1
|
Huang Y, Schaff HV, Bagameri G, Pochettino A, DeMartino RR, Todd A, Greason KL. Differential expansion and outcomes of ascending and descending degenerative thoracic aortic aneurysms. J Thorac Cardiovasc Surg 2024; 167:918-926.e3. [PMID: 35577595 PMCID: PMC9547986 DOI: 10.1016/j.jtcvs.2022.03.032] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 03/02/2022] [Accepted: 03/29/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To evaluate expansion of degenerative thoracic aortic aneurysms (TAAs) and compare results between ascending and descending TAAs. METHODS Among patients with diagnosis of degenerative TAA (1995-2015) in Olmsted County, we studied those having at least 2 computed tomography scans of TAA throughout the follow-up. Patients were classified as ascending or descending groups according to the segment where the maximal aortic diameter was measured. Primary end points were expansion rates and factors associated with TAA growth. RESULTS We investigated 137 patients, 70 (51.1%) of whom were women; 78 (56.9%) were in the ascending and 59 (43.1%) were in the descending group. Median baseline maximal aortic diameter was 48.5 mm (interquartile range, 47.0-49.9 mm) for ascending and 42.4 mm (interquartile range, 40.0-45.4 mm) for descending group (P < .001). Median expansion rate was higher in the descending than the ascending group (2.0 mm/year [interquartile range, 0.9-3.2 mm/year] vs 0.2 mm/year [IQR, 0.1-0.6 mm/year]; P < .001). Aneurysm in the descending aorta and larger baseline maximal aortic diameter were independently associated with TAA expansion. Advanced age and chronic obstructive pulmonary disease but not aneurysm size or location were independently associated with overall mortality (P < .05). Aneurysm in the descending aorta was associated with aortic-related events (P < .05). CONCLUSIONS Degenerative TAAs under surveillance expand slowly. Descending TAA and larger baseline maximal aortic diameter were independently associated with more rapid TAA expansion, but these factors did not influence all-cause mortality.
Collapse
Affiliation(s)
- Ying Huang
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minn
| | | | - Gabor Bagameri
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minn
| | - Alberto Pochettino
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minn; Mayo Clinic Center for Aortic Diseases, Mayo Clinic, Rochester, Minn
| | - Randall R DeMartino
- Mayo Clinic Center for Aortic Diseases, Mayo Clinic, Rochester, Minn; Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, Minn
| | - Austin Todd
- Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minn
| | - Kevin L Greason
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minn
| |
Collapse
|
2
|
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.
Collapse
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
| |
Collapse
|
3
|
Afoke J, Camacho E, Bagameri G. Recurrent ventricular arrhythmia after aortic root replacement and mitral valve repair. Heart 2023; 109:1145-1192. [PMID: 37438056 DOI: 10.1136/heartjnl-2023-322553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/14/2023] Open
Affiliation(s)
- Jonathan Afoke
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Elvis Camacho
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Gabor Bagameri
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota, USA
| |
Collapse
|
4
|
Chait J, Tenorio ER, Kawajiri H, Lima GBB, Cirillo-Penn NC, Bagameri G, Pochettino A, DeMartino RR, Oderich GS, Mendes BC. Mid-Term Outcomes of "Complete Aortic Repair": Surgical or Endovascular Total Arch Replacement With Thoracoabdominal Fenestrated-Branched Endovascular Aortic Repair. J Endovasc Ther 2023:15266028231181211. [PMID: 37313951 DOI: 10.1177/15266028231181211] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To describe a single-center experience of "complete aortic repair" consisting of surgical or endovascular total arch replacement/repair (TAR) followed by thoracoabdominal fenestrated-branched endovascular aortic repair (FB-EVAR). METHODS We reviewed 480 consecutive patients who underwent FB-EVAR with physician-modified endografts (PMEGs) or manufactured stent-grafts between 2013 and 2022. From those, we selected only patients treated with open or endovascular arch repair and distal FB-EVAR for aneurysms involving the ascending, arch and thoracoabdominal aortic segments (zones 0-9). Manufactured devices were used under an investigational device exemption protocol. Endpoints included early/in-hospital mortality, mid-term survival, freedom from secondary intervention, and target artery instability. RESULTS There were 22 patients, 14 men and 8 women with a median age of 72±7 years. Thirteen postdissection and 9 degenerative aortic aneurysms were repaired with a mean maximum diameter of 67±11 mm. Time from index aortic procedure to aneurysm exclusion was 169 and 270 days in those undergoing 2- and 3-stage repair strategies, respectively. The ascending aorta and aortic arch were treated with 19 surgical and 3 endovascular TAR procedures. Three (16%) surgical arch procedures were performed elsewhere, and perioperative details were unavailable. Mean bypass, cross-clamp, and circulatory arrest times were 295±57, 216±63, and 46±11 minutes, respectively. There were 4 major adverse events (MAEs) in 2 patients: both required postoperative hemodialysis, 1 had postbypass cardiogenic shock necessitating extracorporeal membrane oxygenation, and the other required evacuation of an acute-on-chronic subdural hematoma. Thoracoabdominal aortic aneurysm repair was performed with 17 manufactured endografts and 5 PMEGs. There was no early mortality. Six (27%) patients experienced MAEs. There were 4 (18%) cases of spinal cord injury with 3 (75%) experiencing complete symptom resolution before discharge. Mean follow-up was 30±17 months in which there were 5 patient deaths-0 aortic related. Eight patients required ≥1 secondary intervention, and 6 target arteries demonstrated instability (3 IC, 1 IIIC endoleaks; 2 TA stenoses). Kaplan-Meier 3-year estimates of patient survival, freedom from secondary intervention, and target artery instability were 78±8%, 56±11%, and 68±11%, respectively. CONCLUSION Complete aortic repair with staged surgical or endovascular TAR and distal FB-EVAR is safe and effective with satisfactory morbidity, mid-term survival, and target artery outcomes. CLINICAL IMPACT The presented study demonstrates that repair of the entirety of the aorta - via total endovascular or hybrid means- is safe and effective with low rates of spinal cord ischemia. Cardiovascular specialists within comprehensive aortic teams at should feel confident that staged repair of the most complex degenerative and post-dissection thoracoabdominal aortic aneurysms can be safely performed in their patients with complication profile similar to that of less extensive repairs. Meticulous and intentional case planning is imperative for immediate and long-term success.
Collapse
Affiliation(s)
- Jesse Chait
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN, USA
| | - Emanuel R Tenorio
- Division of Vascular and Endovascular Surgery, Department of Cardiothoracic & Vascular Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Hidetake Kawajiri
- Department of Cardiovascular Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Guilherme B B Lima
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN, USA
| | | | - Gabor Bagameri
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, USA
| | | | - Randall R DeMartino
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN, USA
| | - Gustavo S Oderich
- Division of Vascular and Endovascular Surgery, Department of Cardiothoracic & Vascular Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Bernardo C Mendes
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN, USA
| |
Collapse
|
5
|
Huntley GD, Bird JG, Lo YC, Bagameri G, Michelena HI. Raphal Cord Rupture: A Rare Mechanism of Aortic Regurgitation in Bicuspid Aortic Valve. JACC Case Rep 2023; 11:101791. [PMID: 37077439 PMCID: PMC10107042 DOI: 10.1016/j.jaccas.2023.101791] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 01/30/2023] [Accepted: 01/31/2023] [Indexed: 04/21/2023]
Abstract
A 70-year-old male with chronic aortic regurgitation was referred with abrupt worsening heart failure. Late referral markers were pulmonary hypertension, mitral regurgitation, and tricuspid regurgitation. Evaluation revealed rupture of a raphal cord or fenestrated raphe from the conjoined cusp of a congenitally bicuspid aortic valve, a rare mechanism of aortic regurgitation. (Level of Difficulty: Intermediate.).
Collapse
Affiliation(s)
- Geoffrey D. Huntley
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Jared G. Bird
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Ying-Chun Lo
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Gabor Bagameri
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Hector I. Michelena
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
- Address for correspondence: Dr Hector I. Michelena, Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905, USA. @michelenahector
| |
Collapse
|
6
|
El Sherif N, Dearani JA, Connolly HM, Bagameri G, Pochettino A, Stulak JM, Stephens EH. Complexity and Outcome of Reoperations After the Ross Procedure in the Current Era. Ann Thorac Surg 2023; 115:633-639. [PMID: 35644264 DOI: 10.1016/j.athoracsur.2022.05.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Revised: 04/04/2022] [Accepted: 05/09/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND The Ross procedure has several advantages, but the need for reintervention is inevitable. The aim of this study was to examine the complexity and outcomes of reoperation after the Ross procedure. METHODS Retrospective chart review was performed of patients with a prior Ross procedure who underwent reoperation at our institution from September 1991 to January 2021. Demographic, echocardiographic, surgical, and perioperative data were collected. Descriptive statistical and regression analyses were performed. RESULTS A total of 105 patients underwent a reoperation at Mayo Clinic after the initial Ross procedure performed at our institution (n = 16; 16.2%) or elsewhere (n = 83; 83.8%). Mean age at the Ross procedure was 27 ± 17 years, and mean age at reoperation at our institution was 37 ± 19 years. Indications for surgical procedure varied, but 64% had autograft regurgitation as 1 of their indications for reoperation. Autograft interventions were performed in 78 patients (74.2%). Pulmonary valve or conduit replacement was performed in 56 patients (53.3%). Double root replacement was performed in 11 patients (10.5%). Aortic reconstruction was performed in 37 patients (38.4%). There were 5 early deaths (5%). During a median follow-up of 6.25 years (3 months-24 years), late deaths occurred in 14 patients (13.1%). Patients with ejection fraction <30% on preoperative echocardiography had shorter duration between the Ross procedure and subsequent reoperation (P = .03). CONCLUSIONS Reoperations after the Ross procedure are performed for a wide range of indications, with most due to autograft dysfunction. The number of early deaths is not low. Reoperation after the Ross procedure should be advised before left ventricular systolic dysfunction.
Collapse
Affiliation(s)
- Nibras El Sherif
- Division of Pediatric Cardiology, Mayo Clinic, Rochester, Minnesota
| | - Joseph A Dearani
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota
| | - Heidi M Connolly
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Gabor Bagameri
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota
| | | | - John M Stulak
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota
| | | |
Collapse
|
7
|
Crestanello JA, Greason K, Elsisy M, Lahr B, Bagameri G, Daly R, Stulak J, Dearani J, Schaff H. Impact of time to chest closure on early and late survival in adults with delayed sternal closure. Eur J Cardiothorac Surg 2023; 63:7030692. [PMID: 36749008 DOI: 10.1093/ejcts/ezad044] [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] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 01/10/2023] [Accepted: 02/06/2023] [Indexed: 02/08/2023]
Abstract
OBJECTIVES Delayed sternal closure (DSC) after cardiac surgery is a temporizing measure to address coagulopathy or haemodynamic instability after cardiac surgery. We sought to study: (i) indications and temporal trends for DSC, (ii) factors associated with time to chest closure and (iii) its impact on short-term and long-term outcomes. METHODS From January 2007 to December 2017, 494 patients (median age 67 years, 66% males) required DSC after cardiac surgery. Medical records were reviewed for indications, risk factors, time to DSC and outcomes. Multivariable Cox regression via landmark analysis of 486 5-day survivors was used to investigate the impact of time to chest closure on early and late survival. RESULTS Coagulopathy and haemodynamic instability were the most common indications. Median time to chest closure was 2 days. Pre-/intraoperative extracorporeal membranous oxygenation, severe right ventricular dysfunction and diabetes mellitus were associated with longer time to chest closure. Longer time to closure was associated with increased risk of operative complications and operative mortality, but did not have a statistically significant association with late mortality. Increasing age, pulmonary hypertension and a greater number of prior sternotomies were also found to be associated with overall mortality. CONCLUSIONS While longer time to chest closure was associated with increased rates of operative complications and operative mortality, it did not reveal a statistically significant association with long-term survival.
Collapse
Affiliation(s)
| | - Kevin Greason
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, USA
| | - Mohamed Elsisy
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, USA
| | - Brian Lahr
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Gabor Bagameri
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, USA
| | - Richard Daly
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, USA
| | - John Stulak
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, USA
| | - Joseph Dearani
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, USA
| | - Hartzell Schaff
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, USA
| |
Collapse
|
8
|
Crestanello JA, Greason KL, Mathew J, Eleid MF, Nkomo VT, Rihal CS, Bagameri G, Holmes DR, Pislaru SV, Sandhu GS, Lee AT, King KS, Alkhouli M. The Interaction of FEV1 and NT-Pro-BNP with Outcomes after Transcatheter Aortic Valve Replacement. Eur J Cardiothorac Surg 2023; 63:6988033. [PMID: 36645236 DOI: 10.1093/ejcts/ezad017] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 12/29/2022] [Accepted: 01/14/2023] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVES Low forced expiratory volume in 1 second (FEV1) and elevated N-terminal Pro form B-type natriuretic peptide (NT-Pro-BNP) have been individually associated with poor outcomes after transcatheter aortic valve replacement (TAVR). We hypothesized a combination of the two would provide prognostic indication after TAVR. METHODS We categorized 871 patients who received TAVR from 2008 to 2018 into 4 groups according to baseline FEV1 (< or ≥ 60% predicted) and NT-Pro-BNP (< or ≥ 1601 pg/ml): group A (n = 312, high FEV1, low NT-Pro-BNP), group B (n = 275, high FEV1, high NT-Pro-BNP), group C (n = 123 low FEV1, low NT-Pro-BNP), and group D (n = 161, low FEV1, high NT-Pro-BNP). The primary endpoint was survival at 1 and 5 years. RESULTS Patients in group A had more severe aortic stenosis and achieved the best long-term survival at 1- (93% (95% CI: 90-96) and 5- years (45.3% (95% CI: 35.4-58). Low FEV1 and high NT-Pro-BNP (group D) patients had more severe symptoms, higher Society of Thoracic Surgeons predicted risk of operative mortality, lower ejection fraction and aortic valve gradient at baseline. They had the worst survival at 1- (76% (95% CI: 69-83) and at 5-years (13.1% (95% CI: 7-25), Hazard Ratio compared to group A: 2.29 (95% CI: 1.6-3.2, p < 0.001) with 25.7% of patients in NYHA class III-IV. Patients in groups B and C had intermediate outcomes. CONCLUSIONS The combination of FEV1 and NT-Pro-BNP stratify patients into 4 groups with distinct risk profiles and clinical outcomes. Patients with low FEV1 and high NT-Pro-BNP have increased comorbidities, poor functional outcomes, and decreased long term survival after TAVR.
Collapse
Affiliation(s)
| | - Kevin L Greason
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN
| | - Jessey Mathew
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN
| | - Mackram F Eleid
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Vuyisile T Nkomo
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | | | - Gabor Bagameri
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN
| | - David R Holmes
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Sorin V Pislaru
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | | | - Alexander T Lee
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN
| | - Katherine S King
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN
| | - Mohamad Alkhouli
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| |
Collapse
|
9
|
Zheng CR, Mazur P, Arghami A, Jahanian S, Viehman JK, King KS, Dearani JA, Daly RC, Rowse PG, Bagameri G, Crestanello JA. Robotic vs. minimally invasive mitral valve repair: A 5-year comparison of surgical outcomes. J Card Surg 2022; 37:3267-3275. [PMID: 35989503 DOI: 10.1111/jocs.16849] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 06/15/2022] [Accepted: 07/02/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Minimally invasive mitral valve repair (MVr) is commonly performed. Data on the outcomes of robotic MVr versus nonrobotic minimally invasive MVr are lacking. We sought to compare the short-term and mid-term outcomes of robotic and nonrobotic MVr. METHODS We reviewed all patients who underwent robotic MVr (n = 424) or nonrobotic MVr via right mini-thoracotomy (n = 86) at Mayo Clinic, Rochester, MN, from January 2015 to February 2020. Data on baseline and operative characteristics, operative and long-term outcomes were analyzed. Patients were matched 1:1 using propensity scores. RESULTS Sixty-nine matched pairs were included in the study. The median age was 59 years (interquartile range [IQR]: 54-69) and 75% (n = 103) were male. Baseline characteristics were similar after matching. Robotic and nonrobotic MVr had similar operative characteristics, except that robotic had longer cross-clamp times (57 [48-67] vs. 47 [37-58] min, p < .001) and more P2 resections (83% vs. 68%, p = .05) compared to nonrobotic MVr. There was no difference in operative outcomes between groups. Hospital stay was shorter after robotic MVr (4 [3-4] vs. 4 [4-6] days, p = .003). After a median follow-up of 3.3 years (IQR, 2.1-4.5), there was no mortality in either group, and there was no difference in freedom from mitral valve reoperations between robotic and nonrobotic MVr (5 years: 97.1% vs. 95.7%, p = .63). Follow-up echocardiogram analysis predicted excellent freedom from recurrent moderate-or-severe mitral regurgitation at 3 years after robotic and nonrobotic MVr (90% vs. 92%, p = .18, respectively). CONCLUSIONS Both short-term and mid-term outcomes of robotic and nonrobotic minimally invasive mitral repair surgery are comparable.
Collapse
Affiliation(s)
- Clark R Zheng
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Piotr Mazur
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Arman Arghami
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Sepideh Jahanian
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Jason K Viehman
- Division of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, Minnesota, USA
| | - Katherine S King
- Division of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, Minnesota, USA
| | - Joseph A Dearani
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Richard C Daly
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Phillip G Rowse
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Gabor Bagameri
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Juan A Crestanello
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota, USA
| |
Collapse
|
10
|
Ramaprabhu K, Saran N, Dearani J, Lahr B, Schaff H, Greason K, Yalamuri S, Mangukia C, Stulak J, Bagameri G, Crestanello J, Pochettino A. Cannulation strategies for acute type A dissection—role of central cannulation. Eur J Cardiothorac Surg 2022; 62:6561483. [DOI: 10.1093/ejcts/ezac207] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 02/22/2022] [Accepted: 03/23/2022] [Indexed: 11/15/2022] Open
Abstract
Abstract
OBJECTIVES
The purpose of this study was to assess the safety and efficacy of direct cannulation of the ascending aorta in comparison with cannulating peripheral arteries.
METHODS
We retrospectively analysed type A dissection patients [n = 107; median (interquartile range [IQR]) age, 64 [53–73] years] from January 2008 to March 2018. The cohort was divided into 2 groups: direct ascending aorta cannulation (group A, n = 47; median [IQR] age, 69 [54–74] years; 34% female) and non-aortic cannulation (group B, n = 60; median [IQR] age, 62 [52–72] years; 20% female). Postoperative outcomes and long-term survival were compared.
RESULTS
Baseline characteristics were not significantly different between the 2 groups, except for higher creatinine in group B (median 0.9 vs 1.1, P = 0.028) and higher prevalence of dyslipidaemia in group A (58.7% vs 38.3%, P = 0.037). Overall early mortality was 12.1% (n = 13); 12.8% (n = 6) in group A and 11.7% (n = 7) in group B (P = 0.863). The incidence of stroke was 10.6% (n = 5) in group A and 6.7% (n = 4) in group B (P = 0.463). After adjusting for CPB and circulatory arrest times, there was no group difference in the length of ICU (P = 0.257) or hospital stay (P = 0.118), all-cause reoperation (P = 0.709), peak postoperative creatinine (P = 0.426) and lactate values (n = 60; P = 0.862). Overall survival at 1, 3 and 5 years was 84%, 78% and 73%, respectively, with no difference between the 2 groups after adjustment (P = 0.629).
CONCLUSIONS
Direct cannulation of the ascending aorta is a safe cannulation strategy for type A dissection repair, offering the opportunity for rapid arterial cannulation and antegrade perfusion.
Collapse
Affiliation(s)
| | - Nishant Saran
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, USA
| | - Joseph Dearani
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, USA
| | - Brian Lahr
- Division of Biomedical Statistics and Informatics, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Hartzell Schaff
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, USA
| | - Kevin Greason
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, USA
| | - Suraj Yalamuri
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, USA
| | - Chirantan Mangukia
- Division of Cardiovascular Surgery, Temple University Hospital, Philadelphia, PA, USA
| | - John Stulak
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, USA
| | - Gabor Bagameri
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, USA
| | - Juan Crestanello
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, USA
| | | |
Collapse
|
11
|
Kato N, Pellikka PA, Scott CG, Lee AT, Jain V, Eleid MF, Alkhouli MA, Reeder GS, Michelena HI, Pislaru SV, Bagameri G, Crestanello JA, Rihal CS, Guerrero M. Impact of mitral intervention on outcomes of patients with mitral valve dysfunction and annulus calcification. Catheter Cardiovasc Interv 2022; 99:1807-1816. [DOI: 10.1002/ccd.30093] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Revised: 12/14/2021] [Accepted: 01/07/2022] [Indexed: 11/07/2022]
Affiliation(s)
- Nahoko Kato
- Department of Cardiovascular Medicine Mayo Clinic Rochester Minnesota USA
| | | | | | - Alexander T. Lee
- Department of Health Sciences Research Mayo Clinic Rochester Minnesota USA
| | - Vaibhav Jain
- Department of Cardiovascular Medicine Mayo Clinic Rochester Minnesota USA
| | - Mackram F. Eleid
- Department of Cardiovascular Medicine Mayo Clinic Rochester Minnesota USA
| | | | - Guy S. Reeder
- Department of Cardiovascular Medicine Mayo Clinic Rochester Minnesota USA
| | | | - Sorin V. Pislaru
- Department of Cardiovascular Medicine Mayo Clinic Rochester Minnesota USA
| | - Gabor Bagameri
- Department of Cardiovascular Surgery Mayo Clinic Rochester Minnesota USA
| | | | - Charanjit S. Rihal
- Department of Cardiovascular Medicine Mayo Clinic Rochester Minnesota USA
| | - Mayra Guerrero
- Department of Cardiovascular Medicine Mayo Clinic Rochester Minnesota USA
| |
Collapse
|
12
|
Bagameri G, Stulak JM. Commentary: Measure twice, cut once: Does a “STICH” in time truly save nine? JTCVS Open 2021; 7:221-222. [PMID: 36003712 PMCID: PMC9390688 DOI: 10.1016/j.xjon.2021.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 06/10/2021] [Accepted: 06/18/2021] [Indexed: 10/28/2022]
|
13
|
Tan NY, Tarabochia AD, DeSimone DC, DeSimone CV, Wilson JW, Bagameri G, Bennett CE, Abu Saleh OM. Updated Experience of Mycobacterium chimaera Infection: Diagnosis and Management in a Tertiary Care Center. Open Forum Infect Dis 2021; 8:ofab348. [PMID: 34377729 PMCID: PMC8339283 DOI: 10.1093/ofid/ofab348] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 05/13/2021] [Accepted: 06/29/2021] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Despite safety communications from the Food and Drug Administration (FDA) regarding the outbreak of Mycobacterium chimaera infections (MCIs) from contaminated heater-cooler devices, new cases continue to be identified. METHODS We retrospectively reviewed confirmed cases of MCI that were managed at Mayo Clinic sites (Arizona, Florida, and Minnesota) from 09/2015 to 01/2021. Clinical histories including prior cardiovascular surgery were recorded. Diagnostic workup including ophthalmologic examination, imaging, and laboratory testing was reviewed. Treatment and survival outcomes on follow-up were obtained. RESULTS Twelve patients with MCI were included. All patients had aortic valve or graft replacement. Five patients had their surgical procedures following the 10/15/2015 FDA safety communication. The mean time from surgery to symptom onset (range) was 32 (13-73) months. Ten of 11 patients who underwent ophthalmologic examination had chorioretinal abnormalities. Three patients who underwent microbial cell-free deoxyribonucleic acid sequencing tested positive for M. chimaera, which was subsequently confirmed with blood culture growth. Echocardiography and positron emission tomography/computed tomography (PET/CT) revealed evidence of prosthetic valve/graft infection in 7/12 (58.3%) and 6/10 (60.0%) of cases, respectively. Seven patients (58.3%) underwent redo cardiovascular surgery. Of these, 1 patient died 2 days postdischarge, 1 experienced spinal osteomyelitis relapse, and another had interval prosthetic valve fluorodeoxyglucose (FDG) uptake on PET/CT suspicious for recurrent infection. Among 4 patients on medical therapy only, 3 expired or transitioned to hospice during follow-up. CONCLUSIONS MCI continues to occur despite the FDA communications. Incorporation of ophthalmologic examination and use of advanced tools may improve MCI diagnosis. The mortality in these patients is high even with aggressive surgical/medical management.
Collapse
Affiliation(s)
- Nicholas Y Tan
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Alex D Tarabochia
- Division of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Daniel C DeSimone
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
- Department of Infectious Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | | | - John W Wilson
- Department of Infectious Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | - Gabor Bagameri
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Courtney E Bennett
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Omar M Abu Saleh
- Department of Infectious Diseases, Mayo Clinic, Rochester, Minnesota, USA
| |
Collapse
|
14
|
Patlolla SH, Schaff HV, Bagameri G, Dearani JA, Greason KL, Daly RC, Crestanello JA, Stulak JM, King KS, Pochettino A, Saran N. Natural history and outcomes of non-replaced aortic sinuses in patients with bicuspid aortic valves. Ann Thorac Surg 2021; 113:527-534. [PMID: 33811890 DOI: 10.1016/j.athoracsur.2021.03.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 03/07/2021] [Accepted: 03/15/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Enlargement of the sinus of Valsalva (SOV) is common in patients with bicuspid aortic valves (BAV), and management at the time of aortic valve replacement (AVR) and concomitant ascending aorta replacement/repair is controversial. METHODS Between January 2000 and July 2017, 400 patients with BAV underwent AVR and concomitant ascending aorta repair (79%, graft replacement; 21%, aortoplasty). To assess the impact of the initial SOV dimension on future dilatation and outcomes, patients were stratified into two groups: SOV<40mm (n=209) and SOV≥40mm (n=191). RESULTS Patients with SOV≥40 mm were older, and more often male. At a median follow-up of 8.1 years (IQR 7.4-9.1), 6 patients underwent reoperations on the ascending or sinus portion of the aorta due to aneurysmal dilatation; enlargement of the sinus was the primary indication for operation in one patient. Adjusted analysis showed that baseline SOV and SOV dimension over time were not associated with late outcomes. A gradual increase in SOV diameter over time was identified (P=0.004). Patients with smaller baseline SOV diameters showed an initial early decrease in diameter followed by gradual increase, while those with larger baseline diameters had a stable early phase followed by gradual dilatation. CONCLUSIONS Ascending aorta replacement may lead to an initial remodeling/stabilizing effect on the spared bicuspid aortic root, which is more pronounced in patients with lower SOV diameters. In addition, our data demonstrate that the retained aortic sinuses enlarge slowly, and within the limited follow-up of our study, SOV diameter was not a risk factor for survival or reoperation.
Collapse
Affiliation(s)
| | | | - Gabor Bagameri
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester
| | | | - Kevin L Greason
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester
| | - Richard C Daly
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester
| | | | - John M Stulak
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester
| | | | | | - Nishant Saran
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester
| |
Collapse
|
15
|
Fritz AV, Luis SA, Bagameri G, Bird J. A case of mistaken identity: pseudoaneurysm masquerading as pericardial effusion following premature ventricular contraction ablation. Eur Heart J Cardiovasc Imaging 2021; 22:e140. [PMID: 33712821 DOI: 10.1093/ehjci/jeab047] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 03/04/2021] [Indexed: 11/14/2022] Open
Affiliation(s)
- Ashley Virginia Fritz
- Division of Cardiovascular Anesthesia, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - Sushil Allen Luis
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - Gabor Bagameri
- Department of Cardiovascular Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - Jared Bird
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| |
Collapse
|
16
|
Pahwa S, Bernabei A, Schaff H, Stulak J, Greason K, Pochettino A, Daly R, Dearani J, Bagameri G, King K, Viehman J, Crestanello J. Impact of postoperative complications after cardiac surgery on long-term survival. J Card Surg 2021; 36:2045-2052. [PMID: 33686738 DOI: 10.1111/jocs.15471] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Revised: 01/23/2021] [Accepted: 02/06/2021] [Indexed: 12/11/2022]
Abstract
PURPOSE The impact of postoperative complications on long-term survival is not well characterized. We sought to study the prevalence of postoperative complications after cardiac surgery and their impact on long-term survival. METHODS Operative survivors (n = 26,221) who underwent coronary artery bypass grafting (CABG) (n = 13,054, 49.8%), valve surgery (n = 8667, 33.1%) or combined CABG and valve surgery (n = 4500, 17.2%) from 1993 to 2019 were included in the study. Records were reviewed for postoperative complications and long-term survival. Propensity-match analysis was performed between patients who did and did not have a postoperative complication. The associations between postoperative complications and survival were assessed using a Cox-proportional model. RESULTS Complications occurred in 17,463 (66.6%) of 26,221 operative survivors. A total of 17 postoperative complications were analyzed. Postoperative blood product use was the commonest (n = 12,397, 47.3%), followed by atrial fibrillation (n = 8399, 32.0%), prolonged ventilation (n = 2336, 8.9%), renal failure (n = 870, 3.3%), reoperation for bleeding (n = 859, 3.3%) and pacemaker/ICD insertion (n = 795, 3.0%). Stroke (hazard ratio [HR]: 1.55; 95% confidence interval [CI]: 1.36-1.77), renal failure (HR: 1.45; 95% CI: 1.33-1.58) and pneumonia (HR: 1.23; 95% CI: 1.11-1.36) had the strongest impact on long-term survival. Long-term survival decreased as the number of postoperative complications increased. CONCLUSIONS Postoperative complications after cardiac surgery significantly impact outcomes that extend beyond the postoperative period. Stroke, renal failure, and pneumonia are particularly associated with poor long-term survival.
Collapse
Affiliation(s)
| | - Annalisa Bernabei
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Hartzell Schaff
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - John Stulak
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Kevin Greason
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Alberto Pochettino
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Richard Daly
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Joseph Dearani
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Gabor Bagameri
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Katherine King
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota, USA
| | - Jason Viehman
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota, USA
| | - Juan Crestanello
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota, USA
| |
Collapse
|
17
|
Bagameri G, Dearani JA. Papillary Muscle Resection During Myectomy: A Word of Caution. Ann Thorac Surg 2020; 111:1519. [PMID: 33279549 DOI: 10.1016/j.athoracsur.2020.09.049] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 09/13/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Gabor Bagameri
- Department of Cardiovascular Surgery, Mayo Clinic, 200 First St SW, Rochester, MN 55905
| | - Joseph A Dearani
- Department of Cardiovascular Surgery, Mayo Clinic, 200 First St SW, Rochester, MN 55905.
| |
Collapse
|
18
|
Oderich GS, Tenorio ER, Bagameri G, Lima GBB, Marcondes GB, Mendes BC. Endovascular Arch Repair Using Inner Branch Stent-Graft With Transapical Access. Ann Thorac Surg 2020; 111:e323-e327. [PMID: 33121971 DOI: 10.1016/j.athoracsur.2020.07.089] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Revised: 07/13/2020] [Accepted: 07/19/2020] [Indexed: 11/16/2022]
Abstract
Endovascular repair of aortic arch aneurysms has been considered in higher risk patients who are not ideally suited for open surgical or hybrid repair. A limitation of these devices is the 8- to 12-week delay for manufacturing, which does not allow treatment of symptomatic or rapidly expanding aneurysms. This report illustrates an urgent endovascular repair of an aortic arch aneurysm using a physician-modified endograft with 2 inner branches. Transapical access allowed better support and precision during device deployment, which was needed given the short proximal landing zone.
Collapse
Affiliation(s)
- Gustavo S Oderich
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, Minnesota.
| | - Emanuel R Tenorio
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, Minnesota
| | - Gabor Bagameri
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota
| | - Guilherme B B Lima
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, Minnesota
| | - Giuliana B Marcondes
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, Minnesota
| | - Bernardo C Mendes
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, Minnesota
| |
Collapse
|
19
|
Abstract
Catheter ablation is a rapidly expanding and evolving field. The advent of interventional techniques and advances in technology have allowed catheter ablation to supplant antiarrhythmic surgery for ventricular arrhythmia treatment. However, issues related to access and energy delivery limit the use of catheter ablation in some cases. Hybrid catheter-based and surgical techniques represent a novel approach to overcome these limitations. The hybrid technique combines the strengths and minimises the limitations of either catheter or surgical ablation alone. There is a growing body of evidence in the literature supporting the safety and efficacy of the hybrid surgical technique. This review aims to provide an overview of hybrid surgical-catheter ablation for ventricular arrhythmia.
Collapse
Affiliation(s)
- Fouad Khalil
- Department of Cardiovascular Medicine, Division of Heart Rhythm Services, Mayo Clinic, Rochester, MN, US
| | - Konstantinos Siontis
- Department of Cardiovascular Medicine, Division of Heart Rhythm Services, Mayo Clinic, Rochester, MN, US
| | - Gabor Bagameri
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, US
| | - Ammar M Killu
- Department of Cardiovascular Medicine, Division of Heart Rhythm Services, Mayo Clinic, Rochester, MN, US
| |
Collapse
|
20
|
Abdelsattar ZM, Elsisy MF, Schaff H, Stulak J, Greason K, Pochettino A, Arghami A, Rowse P, Bagameri G, Khullar V, Daly R, Cicek S, Dearani J, Crestanello J. Comparative Effectiveness of Mechanical Valves and Homografts in Complex Aortic Endocarditis. Ann Thorac Surg 2020; 111:793-799. [PMID: 32890491 DOI: 10.1016/j.athoracsur.2020.06.082] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 05/07/2020] [Accepted: 06/17/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND The ideal surgical reconstruction of the aortic root in patients with complex endocarditis is controversial. We compared the short- and long-term outcomes between mechanical valves, bioprostheses, and homografts. METHODS We identified all patients undergoing an operation for active complex aortic endocarditis at our institution between 2003 and 2017. We grouped patients according to those who received a mechanical valve, bioprosthesis, or homograft. We used multiple logistic regression and proportional hazards models. To minimize confounding by indication, we used marginal risk adjustment to simulate that every patient would undergo (contrary to fact) all 3 operations. RESULTS Of 159 patients with complex active endocarditis, 48 (30.2%) had a valve plus patch reconstruction, and 85 (53.4%) had a root replacement. Of all, 50 (31.5%) had a mechanical valve, 56 (35.2%) had a bioprosthesis, and 53 (33.3%) had a homograft. The groups were similar in age, sex, body mass index, comorbid conditions, organism, abscess location, and mitral involvement (all P > .05). However, patients receiving mechanical reconstructions were more likely to have native valve endocarditis (46% vs 37.5% vs 17%; P = .005) and less likely to undergo root replacement (32% vs 28.6% vs 100%; P < .001). Marginal risk-adjusted operative mortality was lowest for mechanical valves (4.8%) and highest for homografts (16.9%; P = .041). Long-term survival after root replacement was worse with homografts than with mechanical valve conduits (adjusted hazard ratio, 2.9; P = .045). CONCLUSIONS In patients with complex endocarditis, mechanical valves are associated with similar, if not better, short- and long-term outcomes compared with homografts, even after adjusting for important baseline characteristics and limiting the analysis to root replacements only.
Collapse
Affiliation(s)
- Zaid M Abdelsattar
- Department of Cardiac Surgery, Mayo Clinic, Rochester, Minnesota; Department of Thoracic and Cardiovascular Surgery, Loyola University Chicago, Chicago, Illinois
| | - Mohamed F Elsisy
- Department of Cardiac Surgery, Mayo Clinic, Rochester, Minnesota
| | - Hartzell Schaff
- Department of Cardiac Surgery, Mayo Clinic, Rochester, Minnesota
| | - John Stulak
- Department of Cardiac Surgery, Mayo Clinic, Rochester, Minnesota
| | - Kevin Greason
- Department of Cardiac Surgery, Mayo Clinic, Rochester, Minnesota
| | | | - Arman Arghami
- Department of Cardiac Surgery, Mayo Clinic, Rochester, Minnesota
| | - Philip Rowse
- Department of Cardiac Surgery, Mayo Clinic, Rochester, Minnesota
| | - Gabor Bagameri
- Department of Cardiac Surgery, Mayo Clinic, Rochester, Minnesota
| | - Vishal Khullar
- Department of Cardiac Surgery, Mayo Clinic, Rochester, Minnesota
| | - Richard Daly
- Department of Cardiac Surgery, Mayo Clinic, Rochester, Minnesota
| | - Sertac Cicek
- Department of Cardiac Surgery, Mayo Clinic, Rochester, Minnesota
| | - Joseph Dearani
- Department of Cardiac Surgery, Mayo Clinic, Rochester, Minnesota
| | - Juan Crestanello
- Department of Cardiac Surgery, Mayo Clinic, Rochester, Minnesota.
| |
Collapse
|
21
|
Nguyen A, Schaff HV, Arghami A, Bagameri G, Cicek MS, Crestanello JA, Daly RC, Greason KL, Pochettino A, Rowse PG, Stulak JM, Lahr BD, Dearani JA. Impact of Hematologic Malignancies on Outcome of Cardiac Surgery. Ann Thorac Surg 2020; 111:1278-1283. [PMID: 32822668 DOI: 10.1016/j.athoracsur.2020.06.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 04/28/2020] [Accepted: 06/08/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Previous studies suggest that patients with prior or current hematologic malignancy are at increased risk of intraoperative and postoperative complications when undergoing cardiac surgery. The aim of this review was to compare clinical outcomes of patients with a history of hematologic malignancy to those of similar patients with no known blood dyscrasia. METHODS From January 1993 to June 2017, 37,839 patients underwent elective cardiac surgery at Mayo Clinic. We matched 612 patients (1.6%) with a history of hematologic malignancy to 612 controls, and compared operative details, early postoperative complications, and late survival. RESULTS The median age of matched patients with hematologic malignancy was 71 years (interquartile range [IQR], 62 to 77) and 71 years (IQR, 62 to 77) for patients without cancer. Patients with prior diagnosis of malignancy had lower hemoglobin levels, 12.8 (IQR, 11.5 to 13.8) vs 13.5 (IQR, 12.2 to 14.6; P < .001), but similar platelet counts, 195 (IQR, 147 to 263) vs 203 (IQR, 170 to 245; P = .533). Patients with malignancy were at greater risk of receiving postoperative blood transfusions (47.4% vs 35.6%, P < .001). However, reoperations for postoperative bleeding (4.7% vs 3.3%, P = .253) and stroke (1.3% vs 1.3%, P > .999) were similar. Thirty-day mortality was 3.3% among patients with hematologic malignancy and 1.5% among matched controls (P = .061). Overall survival among patients with cancer was reduced (P < .0001). CONCLUSIONS Although late survival is reduced in patients with hematologic malignancies, early outcomes are generally similar to those of matched controls. Therefore, surgery should not be withheld from patients with a diagnosis of hematologic malignancy who would benefit from cardiac procedures.
Collapse
Affiliation(s)
- Anita Nguyen
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota
| | - Hartzell V Schaff
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota.
| | - Arman Arghami
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota
| | - Gabor Bagameri
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota
| | - M Sertac Cicek
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota
| | | | - Richard C Daly
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota
| | - Kevin L Greason
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota
| | | | - Phillip G Rowse
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota
| | - John M Stulak
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota
| | - Brian D Lahr
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | - Joseph A Dearani
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota
| |
Collapse
|
22
|
Bagameri G, Stulak JM. Commentary: "Chicken or the egg": The causality dilemma of atrial fibrillation and congestive heart failure. J Thorac Cardiovasc Surg 2020; 162:1107-1108. [PMID: 32741634 DOI: 10.1016/j.jtcvs.2020.06.094] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Revised: 06/27/2020] [Accepted: 06/29/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Gabor Bagameri
- Department of Cardiovascular Surgery, Mayo Clinic College of Medicine and Science, Rochester, Minn
| | - John M Stulak
- Department of Cardiovascular Surgery, Mayo Clinic College of Medicine and Science, Rochester, Minn.
| |
Collapse
|
23
|
Bagameri G, Stulak JM. The 301 Classification: Old School Meets New School. Mayo Clin Proc 2020; 95:1304-1305. [PMID: 32622435 DOI: 10.1016/j.mayocp.2020.05.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 05/27/2020] [Indexed: 10/24/2022]
Affiliation(s)
- Gabor Bagameri
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN.
| | - John M Stulak
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN.
| |
Collapse
|
24
|
Thaden JJ, Malouf JF, Rehfeldt KH, Ashikhmina E, Bagameri G, Enriquez-Sarano M, Stulak JM, Schaff HV, Michelena HI. Adult Intraoperative Echocardiography: A Comprehensive Review of Current Practice. J Am Soc Echocardiogr 2020; 33:735-755.e11. [DOI: 10.1016/j.echo.2020.01.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Revised: 01/19/2020] [Accepted: 01/20/2020] [Indexed: 12/15/2022]
|
25
|
Kawajiri H, Khasawneh MA, Bower TC, Bagameri G. Two-Stage Redo Aortic Arch Repair in a Patient With an Isolated Left Vertebral Artery. Innovations (Phila) 2020; 15:376-378. [PMID: 32412398 DOI: 10.1177/1556984520922985] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
A 47-year-old male presented with an enlarging distal aortic arch false lumen 6 months status post ascending and hemiarch replacement with antegrade endograft insertion for acute type A aortic dissection complicated by lower body malperfusion. Preoperative computed tomographic angiography showed an isolated but dominant left vertebral artery. A 2-stage open surgical repair was performed. First, the left subclavian artery was transposed on the common carotid and vertebral onto the subclavian. At the second stage, a redo total arch reconstruction was done with bypass grafts taken to the innominate and left common carotid arteries. The patient did well postoperatively.
Collapse
Affiliation(s)
- Hidetake Kawajiri
- 6915 Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, USA
| | - Mohammad A Khasawneh
- 4352 Department of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN, USA
| | - Thomas C Bower
- 4352 Department of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN, USA
| | - Gabor Bagameri
- 6915 Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, USA
| |
Collapse
|
26
|
Guerrero ME, Killu AM, Gonzalez-Quesada C, Bagameri G, Eleid MF, Alkhouli M, Geske J, Williamson E, Asirvatham S, Rihal C. Pre-Emptive Radiofrequency Septal Ablation to Decrease the Risk of Left Ventricular Outflow Tract Obstruction After TMVR. JACC Cardiovasc Interv 2020; 13:1129-1132. [DOI: 10.1016/j.jcin.2020.02.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 02/12/2020] [Accepted: 02/12/2020] [Indexed: 10/24/2022]
|
27
|
Bagameri G, Crestanello JA. Commentary: When misdiagnosis leads to silver lining-a simple solution to the complex problem of congenital coronary artery fistula. JTCVS Tech 2020; 2:75-76. [PMID: 34317758 PMCID: PMC8298882 DOI: 10.1016/j.xjtc.2020.02.032] [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: 02/19/2020] [Revised: 02/19/2020] [Accepted: 02/20/2020] [Indexed: 11/19/2022] Open
Affiliation(s)
| | - Juan A. Crestanello
- Address for reprints: Juan A. Crestanello, MD, Mayo Clinic, 200 First St SW, JO-5200, Rochester, MN 55905.
| |
Collapse
|
28
|
Helder MR, Schaff HV, Day CN, Pochettino A, Bagameri G, Greason KL, Lansman SL, Girardi LN, Storlie CB, Habermann EB. Regional and Temporal Trends in the Outcomes of Repairs for Acute Type A Aortic Dissections. Ann Thorac Surg 2020; 109:26-33. [DOI: 10.1016/j.athoracsur.2019.06.058] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 06/03/2019] [Accepted: 06/17/2019] [Indexed: 10/26/2022]
|
29
|
Inra ML, McCormick MG, Bagameri G, Lin PT. Thoracic aortic dissection associated with involvement by small lymphocytic lymphoma/chronic lymphocytic leukemia: a possible underappreciated risk factor? Cardiovasc Pathol 2019; 45:107179. [PMID: 31865269 DOI: 10.1016/j.carpath.2019.107179] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 10/18/2019] [Accepted: 11/07/2019] [Indexed: 12/22/2022] Open
Abstract
We report a case of a 77-year-old man with small lymphocytic lymphoma/chronic lymphocytic leukemia (SLL/CLL) thought to be in remission who developed an acute type A thoracic aortic dissection despite no known risk factors for aortic dissection. Surgical pathology evaluation of the aorta specimen removed at surgery showed direct lymphocytic infiltration of the aortic adventitia and media in the region of the aortic dissection. The potential causative role and pathophysiologic mechanisms of SLL/CLL in aortic dissection are discussed.
Collapse
Affiliation(s)
- Matthew L Inra
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, USA
| | | | - Gabor Bagameri
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, USA
| | - Peter T Lin
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA.
| |
Collapse
|
30
|
Greason KL, Crestanello JA, King KS, Bagameri G, Cicek SM, Stulak JM, Daly RC, Dearani JA, Schaff HV. Open hemiarch versus clamped ascending aorta replacement for aortopathy during initial bicuspid aortic valve replacement. J Thorac Cardiovasc Surg 2019; 161:12-20.e2. [PMID: 31757461 DOI: 10.1016/j.jtcvs.2019.09.028] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 09/03/2019] [Accepted: 09/06/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND There is controversy regarding the extent of aortic resection necessary in patients with aortopathy related to bicuspid aortic valve disease. To address this issue, we reviewed our experience in patients undergoing ascending aorta replacement during bicuspid aortic valve replacement. METHODS We reviewed 702 patients who underwent ascending aorta replacement at the time of initial nonemergent native bicuspid aortic valve replacement at our institution between January 2000 and June 2017. Treatment cohorts included an open hemiarch replacement group (n = 225; 32%) and a clamped ascending aorta replacement group (n = 477; 68%). RESULTS Median patient age was 60 years (interquartile range [IQR], 51-67 years), female sex was present in 113 patients 16%, ejection fraction was 62% (IQR, 56%-66%), and aortic arch diameter was 33 mm (IQR, 29-36 mm). Cardiopulmonary bypass time was longer in the hemiarch replacement group (188 minutes vs 97 minutes; P < .001). Procedure-related complications (36%) and mortality (<1%) were similar in the 2 groups; however, the hemiarch group had an increased odds of blood transfusion (odds ratio, 1.62; 95% confidence interval [CI], 1.15-2.28; P = .006). The median duration of follow-up was 6.0 years (95% CI, 5.3-6.8 years). Overall survival was 94 ± 1% at 5 years and 80 ± 2% at 10 years. Multivariable analysis demonstrated similar survival in the 2 groups (hazard ratio, 0.83; 95% CI, 0.51-1.33; P = .439). No repeat aortic arch operations were done for aortopathy over the duration of clinical follow-up. CONCLUSIONS Compared with patients in the clamped ascending aorta replacement group, patients in the hemi-arch replacement group had longer cardiopulmonary bypass and aortic cross-clamp times, along with an increased risk of blood transfusion, but similar freedom from repeat aortic arch operation and survival. We identified no advantage of performing hemiarch replacement in the absence of aortic arch dilation.
Collapse
Affiliation(s)
- Kevin L Greason
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minn.
| | | | - Katherine S King
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, Minn
| | - Gabor Bagameri
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minn
| | - Sertac M Cicek
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minn
| | - John M Stulak
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minn
| | - Richard C Daly
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minn
| | - Joseph A Dearani
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minn
| | | |
Collapse
|
31
|
Calderon-Rojas R, Greason KL, Oh JK, Maltais S, Crestanello J, Bagameri G, Cicek S, Said S, Stulak J, Daly R, Pochettino A, Schaff HV. P4582Tricuspid valve regurgitation in patients with constrictive pericarditis. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p4582] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- R Calderon-Rojas
- Mayo Clinic, Cardiovascular Surgery, Rochester, United States of America
| | - K L Greason
- Mayo Clinic, Cardiovascular Surgery, Rochester, United States of America
| | - J K Oh
- Mayo Clinic, Cardiovascular Diseases, Rochester, United States of America
| | - S Maltais
- Mayo Clinic, Cardiovascular Surgery, Rochester, United States of America
| | - J Crestanello
- Mayo Clinic, Cardiovascular Surgery, Rochester, United States of America
| | - G Bagameri
- Mayo Clinic, Cardiovascular Surgery, Rochester, United States of America
| | - S Cicek
- Mayo Clinic, Cardiovascular Surgery, Rochester, United States of America
| | - S Said
- Mayo Clinic, Cardiovascular Surgery, Rochester, United States of America
| | - J Stulak
- Mayo Clinic, Cardiovascular Surgery, Rochester, United States of America
| | - R Daly
- Mayo Clinic, Cardiovascular Surgery, Rochester, United States of America
| | - A Pochettino
- Mayo Clinic, Cardiovascular Surgery, Rochester, United States of America
| | - H V Schaff
- Mayo Clinic, Cardiovascular Surgery, Rochester, United States of America
| |
Collapse
|
32
|
Nguyen AH, Bagameri G, Larson RA, Strife BJ. IP059. Successful Ablation of a Ruptured Thoracic Aneurysm With Associated Aortobronchial Fistula Using Sodium Tetradecyl Sulfate/Lipiodol Foam. J Vasc Surg 2016. [DOI: 10.1016/j.jvs.2016.03.067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
33
|
McIlhenny S, Zhang P, Tulenko T, Comeau J, Fernandez S, Policha A, Ferroni M, Faul E, Bagameri G, Shapiro I, DiMuzio P. eNOS transfection of adipose-derived stem cells yields bioactive nitric oxide production and improved results in vascular tissue engineering. J Tissue Eng Regen Med 2013; 9:1277-85. [PMID: 23319464 DOI: 10.1002/term.1645] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2012] [Revised: 07/19/2012] [Accepted: 10/04/2012] [Indexed: 11/10/2022]
Abstract
This study evaluates the durability of a novel tissue engineered blood vessel (TEBV) created by seeding a natural vascular tissue scaffold (decellularized human saphenous vein allograft) with autologous adipose-derived stem cells (ASC) differentiated into endothelial-like cells. Previous work with this model revealed the graft to be thrombogenic, likely due to inadequate endothelial differentiation as evidenced by minimal production of nitric oxide (NO). To evaluate the importance of NO expression by the seeded cells, we created TEBV using autologous ASC transfected with the endothelial nitric oxide synthase (eNOS) gene to produce NO. We found that transfected ASC produced NO at levels similar to endothelial cell (EC) controls in vitro which was capable of causing vasorelaxation of aortic specimens ex vivo. TEBV (n = 5) created with NO-producing ASC and implanted as interposition grafts within the aorta of rabbits remained patent for two months and demonstrated a non-thrombogenic surface compared to unseeded controls (n = 5). Despite the xenograft nature of the scaffold, the TEBV structure remained well preserved in seeded grafts. In sum, this study demonstrates that upregulation of NO expression within adult stem cells differentiated towards an endothelial-like lineage imparts a non-thrombogenic phenotype and highlights the importance of NO production by cells to be used as endothelial cell substitutes in vascular tissue engineering applications.
Collapse
Affiliation(s)
- Stephen McIlhenny
- Department of Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Ping Zhang
- Department of Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Thomas Tulenko
- Department of Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Jason Comeau
- Department of Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Sarah Fernandez
- Department of Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Aleksandra Policha
- Department of Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Matthew Ferroni
- Department of Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Elizabeth Faul
- Department of Orthopaedic Research, Thomas Jefferson University, Philadelphia, PA, USA
| | - Gabor Bagameri
- Department of Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Irving Shapiro
- Department of Orthopaedic Research, Thomas Jefferson University, Philadelphia, PA, USA
| | - Paul DiMuzio
- Department of Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| |
Collapse
|
34
|
Assifi MM, Bagameri G, Dimuzio PJ, Eisenberg JA. Management of infected caval filter with simultaneous aortic pseudoaneurysm and retroperitoneal perforation: a case report and literature review. Vascular 2012; 20:225-8. [PMID: 22688925 DOI: 10.1258/vasc.2011.cr0310] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Inferior vena cava (IVC) filters have been reported to have complication rates up to 35%. Penetration of surrounding retroperitoneal structures is an uncommon, but potentially serious, complication, with several reports in the literature. We present a unique case of a 34-year-old intravenous drug user with infected IVC filter struts penetrating multiple structures simultaneously. Definitive operative management was necessary for removal of filter struts from the aorta, the second part of the duodenum and the iliopsoas muscle. Drainage and debridement of an associated iliopsoas abscess was performed, followed by aortic and caval reconstruction.
Collapse
Affiliation(s)
- M Mura Assifi
- Department of Surgery, Division of Vascular and Endovascular Surgery, Thomas Jefferson University, 111 South 11th Street, Philadelphia, PA 19107, USA
| | | | | | | |
Collapse
|