI, Villaquiran J, Kuo J. A challenging case of emergency redo surgery for acute type A aortic dissecting aneurysm of ascending and aortic arch with frozen elephant trunk following aortic root replacement. J Cardiothorac Surg 2024; 19:237. [PMID: 38627730 PMCID: PMC11020323 DOI: 10.1186/s13019-024-02653-7] [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: 10/21/2023] [Accepted: 03/19/2024] [Indexed: 04/19/2024] Open
Abstract
Redo ascending and aortic arch surgeries following previous cardiac or aortic surgery are associated with high risk of morbidity and mortality due to multiple factors included sternal re-entry injury, extensive aortic arch surgery, emergency aortic surgery, prolonged cardiopulmonary bypass duration, poor heart function, and patients with older age. Therefore, appropriate surgical strategies are important. We report a case of a 72-year-old gentleman with previous surgery of aortic root replacement who presented with acute Type A aortic dissecting aneurysm of ascending and aortic arch complicated with left hemothorax, which was successfully treated by emergency redo aortic surgery with frozen elephant trunk (FET) technique.
Collapse
Affiliation(s)
- Yuh Ing Lok
- Department of Cardiothoracic Surgery, Derriford Hospital, Derriford Road, Plymouth, PL6 8DH, UK.
| | - Jaime Villaquiran
- Department of Cardiothoracic Surgery, Derriford Hospital, Derriford Road, Plymouth, PL6 8DH, UK
| | - James Kuo
- Department of Cardiothoracic Surgery, Derriford Hospital, Derriford Road, Plymouth, PL6 8DH, UK
| |
Collapse
|
2
|
Suzuki R, Akita M, Miyazaki S, Shimano R. Extra-anatomical left common carotid and subclavian artery bypass followed by aortic arch replacement with frozen elephant trunk. J Cardiothorac Surg 2023; 18:276. [PMID: 37807044 PMCID: PMC10561458 DOI: 10.1186/s13019-023-02403-1] [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: 03/30/2023] [Accepted: 09/30/2023] [Indexed: 10/10/2023] Open
Abstract
BACKGROUND Total arch replacement (TAR) using a frozen elephant trunk (FET) allows for simultaneous treatment of the aortic arch and descending aortic pathology via median sternotomy. In addition, an extra-anatomical bypass performed between the left common carotid artery (CCA) and subclavian artery (SCA) prior to TAR allowed further proximalisation of the FET prosthesis, facilitated distal anastomosis of the TAR and spared the demanding left subclavian artery (LSA) anastomosis in the deep thorax. We investigated the efficacy of this debranching-first technique, followed by TAR using a frozen elephant trunk, as a two-stage operation for extensive thoracic aortic aneurysms in high-risk patients. METHODS Forty-nine consecutive patients with diffuse degenerative aneurysms from the aortic arch to the descending aorta or chronic aortic dissection who underwent left common carotid to subclavian artery bypass followed by TAR using a frozen elephant trunk and subsequent thoracic endovascular aortic repair between 2016 and 2021 were analysed. The baseline characteristics and clinical outcomes were assessed. The estimated overall survival, 5-year aortic event-free survival, and aortic reintervention rates were analysed. RESULTS The average European System for Cardiac Operative Risk Evaluation (EuroSCORE II) was 4.7 ± 2.5. The operative mortality rate was 4.1%, with no paraplegia events. The estimated 5-year overall survival, cumulative aortic-related mortality rates were 76.8% and 2%, respectively. The estimated 5-year overall cumulative aortic reintervention rate, including the intended intervention, was 31.3%. The estimated 5-year cumulative rate of non-intended reintervention was 4.5%. CONCLUSIONS The assessed technique enables a less technically demanding surgery with reasonable outcomes. The estimated 5-year aortic event-free survival and reintervention rates were acceptable, suggesting that multiple stages of alternative open and endovascular interventions, such as this technique, may reduce the morbidity and mortality rates of high-risk patients with diffuse thoracic aortic aneurysm. UMIN-CTR (University hospital Medical Information Network-Clinical Trial Registry) https://center6.umin.ac.jp/cgi-open-bin/ctr_e/index.cgi Clinical registration number: UMIN000051531.
Collapse
Affiliation(s)
- Ryo Suzuki
- Department of Cardiovascular Surgery, Shinmatsudo Central General Hospital, 1-380 Shinmatsudo, Matsudo, Chiba, 270-0034, Japan.
| | - Masafumi Akita
- Department of Cardiovascular Surgery, Shinmatsudo Central General Hospital, 1-380 Shinmatsudo, Matsudo, Chiba, 270-0034, Japan
| | - Suguru Miyazaki
- Department of Cardiovascular Surgery, Shinmatsudo Central General Hospital, 1-380 Shinmatsudo, Matsudo, Chiba, 270-0034, Japan
| | - Ryo Shimano
- Department of Cardiovascular Surgery, Shinmatsudo Central General Hospital, 1-380 Shinmatsudo, Matsudo, Chiba, 270-0034, Japan
| |
Collapse
|
3
|
Nakamura H, Maeda T, Minote T, Kotoku A, Koizumi S, Matsuda H, Ohnishi Y. Transesophageal Echocardiography for Plug Closure After Aortic Arch Replacement. J Cardiothorac Vasc Anesth 2023; 37:672-673. [PMID: 36670020 DOI: 10.1053/j.jvca.2022.12.026] [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: 11/24/2022] [Revised: 12/21/2022] [Accepted: 12/25/2022] [Indexed: 12/31/2022]
Affiliation(s)
- Hiroki Nakamura
- Department of Anesthesiology, National Cerebral and Cardiovascular Center, Osaka, Japan.
| | - Takuma Maeda
- Department of Anesthesiology, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Takamune Minote
- Department of Anesthesiology, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Akiyuki Kotoku
- Department of Radiology, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Shigeki Koizumi
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Hitoshi Matsuda
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Yoshihiko Ohnishi
- Department of Anesthesiology, National Cerebral and Cardiovascular Center, Osaka, Japan
| |
Collapse
|
4
|
Wong J, Tenorio ER, Lima G, Dias-Neto M, Baghbani-Oskouei A, Mendes B, Kratzberg J, Ocasio L, Macedo TA, Oderich GS. Early Feasibility of Endovascular Repair of Distal Aortic Arch Aneurysms Using Patient-Specific Single Retrograde Left Subclavian Artery Branch Stent Graft. Cardiovasc Intervent Radiol 2023; 46:249-254. [PMID: 36319711 PMCID: PMC9628377 DOI: 10.1007/s00270-022-03304-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Accepted: 10/14/2022] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To describe the feasibility and outcomes of endovascular repair of distal aortic arch aneurysms using a patient-specific stent graft with a pre-loaded single retrograde left subclavian artery (LSA) branch stent graft. METHODS We reviewed the clinical data and outcomes of consecutive patients enrolled in an ongoing prospective, non-randomized physician-sponsored investigational device exemption study to evaluate the outcomes of endovascular aortic arch repair using patient-specific arch branch stent grafts (William Cook Europe, Bjaeverskov, Denmark) between 2019 and 2022. All patients received a design with triple-wide scallop and a single retrograde LSA branch with a pre-loaded catheter. RESULTS There were five male patients with median age of 77 years old (72-80) treated using the single LSA branch stent graft. Technical success was achieved in all patients. Median operating time, fluoroscopy time, and total radiation dose area product were 103 (78-134) minutes, 26 (19-39) minutes, and 123 (71-270) mGy.cm2, respectively. There were no 30-day or in-hospital mortality, neurological or other major adverse events (MAEs). During median follow-up of 21 (20-27) months, all patients were alive with patent LSA branches, except for one who died of COVID-19 complications. There was no branch instability or secondary interventions. CONCLUSION This early feasibility study demonstrates successful endovascular repair of distal aortic arch aneurysms using a patient-specific stent graft with single retrograde LSA branch without technical failures, mortality or neurological events. Larger clinical experience and longer follow-up are needed to determined effectiveness of this approach in patients who need endovascular repair with proximal extension into Zone 2.
Collapse
Affiliation(s)
- Joshua Wong
- Advanced Aortic Research Program, Department of Cardiothoracic & Vascular Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Emanuel R Tenorio
- Advanced Aortic Research Program, Department of Cardiothoracic & Vascular Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Guilherme Lima
- Advanced Aortic Research Program, Department of Cardiothoracic & Vascular Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Marina Dias-Neto
- Advanced Aortic Research Program, Department of Cardiothoracic & Vascular Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Aidin Baghbani-Oskouei
- Advanced Aortic Research Program, Department of Cardiothoracic & Vascular Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Bernardo Mendes
- Advanced Aortic Research Program, Department of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN, USA
| | - Jarin Kratzberg
- Advanced Aortic Research Program, Department of Cardiothoracic & Vascular Surgery, Cook Medical Inc., Bloomington, IN, USA
| | - Laura Ocasio
- Advanced Aortic Research Program, Department of Cardiothoracic & Vascular Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Thanila A Macedo
- Advanced Aortic Research Program, Department of Cardiothoracic & Vascular Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Gustavo S Oderich
- Advanced Aortic Research Program, Department of Cardiothoracic & Vascular Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA.
- Texas Medical Center, McGovern Medical School, University of Texas Health Science Center, 6400 Fannin, Suite 2850, Houston, TX, 77030, USA.
| |
Collapse
|
5
|
Goebel N, Holder SA, Huether F, Bail DHL, Franke UFW. Left Subclavian Artery Sacrifice in Acute Aortic Dissection Repair using the Frozen Elephant Trunk. Thorac Cardiovasc Surg 2022; 70:623-629. [PMID: 35038756 DOI: 10.1055/s-0041-1741058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVE Surgery of acute aortic dissection using the frozen elephant trunk (FET) can be complicated when the origin of the left subclavian artery (LSA) is dissected and sacrifice by ligation is a viable option. However, the LSA is supposed to play a role in neuroprotection as a major collateral. We, therefore, analyzed our results of LSA sacrifice in this cohort. METHODS We identified a total of 84 patients from our prospectively collected database who underwent FET repair of acute aortic dissection between October 2009 and April 2018. LSA was sacrificed in 19 patients (22.6%). Results were analyzed and compared with regard to neurological outcomes. RESULTS New postoperative stroke was seen in two patients (2.4%) and spinal cord injury in three patients (3.6%) overall, none in the LSA-sacrifice group. We observed a temporary neurological deficit in five patients (6.0%) overall, none in the LSA-sacrifice group. None of the patients developed acute ischemia of the left arm. Only two patients (12.5%) came back for carotid-subclavian artery bypass due to exertion-induced weakness of the left arm 3 to 4 months after the initial surgery. In-hospital mortality was 15.5% overall, with no difference between groups. CONCLUSION LSA sacrifice was not associated with elevated postoperative risk of either central or spinal neurological injury. Thus, it can facilitate FET repair of acute aortic dissection in selected cases when the left subclavian origin cannot be preserved. Carotid-subclavian artery bypass became necessary in only a small fraction of these patients and can be performed as a second-stage procedure.
Collapse
Affiliation(s)
- Nora Goebel
- Department of Cardiac and Vascular Surgery, Robert Bosch Hospital, Stuttgart, Germany
| | - Simone A Holder
- Department of Cardiac and Vascular Surgery, Robert Bosch Hospital, Stuttgart, Germany
| | - Franziska Huether
- Department of Cardiac and Vascular Surgery, Robert Bosch Hospital, Stuttgart, Germany
| | - Dorothee H L Bail
- Department of Cardiac and Vascular Surgery, Robert Bosch Hospital, Stuttgart, Germany
| | - Ulrich F W Franke
- Department of Cardiac and Vascular Surgery, Robert Bosch Hospital, Stuttgart, Germany
| |
Collapse
|
6
|
Vekstein AM, Hughes GC, Chen EP. Open arch surgery in the redo setting: contemporary outcomes. THE JOURNAL OF CARDIOVASCULAR SURGERY 2022; 63:415-424. [PMID: 35621063 DOI: 10.23736/s0021-9509.22.12388-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND Aortic arch reconstruction after prior cardiac surgery is technically complex, especially after proximal aortic surgery. While multiple surgical adaptations in the redo setting have been described, traditional open reconstruction remains the most common approach with significant variability in outcomes in prior reports. This study describes institutional adaptations to surgical technique and perioperative care and assesses operative and long-term outcomes after redo-aortic arch repair in the modern era. METHODS Patients undergoing hemi- or total arch reconstruction after prior cardiac surgery (2005-2022) were identified from a prospectively maintained institutional database. Strategic adaptations in approach over the study interval included a shift towards Type II hybrid arch repair for patients with "mega-aorta," redo-cannulation of the axillary artery when necessary, and adoption of transfusion and early extubation protocols. Outcomes of interest included 30-day/in-hospital adverse events and actuarial long-term overall and aorta-specific survival. RESULTS The study cohort included 214 patients undergoing hemi-arch (N.=154, 72%) or total arch (N.=60, 28%) after prior cardiac surgery (50% prior proximal aortic surgery). Surgical indications included degenerative aneurysm (47%, N.=101), residual arch dissection after prior type A repair (29%, N.=61), acute or chronic type A dissection (18%, N.=39) or other (6%, N.=13). 30-day/in-hospital mortality was 6% (5% hemi-arch; 10% total arch) and stroke was 3% (3% hemi-arch; 2% total arch). At median follow-up of 56 months, overall 5- and 10-year survival was 76% and 58% (hemi-arch: 81%, 62%; total arch: 63%, 43%); aorta-specific survival was 91% and 90% (hemi-arch: 96%, 94%; total arch: 79%, 79%). CONCLUSIONS In this modern single-institution series, a systematic approach to redo-arch repair yields excellent operative outcomes and late aorta-specific survival. Reduced late overall survival reflects the comorbidity burden of this population. Open reconstruction continues to play an important role in reoperative arch repair in the modern era.
Collapse
Affiliation(s)
- Andrew M Vekstein
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, NC, USA -
| | - G Chad Hughes
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, NC, USA
| | - Edward P Chen
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, NC, USA
| |
Collapse
|
7
|
Hirashima F, Polomsky M, Dong W, Risi JL, Rokkas CK. A hybrid aortic re-arching technique. JTCVS Tech 2022; 15:18-21. [PMID: 36276705 PMCID: PMC9579851 DOI: 10.1016/j.xjtc.2022.07.021] [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: 06/02/2022] [Revised: 07/26/2022] [Accepted: 07/29/2022] [Indexed: 11/29/2022] Open
Affiliation(s)
- Fuyuki Hirashima
- University of Vermont Medical Center, University of Vermont, Burlington, Vt
- Larner College of Medicine, University of Vermont, Burlington, Vt
| | - Marek Polomsky
- University of Vermont Medical Center, University of Vermont, Burlington, Vt
- Larner College of Medicine, University of Vermont, Burlington, Vt
| | - Willie Dong
- Larner College of Medicine, University of Vermont, Burlington, Vt
| | - Jennifer L. Risi
- Larner College of Medicine, University of Vermont, Burlington, Vt
| | - Chris K. Rokkas
- University of Vermont Medical Center, University of Vermont, Burlington, Vt
- Address for reprints: Chris K. Rokkas, MD, University of Vermont Medical Center, H4/344A CSC, 600 Highland Ave, Madison, WI 53792.
| |
Collapse
|
8
|
Schleiger A, Michel J, Kramer P, Buz S, Peters B, Photiadis J, Berger F, Nordmeyer J, Schubert S. Revascularization of Left Subclavian to Common Carotid Artery Prepares for Covered Stent Implantation in Patients With Complex Aortic Coarctation. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2022; 17:237-243. [PMID: 35616926 DOI: 10.1177/15569845221099298] [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: 01/28/2023]
Abstract
Seven adult patients underwent a two-stage treatment of complex coarctation (CoA), including surgical revascularization of the left subclavian artery (LSA) to left common carotid artery (LCCA), followed by transcatheter covered stent implantation. The majority of patients (5 of 7, 71%) received 1 covered stent (covered Cheatham Platinum stent: 8 zig/45 mm [n = 2], 10 zig/60 mm [n = 1], 10 zig/65 mm [n = 1]; BeGraft: 24/48 mm [n = 2]). In 1 patient (14%), the implantation of 2 covered stents (BeGraft 20/48 mm) was necessary. During a median follow-up of 2.4 years (interquartile range, 0.1 to 4.9 years), complications occurred in 3 of 7 patients (43%), including an asymptomatic but severe stenosis of the LSA bypass (n = 1), a recoarctation with a mild endoleak (n = 1), and a severe endoleak (n = 1). Surgical revascularization of the LSA to the LCCA can successfully prepare for covered stent implantation in complex CoA in adult patients. This two-stage approach was feasible and safe with complications occurring in 3 of 7 patients (43%). All complications were managed by catheter reintervention only.
Collapse
Affiliation(s)
- Anastasia Schleiger
- Department of Congenital Heart Disease-Pediatric Cardiology, German Heart Center Berlin, Germany.,Anastasia Schleiger and Jörg Michel share first authorship, and Johannes Nordmeyer and Stephan Schubert share last authorship
| | - Jörg Michel
- Department of Pediatric Cardiology, Pulmonology, and Pediatric Intensive Care Medicine, University Children's Hospital Tübingen, Germany.,Anastasia Schleiger and Jörg Michel share first authorship, and Johannes Nordmeyer and Stephan Schubert share last authorship
| | - Peter Kramer
- Department of Congenital Heart Disease-Pediatric Cardiology, German Heart Center Berlin, Germany
| | - Semih Buz
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Germany
| | - Björn Peters
- Department of Congenital Heart Disease-Pediatric Cardiology, German Heart Center Berlin, Germany
| | - Joachim Photiadis
- Department of Congenital Heart Surgery-Pediatric Heart Surgery, German Heart Center Berlin, Germany
| | - Felix Berger
- Department of Congenital Heart Disease-Pediatric Cardiology, German Heart Center Berlin, Germany
| | - Johannes Nordmeyer
- Department of Congenital Heart Disease-Pediatric Cardiology, German Heart Center Berlin, Germany.,Anastasia Schleiger and Jörg Michel share first authorship, and Johannes Nordmeyer and Stephan Schubert share last authorship
| | - Stephan Schubert
- Center for Congenital Heart Disease/Pediatric Cardiology, Heart and Diabetes Center NRW, University Clinic of Ruhr University Bochum, Bad Oeynhausen, Germany.,Anastasia Schleiger and Jörg Michel share first authorship, and Johannes Nordmeyer and Stephan Schubert share last authorship
| |
Collapse
|
9
|
Fujimori T, Okamura H, Kitada Y, Wada Y, Adachi H. Reconstruction of the left subclavian artery in arch repair: An end-to-side anastomosis technique. J Card Surg 2022; 37:2194-2196. [PMID: 35438808 DOI: 10.1111/jocs.16536] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Revised: 03/26/2022] [Accepted: 04/06/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND The left subclavian artery (LSCA) is deeply located and difficult to visualize in some cases of total arch replacement. AIMS We report an end-to-side anastomosis technique that enables safer and easier anatomical reconstruction of the LSCA. MATERIALS AND METHODS Under Hypothermic circulatory arrest, the origin of the LSCA was ligated and pulled caudally. With clamping the distal LSCA, a graft was anastomosed to the anterior wall of the LSCA and antegrade cerebral perfusion to the LSCA was ensured through the anastomosed graft. Thereafter, distal anastomosis was performed proximal to the LSCA. RESULTS The postoperative course was uneventful. DISCUSSION Our reconstruction technique provides excellent exposure of the LSCA by pulling the origin of the LSCA caudally. Hemostasis after reconstruction is feasible, as the anastomosis in the anterior wall of the LSCA is easily visualized. CONCLUSION The end-to-side anastomosis technique for LSCA reconstruction is a simple alternative in arch repair.
Collapse
Affiliation(s)
- Tomonari Fujimori
- Department of Cardiovascular Surgery, Nerima Hikarigaoka Hospital, Tokyo, Japan
| | - Homare Okamura
- Department of Cardiovascular Surgery, Nerima Hikarigaoka Hospital, Tokyo, Japan
| | - Yuichiro Kitada
- Department of Cardiovascular Surgery, Nerima Hikarigaoka Hospital, Tokyo, Japan
| | - Yohnosuke Wada
- Department of Cardiovascular Surgery, Nerima Hikarigaoka Hospital, Tokyo, Japan
| | - Hideo Adachi
- Department of Cardiovascular Surgery, Nerima Hikarigaoka Hospital, Tokyo, Japan
| |
Collapse
|
10
|
Awad H, Raza A, Saklayen S, Bhandary S, Kelani H, Powers C, Bourekas E, Essandoh M. Combined Stroke and Spinal Cord Infarction in Hybrid Type I Aortic Arch Debranching and TEVAR and the Dual Role of the Left Subclavian Artery. J Cardiothorac Vasc Anesth 2022:S1053-0770(22)00122-7. [PMID: 35339354 DOI: 10.1053/j.jvca.2022.02.012] [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: 10/27/2020] [Accepted: 02/08/2022] [Indexed: 11/11/2022]
Affiliation(s)
- Hamdy Awad
- Department of Anesthesiology at the Wexner Medical Center at the Ohio State University in Columbus, Columbus, OH.
| | - Arwa Raza
- Ohio State University College of Medicine in Columbus, Columbus, OH
| | - Samiya Saklayen
- Department of Anesthesiology at the Wexner Medical Center at the Ohio State University in Columbus, Columbus, OH
| | - Sujatha Bhandary
- Department of Anesthesiology at Emory University School of Medicine in Atlanta, Atlanta, GA
| | - Hesham Kelani
- Department of Anesthesiology at the Wexner Medical Center at the Ohio State University in Columbus, Columbus, OH
| | - Ciaran Powers
- Department of Neurosurgery at the Wexner Medical Center at the Ohio State University in Columbus, Columbus, OH
| | - Eric Bourekas
- Department of Radiology at Wexner Medical Center at the Ohio State University in Columbus, Columbus, OH
| | - Michael Essandoh
- Department of Anesthesiology at the Wexner Medical Center at the Ohio State University in Columbus, Columbus, OH
| |
Collapse
|
11
|
Haldenwang PL, Elghannam M, Buchwald D, Strauch J. Use of On-Site Digital Subtraction Angiography for Left Subclavian Artery Management During Hybrid Aortic Arch Repair in DeBakey I Dissection. J Endovasc Ther 2022; 29:975-978. [PMID: 35012388 DOI: 10.1177/15266028211068759] [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: 11/15/2022]
Abstract
PURPOSE A hybrid aortic repair using the frozen elephant trunk (FET) technique with an open distal anastomosis in zone 2 and debranching of the left subclavian artery (LSA) has been demonstrated to be favorable and safe. Although a transposition of the LSA reduces the risk of cerebellar or medullar ischemia, this may be challenging in difficult LSA anatomies. CASE REPORT We present the case of a 61-year old patient with DeBakey I aortic dissection, treated with FET in moderate hypothermic circulatory arrest (26°C) and selective cerebral perfusion using a Thoraflex-Hybrid (Vascutek Terumo) prosthesis anchored in zone 2, with overstenting of the LSA orifice and no additional LSA debranching. Sufficient perfusion of the LSA was proved intraoperatively using LSA backflow analysis during selective cerebral perfusion in combination with on-site digital subtraction angiography (ARTIS Pheno syngo software). No neurologic dysfunction or ischemia occurred in the postoperative course. An angiographic computed tomography revealed physiologic LSA perfusion, with subsequent thrombotic occlusion of the false lumen in the proximal descending aorta after 7 days. CONCLUSION Using an angiography-guided management in patients with complex DeBakey I dissection and difficult anatomy may simplify a proximalization of the distal anastomosis in zone 2 for FET, even without an additional LSA debranching.
Collapse
Affiliation(s)
- Peter-Lukas Haldenwang
- Department of Cardiothoracic Surgery, University Hospital Bergmannsheil, Bochum, Germany
| | - Mahmoud Elghannam
- Department of Cardiothoracic Surgery, University Hospital Bergmannsheil, Bochum, Germany
| | - Dirk Buchwald
- Department of Cardiothoracic Surgery, University Hospital Bergmannsheil, Bochum, Germany
| | - Justus Strauch
- Department of Cardiothoracic Surgery, University Hospital Bergmannsheil, Bochum, Germany
| |
Collapse
|
12
|
Mazine A, Dhingra NK, Chu MWA, El-Hamamsy I, Peterson MD. Aortic Arch Replacement: How I Teach It. Ann Thorac Surg 2021; 113:1787-1793. [PMID: 34929142 DOI: 10.1016/j.athoracsur.2021.11.035] [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: 11/11/2021] [Accepted: 11/12/2021] [Indexed: 11/01/2022]
Affiliation(s)
- Amine Mazine
- Division of Cardiac Surgery, Department of Surgery, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Nitish K Dhingra
- Division of Cardiac Surgery, Department of Surgery, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Michael W A Chu
- Division of Cardiac Surgery, Department of Surgery, Western University, London Health Sciences Centre, London, Ontario, Canada
| | - Ismail El-Hamamsy
- Department of Cardiovascular Surgery, Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Mark D Peterson
- Division of Cardiac Surgery, Department of Surgery, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
| |
Collapse
|
13
|
Awad H, Raza A, Saklayen S, Bhandary S, Kelani H, Powers C, Bourekas E, Stine I, Milner R, Valentine E, Essandoh M. Combined Stroke and Spinal Cord Ischemia in Hybrid Type I Aortic Arch Debranching and TEVAR and the Dual Role of the Left Subclavian Artery. J Cardiothorac Vasc Anesth 2021; 36:3687-3700. [PMID: 34538558 DOI: 10.1053/j.jvca.2021.08.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 08/20/2021] [Indexed: 11/11/2022]
Affiliation(s)
- Hamdy Awad
- Department of Anesthesiology at the Wexner Medical Center at the Ohio State University, Columbus, OH.
| | - Arwa Raza
- Ohio State University College of Medicine, Columbus, OH
| | - Samiya Saklayen
- Department of Anesthesiology at the Wexner Medical Center at the Ohio State University, Columbus, OH
| | - Sujatha Bhandary
- Department of Anesthesiology at Emory University School of Medicine, Atlanta, GA
| | - Hesham Kelani
- Department of Anesthesiology at the Wexner Medical Center at the Ohio State University, Columbus, OH
| | - Ciaran Powers
- Department of Neurosurgery at the Wexner Medical Center at the Ohio State University, Columbus, OH
| | - Eric Bourekas
- Department of Radiology at Wexner Medical Center at the Ohio State University, Columbus, OH
| | - Ian Stine
- Department of Surgery at the University of Chicago, Chicago, IL
| | - Ross Milner
- Department of Surgery at the University of Chicago, Chicago, IL
| | - Elizabeth Valentine
- Department of Anesthesiology and Critical Care, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Michael Essandoh
- Department of Anesthesiology at the Wexner Medical Center at the Ohio State University, Columbus, OH
| |
Collapse
|
14
|
Bashir M, Bailey D, Jones WD, White RD, Williams IM. The fate of the left subclavian artery in TEVAR for aortic arch pathology. J Card Surg 2021; 36:3547-3553. [PMID: 34309881 DOI: 10.1111/jocs.15831] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 07/10/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND AIM OF STUDY The origin of the vertebral artery (VA) from the left subclavian (LSA) is variable and must be considered when proximal ligation or embolization is performed post thoracic endovascular aortic repair (TEVAR) and extra-anatomical bypass (EAB). A retrospective study was conducted to understand the patency of the LSA and VAs after TEVAR and the relationship of the EAB to the LSA. METHODS Fifty-six patients underwent TEVAR where the LSA origin was occluded. A comparison was performed between the length of the proximal LSA from the arch of the aorta to the origin of the VA. Patient outcomes included posterior or anterior circulation cerebrovascular accident, spinal cord ischemia (SCI), and symptoms and signs of left arm ischemia (LAI). Thirty one underwent EAB with 8 undergoing occlusion of the LSA proximal to the origin of the left VA. A further 25 underwent TEVAR with no EAB performed. The mean (standard deviation) of origin of the VA from the origin at the arch was 37.0 (12.9) mm compared to 34.0 (13.7) mm in those where no bypass was performed (p 0.45). Four patients underwent intraluminal plug occlusion and four had external ligation of the proximal LSA in those undergoing EAB. CONCLUSIONS Careful evaluation of the LSA is needed when planning TEVAR as occlusion techniques may be dependent on a minimum length of the VA from the aortic arch. The mean length of the VA from the aorta has high heterogeneity which may dictate the optimum occlusion method for LSA.
Collapse
Affiliation(s)
- Mohamad Bashir
- Department of Vascular Surgery, University Hospital of Wales, Heath Park, Cardiff, UK
| | - Damian Bailey
- Neurovascular Research Laboratory, Faculty of Life Sciences and Education, University of South Wales, Pontypridd, UK
| | - William D Jones
- Department of Vascular Surgery, University Hospital of Wales, Heath Park, Cardiff, UK
| | - Richard D White
- Department of Vascular Surgery, University Hospital of Wales, Heath Park, Cardiff, UK
| | - Ian M Williams
- Department of Vascular Surgery, University Hospital of Wales, Heath Park, Cardiff, UK
| |
Collapse
|
15
|
Fleischman F, Elsayed RS. Commentary: Flow delivery to the left subclavian artery using a novel branched graft in total arch replacement. JTCVS Tech 2021; 7:43-44. [PMID: 34471909 PMCID: PMC8312234 DOI: 10.1016/j.xjtc.2021.04.004] [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: 04/06/2021] [Revised: 04/06/2021] [Accepted: 04/06/2021] [Indexed: 11/28/2022] Open
Affiliation(s)
- Fernando Fleischman
- Division of Cardiac Surgery, Department of Surgery, Keck School of Medicine of USC, University of Southern California, Los Angeles, Calif
| | - Ramsey S. Elsayed
- Division of Cardiac Surgery, Department of Surgery, Keck School of Medicine of USC, University of Southern California, Los Angeles, Calif
| |
Collapse
|
16
|
Ho JYK, Bashir M, Jakob H, Wong RHL. Management of left subclavian artery in total arch replacement and frozen elephant trunk procedure. JTCVS Tech 2021; 7:36-40. [PMID: 34318200 PMCID: PMC8312104 DOI: 10.1016/j.xjtc.2021.03.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Accepted: 03/22/2021] [Indexed: 12/03/2022] Open
Affiliation(s)
- Jacky Y K Ho
- Division of Cardiothoracic Surgery, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China
| | - Mohamad Bashir
- Vascular & Endovascular Surgery, Royal Blackburn Teaching Hospital, Blackburn, United Kingdom
| | - Heinz Jakob
- Department of Thoracic and Cardiovascular Surgery, West German Heart Center Essen, University Hospital Essen, Essen, Germany
| | - Randolph H L Wong
- Division of Cardiothoracic Surgery, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China
| |
Collapse
|
17
|
Chung JCY, Ouzounian M, Chu MWA, El-Hamamsy I. The Evolving Role of Hybrid Arch Repair. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2020; 15:506-512. [PMID: 33108237 DOI: 10.1177/1556984520967007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Jennifer C-Y Chung
- 7938 Division of Cardiovascular Surgery, Department of Surgery, Peter Munk Cardiac Centre, University Health Network, University of Toronto, ON, Canada
| | - Maral Ouzounian
- 7938 Division of Cardiovascular Surgery, Department of Surgery, Peter Munk Cardiac Centre, University Health Network, University of Toronto, ON, Canada
| | - Michael W A Chu
- 70384 Division of Cardiac Surgery, Department of Surgery, Western University, London, ON, Canada
| | - Ismail El-Hamamsy
- 526004 Department of Cardiovascular Surgery, Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, NY, USA
| |
Collapse
|
18
|
Brookes JDL, Yan TD. Mini-access branch-first total arch replacement and frozen elephant trunk procedure-how I do it. Ann Cardiothorac Surg 2020; 9:246-247. [PMID: 32551262 DOI: 10.21037/acs-2020-fet-28] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- John D L Brookes
- Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, The University of Sydney, Sydney, NSW, Australia
| | - Tristan D Yan
- Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, The University of Sydney, Sydney, NSW, Australia
| |
Collapse
|
19
|
Hage F, Hage A, Gelinas J, Power A, Chu MWA. Aortic valve sparing and hybrid arch frozen elephant trunk repair for mega-aortic syndrome. Ann Cardiothorac Surg 2020; 9:262-264. [PMID: 32551268 DOI: 10.21037/acs.2020.02.06] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Fadi Hage
- Division of Cardiac Surgery, Department of Surgery, Western University, London Health Sciences Centre, London, ON, Canada
| | - Ali Hage
- Division of Cardiac Surgery, Department of Surgery, Western University, London Health Sciences Centre, London, ON, Canada
| | - Jill Gelinas
- Division of Cardiac Surgery, Department of Surgery, Western University, London Health Sciences Centre, London, ON, Canada
| | - Adam Power
- Division of Vascular Surgery, Department of Surgery, Western University, London Health Sciences Centre, London, ON, Canada
| | - Michael W A Chu
- Division of Cardiac Surgery, Department of Surgery, Western University, London Health Sciences Centre, London, ON, Canada
| |
Collapse
|
20
|
Ouzounian M, Hage A, Chung J, Stevens LM, El-Hamamsy I, Chauvette V, Dagenais F, Cartier A, Peterson M, Harrington A, Boodhwani M, Guo M, Bozinovski J, Fox S, Guo L, Chu MWA. Hybrid arch frozen elephant trunk repair: evidence from the Canadian Thoracic Aortic Collaborative. Ann Cardiothorac Surg 2020; 9:189-196. [PMID: 32551251 DOI: 10.21037/acs-2020-fet-22] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background The frozen elephant trunk (FET) technique has become an increasingly popular strategy for aortic reconstruction in the setting of extensive thoracic aortic aneurysms or dissections. The objective of this study is to report on the Canadian experience with the FET technique in both the elective and emergent settings. Methods A total of 167 consecutive patients (mean age 65±13 years, 30% female, 25% re-operation) underwent elective (70%) and non-elective (30%) aortic arch reconstruction with the FET technique between May 2008 and October 2019 in six centers of the Canadian Thoracic Aortic Collaborative (CTAC). In-hospital clinical endpoints and early imaging endpoints were prospectively collected and analyzed. Results All 167 patients underwent successful FET implantation. In-hospital mortality occurred in 14 patients (8%), stroke occurred in 22 patients (13%) and temporary and permanent spinal cord ischemia (SCI) occurred in 6 (3.6%) and 3 (1.8%) patients, respectively. Prolonged mechanical ventilation was required in 35 patients (21%), renal failure requiring dialysis in 14 patients (8%) and atrial fibrillation in 59 patients (36%). The median hospital and intensive care unit (ICU) lengths of stay were 3 [interquartile range (IQR): 1, 6] and 10 (IQR: 7, 17) days, respectively. The rate of type 1A endoleak was 3.6%, with the lowest rate in patients who underwent a total arch replacement with a hybrid FET graft (0%) and the highest among patients who had a hemiarch with antegrade thoracic endovascular aortic repair (TEVAR) deployment (25%). The rate of other types of endoleak and stent complications was comparatively low. Conclusions The early CTAC experience with the FET operation demonstrates technical feasibility and good early clinical outcomes in elective and emergent patients. Further analysis is required to explore variations in technique and their potential impact on early and late outcomes.
Collapse
Affiliation(s)
- Maral Ouzounian
- Division of Cardiac Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Ali Hage
- Division of Cardiac Surgery, Department of Surgery, Western University, London, ON, Canada
| | - Jennifer Chung
- Division of Cardiac Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Louis-Mathieu Stevens
- Division of Cardiac Surgery, Department of Surgery, University of Montreal, Montreal, QC, Canada
| | - Ismail El-Hamamsy
- Department of Cardiovascular Surgery, Mount Sinai Hospital, Icahn School of Medicjne at Mount Sinai, New York, NY, USA
| | - Vincent Chauvette
- Division of Cardiac Surgery, Department of Surgery, University of Montreal, Montreal, QC, Canada
| | - Francois Dagenais
- Division of Cardiac Surgery, Department of Surgery, Laval University, Quebec City, QC, Canada
| | - Andreanne Cartier
- Division of Cardiac Surgery, Department of Surgery, Laval University, Quebec City, QC, Canada
| | - Mark Peterson
- Division of Cardiac Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Alana Harrington
- Division of Cardiac Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Munir Boodhwani
- Division of Cardiac Surgery, Department of Surgery, University of Ottawa, Ottawa, ON, Canada
| | - Ming Guo
- Division of Cardiac Surgery, Department of Surgery, University of Ottawa, Ottawa, ON, Canada
| | - John Bozinovski
- Division of Cardiac Surgery, Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Stephanie Fox
- Division of Cardiac Surgery, Department of Surgery, Western University, London, ON, Canada
| | - Linrui Guo
- Division of Cardiac Surgery, Department of Surgery, Western University, London, ON, Canada
| | - Michael W A Chu
- Division of Cardiac Surgery, Department of Surgery, Western University, London, ON, Canada
| | | |
Collapse
|
21
|
Chung JC, Lodewyks CL, Forbes TL, Chu MWA, Peterson MD, Arora RC, Ouzounian M. Prevention and management of spinal cord ischemia following aortic surgery: A survey of contemporary practice. J Thorac Cardiovasc Surg 2020; 163:16-23.e7. [PMID: 32334886 DOI: 10.1016/j.jtcvs.2020.03.034] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 03/05/2020] [Accepted: 03/09/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Spinal cord ischemia (SCI) is a devastating complication of thoracoabdominal aortic aneurysm repair. We aim to characterize current practices pertaining to SCI prevention and treatment across Canada. METHODS Two questionnaires were developed by the Canadian Thoracic Aortic Collaborative and the Canadian Cardiovascular Critical Care Society targeting aortic surgeons and intensivists. A list of experts in the management of patients at risk of SCI was developed, with representation from each of the Canadian centers that perform complex aortic surgery. RESULTS The response rate was 91% for both intensivists (21/23), and from cardiac and vascular surgeons (39/43). Most surgeons agreed that staging is important during endovascular repair of extent II thoracoabdominal aortic aneurysm (60%) but not for open repair (34%). All of the surgeons felt prophylactic lumbar drains were effective in reducing SCI, whereas only 66.7% of intensivists felt that lumbar drains were effective (P < .001). There was consensus among surgeons over when to employ lumbar drains. A majority of surgeons preferred to keep the hemoglobin over 100 g/L if the patient demonstrated loss of lower-extremity function, whereas most intensivists felt a target of 80 g/L was adequate (P < .001). Management of perioperative antihypertensives, use of intraoperative adjuncts, and management of venous thromboembolism prophylaxis in the presence of a lumbar drain, were highly variable. CONCLUSIONS We observed some consensus but considerable variability in the approach to SCI prevention and management across Canada. Future studies focused on the areas of variability may lead to more consistent and improved care for this high-risk population.
Collapse
Affiliation(s)
- Jennifer C Chung
- Division of Cardiovascular Surgery, Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Carly L Lodewyks
- Section of Cardiac Surgery, St Boniface General Hospital, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Thomas L Forbes
- Division of Vascular Surgery, Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Michael W A Chu
- Division of Cardiac Surgery, London Health Sciences Centre, Western University, London, Ontario, Canada
| | - Mark D Peterson
- Division of Cardiovascular Surgery, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Rakesh C Arora
- Section of Cardiac Surgery, St Boniface General Hospital, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Maral Ouzounian
- Division of Cardiovascular Surgery, Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada.
| | | | | |
Collapse
|
22
|
Hage A, Stevens LM, Ouzounian M, Chung J, El-Hamamsy I, Chauvette V, Dagenais F, Cartier A, Peterson MD, Boodhwani M, Guo M, Bozinovski J, Moon MC, White A, Kumar K, Lodewyks C, Bittira B, Payne D, Chu MWA. Impact of brain protection strategies on mortality and stroke in patients undergoing aortic arch repair with hypothermic circulatory arrest: evidence from the Canadian Thoracic Aortic Collaborative. Eur J Cardiothorac Surg 2020; 58:95-103. [DOI: 10.1093/ejcts/ezaa023] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 12/26/2019] [Accepted: 01/04/2020] [Indexed: 11/14/2022] Open
Abstract
Abstract
OBJECTIVES
The aim of this study was to investigate the impact of various brain perfusion techniques and nadir temperature cooling strategies on outcomes after aortic arch repair in a contemporary, multicentre cohort.
METHODS
A total of 2520 patients underwent aortic arch repair with hypothermic circulatory arrest (HCA) between 2002 and 2018 in 11 centres of the Canadian Thoracic Aortic Collaborative. Primary outcomes included mortality; stroke; a composite of mortality or stroke; and a Society of Thoracic Surgeons-defined composite (STS-COMP) end point for mortality or major morbidity including stroke, reoperation, renal failure, prolonged ventilation and deep sternal wound infection. Multivariable logistic regression and propensity score matching were performed for cerebral perfusion and nadir temperature practices.
RESULTS
Antegrade cerebral perfusion was found on multivariable analysis to be protective against mortality [odds ratio (OR) 0.64, 95% confidence interval (CI) 0.48–0.86; P = 0.005], stroke (OR 0.55, 95% CI 0.37–0.81; P = 0.006), composite of mortality or stroke (OR 0.57, 95% CI 0.45–0.72; P = 0.0001) and STS-COMP (OR 0.53, 95% CI 0.41–0.67; P < 0.0001), as compared to HCA alone. Retrograde cerebral perfusion yielded similar outcomes as compared to antegrade cerebral perfusion. When compared to HCA with nadir temperature <24°C, a propensity score analysis of 647 matched pairs identified nadir temperature ≥24°C as predictor of lower mortality (OR 0.62, 95% CI 0.40–0.98; P = 0.04), stroke (OR 0.51, 95% CI 0.31–0.84; P = 0.008), composite of mortality or stroke (OR 0.62, 95% CI 0.43–0.89; P = 0.01) and STS-COMP (OR 0.64, 95% CI 0.49–0.85; P = 0.002).
CONCLUSIONS
Antegrade cerebral perfusion and nadir temperature ≥24°C during HCA for aortic arch repair are predictors of improved survival and neurological outcomes.
Collapse
Affiliation(s)
- Ali Hage
- Division of Cardiac Surgery, Department of Surgery, Western University, London, ON, Canada
| | - Louis-Mathieu Stevens
- Division of Cardiac Surgery, Department of Surgery, University of Montreal, Montreal, QC, Canada
| | - Maral Ouzounian
- Division of Cardiac Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Jennifer Chung
- Division of Cardiac Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Ismail El-Hamamsy
- Division of Cardiac Surgery, Department of Surgery, University of Montreal, Montreal, QC, Canada
| | - Vincent Chauvette
- Division of Cardiac Surgery, Department of Surgery, University of Montreal, Montreal, QC, Canada
| | - Francois Dagenais
- Division of Cardiac Surgery, Department of Surgery, Laval University, Quebec, QC, Canada
| | - Andreanne Cartier
- Division of Cardiac Surgery, Department of Surgery, Laval University, Quebec, QC, Canada
| | - Mark D Peterson
- Division of Cardiac Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Munir Boodhwani
- Division of Cardiac Surgery, Department of Surgery, University of Ottawa, Ottawa, ON, Canada
| | - Ming Guo
- Division of Cardiac Surgery, Department of Surgery, University of Ottawa, Ottawa, ON, Canada
| | | | - Michael C Moon
- Division of Cardiac Surgery, Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Abigail White
- Division of Cardiac Surgery, Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Kanwal Kumar
- Division of Cardiac Surgery, Department of Surgery, University of Manitoba, Winnipeg, MB, Canada
| | - Carly Lodewyks
- Division of Cardiac Surgery, Department of Surgery, University of Manitoba, Winnipeg, MB, Canada
| | - Bindu Bittira
- Division of Cardiac Surgery, Department of Surgery, Health Sciences North, Sudbury, ON, Canada
| | - Darrin Payne
- Division of Cardiac Surgery, Department of Surgery, Queen’s University, Kingston, ON, Canada
| | - Michael W A Chu
- Division of Cardiac Surgery, Department of Surgery, Western University, London, ON, Canada
| |
Collapse
|
23
|
Hage F, Hage A, Chu MWA. Hybrid arch frozen elephant trunk repair for acute type A intramural hematoma. Ann Cardiothorac Surg 2019; 8:577-584. [PMID: 31667159 DOI: 10.21037/acs.2019.08.01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Fadi Hage
- Division of Cardiac Surgery, Department of Surgery, Western University, London Health Sciences Centre, London, ON, Canada
| | - Ali Hage
- Division of Cardiac Surgery, Department of Surgery, Western University, London Health Sciences Centre, London, ON, Canada
| | - Michael W A Chu
- Division of Cardiac Surgery, Department of Surgery, Western University, London Health Sciences Centre, London, ON, Canada
| |
Collapse
|
24
|
Chu MW, Losenno KL, Dubois LA, Jones PM, Ouzounian M, Whitlock R, Dagenais F, Boodhwani M, Bhatnagar G, Poostizadeh A, Pozeg Z, Moon M, Kiaii B, Peterson MD. Early Clinical Outcomes of Hybrid Arch Frozen Elephant Trunk Repair With the Thoraflex Hybrid Graft. Ann Thorac Surg 2019; 107:47-53. [DOI: 10.1016/j.athoracsur.2018.07.091] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 06/27/2018] [Accepted: 07/30/2018] [Indexed: 12/01/2022]
|