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Karadzha A, Schaff HV, Frye RL, Bois MC, Crestanello JA, Bagameri G, Greason KL, Shrestha ML. Post-mortem examination of fatal acute type A aortic dissection: what does it teach us? Eur J Cardiothorac Surg 2024; 65:ezad432. [PMID: 38175790 DOI: 10.1093/ejcts/ezad432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 12/06/2023] [Indexed: 01/06/2024] Open
Abstract
OBJECTIVES Acute type A aortic dissection (ATAAD) remains a highly life-threatening condition. This study investigates factors associated with fatal ATAAD prior to surgical treatment. METHODS We reviewed autopsy reports of ATAAD decedents who died before surgical intervention and underwent postmortem examination at our clinic from 1994 to 2022. RESULTS Among 94 eligible cases, 50 (53.2%) decedents had DeBakey type I dissection, and 44 (46.8%) had DeBakey type II dissection. Most were males, 63 (67%), and 72 (77%) had a history of hypertension. The median age was 70.5 years, and the type II group was a decade older than the type I group (P < 0.001). Decedents in the type II group predominantly died during the first hour after symptoms onset 16 (52%), while in the type I group, fatalities occurred between 1 h and 1 day, 27 (66%). The most common site of the intimal tear was the midportion of the ascending aorta, 45 (48%). The median ascending aorta size was 5 cm for the entire cohort, 5.2 cm for type I and 4.6 cm for type II (P < 0.045). CONCLUSIONS In this autopsy study of fatal acute aortic dissection, the median aortic size was below the current guideline threshold for elective repair. Type II acute aortic dissections were found more frequently than expected and were characterized by older age, advanced aortic atherosclerosis, smaller aortic size, a shorter interval from symptom onset to death and a higher frequency of syncope compared to type I dissection.
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Affiliation(s)
| | - Hartzell V Schaff
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, USA
| | - Robert L Frye
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Melanie C Bois
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | | | - Gabor Bagameri
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, USA
| | - Kevin L Greason
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, USA
| | - Malakh L Shrestha
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, USA
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Bogachev-Prokophiev A, Sharifulin R, Demin I, Karadzha A, Zheleznev S, Karaskov A, Afanasyev A, Pivkin A, Ovcharov M, Zalesov A, Murashov I, Tsaroev B, Chernyavsky A. Redo aortic root surgery post-Ross procedure. Front Cardiovasc Med 2023; 10:1306445. [PMID: 38155981 PMCID: PMC10754512 DOI: 10.3389/fcvm.2023.1306445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 11/23/2023] [Indexed: 12/30/2023] Open
Abstract
Background Despite numerous advantages of the Ross procedure, it presents a risk of late autograft and right ventricular outflow tract conduit failure. This study aimed to analyze the outcomes of autograft dysfunction reoperations using autograft-sparing and root replacement techniques. Methods Between 2015 and 2023, 49 patients underwent redo root surgery in our institution. Autograft valve-sparing procedures (VSP) were performed in 20 cases and the Bentall procedure (BP) in 29 patients. The short and long-term clinical outcomes along with echocardiographic results of VSP and BP were investigated. Results Overall early mortality rate was 2.0% with no significant difference between the groups. Severe autograft valve insufficiency at the time of redo (OR 4.07, P = 0.03) and patient age (OR 1.07, P = 0.04) were associated with a valve replacement procedure instead of VSP. The median follow-up duration was 34 months. No late deaths occurred in either group. Freedom from VSP failure and aortic prosthesis dysfunction were 93.8% and 94.1% in the VSP and BP groups, respectively. No reoperations were necessary in either group. Conclusion Redo aortic root surgery can be safely performed in patients with autograft failure. Both root replacement and autograft valve-sparing procedures demonstrated acceptable results at mid-term follow-up. Early redo surgery pre-empting severe aortic insufficiency increases the likelihood of preservation of the dilated autograft valve.
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Affiliation(s)
| | - Ravil Sharifulin
- Heart Valve Surgery Department, E. Meshalkin National Medical Research Centre, Novosibirsk, Russia
| | - Igor Demin
- Heart Valve Surgery Department, E. Meshalkin National Medical Research Centre, Novosibirsk, Russia
| | - Anastasiia Karadzha
- Heart Valve Surgery Department, E. Meshalkin National Medical Research Centre, Novosibirsk, Russia
| | - Sergey Zheleznev
- Heart Valve Surgery Department, E. Meshalkin National Medical Research Centre, Novosibirsk, Russia
| | - Alexander Karaskov
- Heart Valve Surgery Department, E. Meshalkin National Medical Research Centre, Novosibirsk, Russia
| | - Alexander Afanasyev
- Heart Valve Surgery Department, E. Meshalkin National Medical Research Centre, Novosibirsk, Russia
| | - Alexey Pivkin
- Heart Valve Surgery Department, E. Meshalkin National Medical Research Centre, Novosibirsk, Russia
| | - Mikhail Ovcharov
- Heart Valve Surgery Department, E. Meshalkin National Medical Research Centre, Novosibirsk, Russia
| | - Anton Zalesov
- Heart Valve Surgery Department, E. Meshalkin National Medical Research Centre, Novosibirsk, Russia
| | - Ivan Murashov
- Department of Pathology, E. Meshalkin National Medical Research Center, Novosibirsk, Russia
| | - Bashir Tsaroev
- Heart Valve Surgery Department, E. Meshalkin National Medical Research Centre, Novosibirsk, Russia
| | - Alexander Chernyavsky
- Heart Valve Surgery Department, E. Meshalkin National Medical Research Centre, Novosibirsk, Russia
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Karadzha A, Schaff HV. Malnutrition complicating clinical presentation of obstructive hypertrophic cardiomyopathy. JTCVS Tech 2023; 22:225-227. [PMID: 38152214 PMCID: PMC10750470 DOI: 10.1016/j.xjtc.2023.08.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 07/31/2023] [Accepted: 08/14/2023] [Indexed: 12/29/2023] Open
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Tsaroev B, Sharifulin R, Karadzha A, Pivkin A, Afanasyev A, Zalesov A, Mustaev M, Bogachev-Prokophiev A. The David procedure through a right anterior minithoracotomy. Multimed Man Cardiothorac Surg 2023; 2023. [PMID: 37860854 DOI: 10.1510/mmcts.2023.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2023]
Abstract
A right anterior minithoracotomy is the least-frequently utilized approach in minimally invasive aortic valve surgery; moreover, this access is rarely used for aortic root procedures. With careful patient selection, some technical considerations, e.g. institution of peripheral cardiopulmonary bypass, and a sufficient learning curve, the right anterior minithoracotomy can become a convenient access for surgical interventions on the aortic root. We present the case of a 31-year-old female patient with Marfan syndrome and severe aortic regurgitation due to an aortic root aneurysm. We demonstrate a step-by-step guide through the David procedure via a right anterior minithoracotomy.
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Affiliation(s)
- Bashir Tsaroev
- Department of Heart Valve Surgery, E. Meshalkin National Medical Research Center, Novosibirsk, Russian Federation
| | - Ravil Sharifulin
- Department of Heart Valve Surgery, E. Meshalkin National Medical Research Center 15, Rechkunovskaya Street, Novosibirsk 630055 Russian Federation
| | - Anastasiia Karadzha
- Department of Heart Valve Surgery, E. Meshalkin National Medical Research Center 15, Rechkunovskaya Street, Novosibirsk 630055 Russian Federation
| | - Alexey Pivkin
- Department of Heart Valve Surgery, E. Meshalkin National Medical Research Center 15, Rechkunovskaya Street, Novosibirsk 630055 Russian Federation
| | - Alexander Afanasyev
- Department of Heart Valve Surgery, E. Meshalkin National Medical Research Center 15, Rechkunovskaya Street, Novosibirsk 630055 Russian Federation
| | - Anton Zalesov
- Department of Heart Valve Surgery, E. Meshalkin National Medical Research Center, Novosibirsk, Russian Federation
| | - Muslim Mustaev
- Department of Adult Cardiac Surgery, St Thomas' Hospital, London, United Kingdom
| | - Alexander Bogachev-Prokophiev
- Department of Heart Valve Surgery, E. Meshalkin National Medical Research Center 15, Rechkunovskaya Street, Novosibirsk 630055 Russian Federation
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Bogachev‐Prokophiev A, Sharifulin R, Karadzha A, Larionova N, Shmyrev V, Kornilov I, Mamaev A, Afanasyev A, Pivkin A. Minimally invasive mitral valve repair and ablation of concomitant atrial fibrillation in a patient with severe hemophilia A. Clin Case Rep 2022; 10:e04174. [PMID: 36052022 PMCID: PMC9422630 DOI: 10.1002/ccr3.4174] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 12/25/2020] [Accepted: 02/11/2021] [Indexed: 11/29/2022] Open
Abstract
Minimally invasive mitral valve repair and ablation of atrial fibrillation, combined with FVIII level‐controlled replacement therapy, can be safely performed in patients with severe hemophilia.
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Affiliation(s)
| | - Ravil Sharifulin
- FSBI National Medical Research Center named after EN Meshalkin Novosibirsk Russia
| | - Anastasiia Karadzha
- FSBI National Medical Research Center named after EN Meshalkin Novosibirsk Russia
| | - Natalya Larionova
- FSBI National Medical Research Center named after EN Meshalkin Novosibirsk Russia
| | - Vladimir Shmyrev
- FSBI National Medical Research Center named after EN Meshalkin Novosibirsk Russia
| | - Igor Kornilov
- FSBI National Medical Research Center named after EN Meshalkin Novosibirsk Russia
| | - Andrey Mamaev
- FSBI National Research Center for Hematology of the Ministry of Health of the Russian Federation Barnaul Russia
| | - Alexander Afanasyev
- FSBI National Medical Research Center named after EN Meshalkin Novosibirsk Russia
| | - Alexey Pivkin
- FSBI National Medical Research Center named after EN Meshalkin Novosibirsk Russia
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Karadzha A, Bogachev-Prokophiev A, Sharifulin R, Ovcharov M, Pivkin A, Afanasyev A. The Bio-Bentall procedure with concomitant hemiarch replacement through a right anterolateral minithoracotomy. Multimed Man Cardiothorac Surg 2022; 2022. [PMID: 35470990 DOI: 10.1510/mmcts.2022.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
A right anterior minithoracotomy is a surgical approach that can be an excellent alternative to a median sternotomy. However, for aortic root interventions, the median sternotomy is still the gold standard. Most surgeons are slow to master this method because the visualization is poor and less convenient. These problems can be solved by careful selection of patients and using some technical tricks. The patient is a male with a severe aortic valve lesion and an aneurysm of the ascending aorta involving the proximal arch. We demonstrate step-by- step how to perform a minimally invasive Bio-Bentall procedure with a "hemiarch" replacement through a right anterolateral thoracotomy.
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Affiliation(s)
- Anastasiia Karadzha
- Department of Heart Valve Surgery, E. Meshalkin National Medical Research Center 15, Rechkunovskaya Street, Novosibirsk 630055 Russian Federation
| | - Alexander Bogachev-Prokophiev
- Department of Heart Valve Surgery, E. Meshalkin National Medical Research Center 15, Rechkunovskaya Street, Novosibirsk 630055 Russian Federation
| | - Ravil Sharifulin
- Department of Heart Valve Surgery, E. Meshalkin National Medical Research Center 15, Rechkunovskaya Street, Novosibirsk 630055 Russian Federation
| | - Mikhail Ovcharov
- Department of Heart Valve Surgery, E. Meshalkin National Medical Research Center 15, Rechkunovskaya Street, Novosibirsk 630055 Russian Federation
| | - Alexey Pivkin
- Department of Heart Valve Surgery, E. Meshalkin National Medical Research Center 15, Rechkunovskaya Street, Novosibirsk 630055 Russian Federation
| | - Alexander Afanasyev
- Department of Heart Valve Surgery, E. Meshalkin National Medical Research Center 15, Rechkunovskaya Street, Novosibirsk 630055 Russian Federation
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Bogachev-Prokophiev A, Sharifulin R, Karadzha A, Zheleznev S, Afanasyev A, Ovcharov M, Pivkin A, Zalesov A, Budagaev S, Ivantsov S, Chernyavsky A. Results of concomitant cryoablation for atrial fibrillation during mitral valve surgery. Interact Cardiovasc Thorac Surg 2021; 34:540-547. [PMID: 34791269 PMCID: PMC8972332 DOI: 10.1093/icvts/ivab322] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 10/07/2021] [Accepted: 10/18/2021] [Indexed: 12/03/2022] Open
Affiliation(s)
| | - Ravil Sharifulin
- Department of Heart Valve Surgery, E. Meshalkin National Medical Research Centre, Novosibirsk, Russian Federation
| | - Anastasiia Karadzha
- Department of Heart Valve Surgery, E. Meshalkin National Medical Research Centre, Novosibirsk, Russian Federation
| | - Sergey Zheleznev
- Department of Heart Valve Surgery, E. Meshalkin National Medical Research Centre, Novosibirsk, Russian Federation
| | - Alexander Afanasyev
- Department of Heart Valve Surgery, E. Meshalkin National Medical Research Centre, Novosibirsk, Russian Federation
| | - Mikhail Ovcharov
- Department of Heart Valve Surgery, E. Meshalkin National Medical Research Centre, Novosibirsk, Russian Federation
| | - Alexey Pivkin
- Department of Heart Valve Surgery, E. Meshalkin National Medical Research Centre, Novosibirsk, Russian Federation
| | - Anton Zalesov
- Department of Heart Valve Surgery, E. Meshalkin National Medical Research Centre, Novosibirsk, Russian Federation
| | - Sergey Budagaev
- Department of Heart Valve Surgery, E. Meshalkin National Medical Research Centre, Novosibirsk, Russian Federation
| | - Sergey Ivantsov
- Department of Heart Valve Surgery, E. Meshalkin National Medical Research Centre, Novosibirsk, Russian Federation.,Department of Congenital Heart Disease, E. Meshalkin National Medical Research Centre, Novosibirsk, Russian Federation
| | - Alexander Chernyavsky
- Department of Aortic and Coronary Artery Surgery, E. Meshalkin National Medical Research Centre, Novosibirsk, Russian Federation
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