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Aortic arch dissection

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https://www.readbyqxmd.com/read/29786413/frozen-elephant-trunk-and-arch-endografts-for-chronic-thoracoabdominal-aortic-dissections
#1
Giovanni Tinelli, Marco Ferraresi, A Claire Watkins, Raphael Soler, Elie Fadel, Dominique Fabre, Stéphan Haulon
Chronic aortic dissecting aneurysms (TAAD) presenting after acute Stanford Type A or B dissection includes both arch and/or thoracoabdominal aortic aneurysms (TAAA). Approximately 60% of patients who survive surgical treatment of acute Type A aortic dissections will require another aortic procedure. Similarly, more than 70% of patients with chronic Type B aortic dissections will experience false lumen dilation at 5-year follow-up, often requiring intervention. Open or hybrid aortic repairs of complex TAAD involving the arch and the TAAA are very demanding procedures for both patients and clinicians...
May 22, 2018: Journal of Cardiovascular Surgery
https://www.readbyqxmd.com/read/29780728/intimal-re-layering-technique-for-type-a-acute-aortic-dissection-reconstructing-the-intimal-layer-continuity-to-induce-remodeling-of-the-false-channel
#2
Eugenio Neri, Enrico Tucci, Giulio Tommasino, Giulia Guaccio, Carmelo Ricci, Pierleone Lucatelli, Marco Cini, Roberto Ceresa, Antonio Benvenuti, Luigi Muzzi
Background: Residual false channel is common after repair of type A acute aortic dissection (TAAAD). Starting from our recent series of TAAAD patients we carried out a retrospective analysis, regarding the failure of primary exclusion at the time of the initial operation. We classified the location of the principal entry tears perfusing the residual false channel. The proposed technique represents our attempt to correct the mechanism of false channel perfusion during primary repair. We describe a new technique designed to address some limitations of standard hemiarch aortic replacement...
2018: Journal of Visualized Surgery
https://www.readbyqxmd.com/read/29780725/total-aortic-repair-for-acute-type-a-aortic-dissection-a-new-paradigm
#3
George Matalanis, Shoane Ip
The currently accepted guidelines of open surgical repair for acute type A aortic dissection (ATAAD) include the resection of the primary entry tear, replacement of the ascending aorta and "hemi-arch" with an open distal anastomosis, and aortic valve resuspension and some form of obliteration of the aortic root false lumen. The principal aim being protection against aortic rupture, aortic regurgitation, and coronary ischemia and restoration of antegrade preferential true lumen perfusion. Proponents argue that this operation is tailored to be in the armamentarium of most cardiac surgeons and deliver the lowest early operative risk, while leaving the infrequent long-term sequelae to be dealt with electively by experienced aortic centres...
2018: Journal of Visualized Surgery
https://www.readbyqxmd.com/read/29780723/cerebral-perfusion-issues-in-type-a-aortic-dissection
#4
REVIEW
Davide Pacini, Giacomo Murana, Luca Di Marco, Marianna Berardi, Carlo Mariani, Giuditta Coppola, Mariafrancesca Fiorentino, Alessandro Leone, Roberto Di Bartolomeo
Stroke events are very common in acute type A aortic dissection. Cerebral malperfusion could manifest at presentation due to prolonged arch vessels hypoperfusion or develop after surgery for inadequate cerebral protection during arch repair. To reduce this detrimental complication there are several adjuncts that can be adopted for cerebral protection such as direct antegrade or retrograde cerebral perfusion (RCP) and use period of deep to moderate hypothermic circulatory arrest time; however, they are often insufficient as preoperative malperfusion already caused irreversible ischemic damages...
2018: Journal of Visualized Surgery
https://www.readbyqxmd.com/read/29778817/extent-of-aortic-replacement-in-type-a-dissection-current-answers-for-an-endless-debate
#5
REVIEW
Stephen D Waterford, Rita L Gardner, Marc R Moon
BACKGROUND: The proximal and distal extent of surgery for type A dissection is the subject of this review article. METHODS: In this report, we summarize select series that illumine the issue at hand and provide insight into the surgical approach at our institution to DeBakey type I aortic dissections. RESULTS: For proximal extent, we discuss preservation of the aortic valve in the presence of aortic insufficiency, as well as management of the aortic root in the setting of root dilation...
May 17, 2018: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/29765495/effect-of-the-antioxidant-lipoic-acid-in-aortic-phenotype-in-a-marfan-syndrome-mouse-model
#6
Maria C Guido, Victor Debbas, Vera M Salemi, Elaine R Tavares, Thayna Meirelles, Thaís L S Araujo, Patricia Nolasco, Julio C A Ferreira-Filho, Celso K Takimura, Lygia V Pereira, Francisco R Laurindo
Marfan syndrome (MFS) cardiovascular manifestations such as aortic aneurysms and cardiomyopathy carry substantial morbidity/mortality. We investigated the effects of lipoic acid, an antioxidant, on ROS production and aortic remodeling in a MFS mgΔloxPneo mouse model. MFS and WT (wild-type) 1-month-old mice were allocated to 3 groups: untreated, treated with losartan, and treated with lipoic acid. At 6 months old, echocardiography, ROS production, and morphological analysis of aortas were performed. Aortic ROS generation in 6-month-old MFS animals was higher at advanced stages of disease in MFS...
2018: Oxidative Medicine and Cellular Longevity
https://www.readbyqxmd.com/read/29755088/-hybrid-repair-of-distal-arch-aortic-aneurysm-total-aortic-arch-repair-with-the-lupiae-vascular-graft-and-thoracic-endovascular-aortic-repair-report-of-two-cases
#7
Nobu Yokoyama, Daigo Shinoda, Mitsunori Nakano, Manabu Shiraishi, Satoshi Itoh
Surgical treatment for distal arch aortic aneurysm is generally invasive, and there is no definitive approach for it. We report 2 cases of men who was admitted for the treatment of aortic aneurysm. First case is a 78-year-old man. Two saccular aneurysm were observed on distal aortic arch and descending aorta by contrast-enhanced computed tomography. Two staged-repair was performed with using the Lupiae vascular graft and thoracic endovascular aortic repair(TEVAR). The postoperative course was uneventful, and he was discharged on day 21 after 1st operation...
May 2018: Kyobu Geka. the Japanese Journal of Thoracic Surgery
https://www.readbyqxmd.com/read/29755087/-successful-echo-guided-deployment-of-stent-graft-for-intraoperative-retrograde-aortic-dissection-and-rupture-report-of-a-case
#8
Naoki Kanemitsu, Takehiko Matsuo, Hiroaki Osada, Kazuo Yamanaka, Junichi Tazaki
We report a case of chronic dissecting thoracoabdominal aneurysm with intraoperative retrograde aortic dissection and rupture at proximal descending aorta, which was successfully treated by echoguided stent-graft insertion. An 82-year old male underwent thoracoabdominal aortic replacement for dilatation of infra-diaphragmatic aorta. Under F-F bypass, his thoracoabdominal aorta was replaced by a Dacron graft with 4-branches. After he weaned from F-F bypass, we found massive bleeding from proximal descending aorta...
May 2018: Kyobu Geka. the Japanese Journal of Thoracic Surgery
https://www.readbyqxmd.com/read/29755086/-total-arch-replacement-with-concomitant-thoracic-endovascular-aortic-repair-via-the-ascending-aorta-for-extended-thoracic-aneurysm-report-of-a-case
#9
Yoshiki Endo, Yoshihito Irie, Kousuke Nishida, Tsuyoshi Fujimiya, Yoshiaki Katada
The patient was a 66 year-old male. Computed tomography (CT) angiography showed a huge aneurysm(120 mm) in the aortic arch and chronic type B aortic dissection(45 mm) in the descending aorta. Echocardiography showed patent ductus arteriosus( PDA). Because of pulmonary hypertension due to PDA, it was considered unacceptable to put him under general anesthesia twice. We performed thoracic endovascular aortic repair (TEVAR) via the ascending aorta and total arch replacement (TAR) simultaneously to prevent paraplegia...
May 2018: Kyobu Geka. the Japanese Journal of Thoracic Surgery
https://www.readbyqxmd.com/read/29753501/low-rate-of-reoperations-after-acute-type-a-aortic-dissection-repair-from-the-nordic-consortium-registry
#10
Emily Pan, Tomas Gudbjartsson, Anders Ahlsson, Simon Fuglsang, Arnar Geirsson, Emma C Hansson, Vibeke Hjortdal, Anders Jeppsson, Kati Järvelä, Ari Mennander, Shahab Nozohoor, Christian Olsson, Anders Wickbom, Igor Zindovic, Jarmo Gunn
OBJECTIVES: To describe the relationship between the extent of primary aortic repair and the incidence of reoperations after surgery for type A aortic dissection. METHODS: A retrospective cohort of 1159 patients treated for type A aortic dissection at eight Nordic low- to medium-sized cardiothoracic centers from 2005 to 2014. Data were gathered from patient records and national registries. Patients were separately divided into 3 groups according to the distal anastomoses technique (ascending aorta [n = 791], hemiarch [n = 247], and total arch [n = 66]), and into 2 groups for proximal repair (aortic root replacement [n = 285] and supracoronary repair [n = 832])...
April 12, 2018: Journal of Thoracic and Cardiovascular Surgery
https://www.readbyqxmd.com/read/29750927/frozen-elephant-trunk-for-acute-type-b-dissection-involving-the-distal-arch-in-the-hybrid-repair-era
#11
Rui-Dong Qi, Jun-Ming Zhu, Yong-Min Liu, Lei Chen, Cheng-Nan Li, Xiao-Yan Xing, Nan Zhang, Li-Zhong Sun
BACKGROUND: Hybrid repair of complicated acute type B aortic dissection(ATBAD) with aortic arch involvement is associated with a high rate of endoleak, stroke, and retrograde aortic dissection. Optimal management of this lesion remains uncertain. In this hybrid repair era, surgical results of ATBAD with distal aortic arch involvement using a frozen elephant trunk(FET) procedure with left subclavian artery(LSCA)-left common carotid artery(LCCA) transposition is reported. METHODS: From April 2011 to April 2016, 53 patients with complicated ATBAD with distal aortic arch involvement underwent a FET procedure with LSCA-LCCA transposition...
May 8, 2018: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/29748059/experience-with-the-axillary-artery-as-an-arterial-cannulation-site-in-patients-with-acute-type-a-aortic-dissection
#12
Arpit Talwar, Elvina Wiadji, Manu N Mathur
BACKGROUND: The optimal arterial cannulation site in patients undergoing surgical management of acute type A aortic dissection (ATAAD) remains controversial. The axillary artery is rarely involved in the dissection process, provides antegrade flow in the descending aorta and minimises intraoperative malperfusion. The purpose of this study is to evaluate a single surgeon's experience of axillary artery cannulation for ATAAD repair. METHODS: All consecutive patients over a 15-year period having surgical repair of ATAAD were included in this study...
March 29, 2018: Heart, Lung & Circulation
https://www.readbyqxmd.com/read/29747330/-aortic-dissection-involving-kommerell-s-diverticulum-and-right-sided-aortic-arch-with-right-sided-descending-aorta-in-one-patient
#13
Y Z Qi, Y P Ma, Q Li
No abstract text is available yet for this article.
April 24, 2018: Zhonghua Xin Xue Guan Bing za Zhi
https://www.readbyqxmd.com/read/29724522/influence-of-primary-intimal-tear-location-in-type-b-aortic-dissection-as-a-factor-portending-retrograde-type-a-aortic-dissection-after-endovascular-repair
#14
Adel Mohammed Amer Al-Kalei, Ziheng Wu, Hongkun Zhang
PURPOSE: To investigate the effect of a primary intimal tear's position on the distal convexity as a factor predisposing patients to developing a retrograde type A aortic dissection (RTAAD) after endovascular repair for type B aortic dissections. MATERIALS AND METHODS: From January 2010 to December 2015, 334 patients with type B aortic dissections identified from a retrospective thoracic endovascular repair database were assigned to 2 groups based on the location of primary intimal tears in the distal aortic arch...
April 30, 2018: Journal of Vascular and Interventional Radiology: JVIR
https://www.readbyqxmd.com/read/29720205/retrograde-type-a-dissection-in-a-24th-gestational-week-pregnant-patient-the-importance-of-interdisciplinary-interaction-to-a-successful-outcome
#15
Jerry Easo, Michael Horst, Bernhard Schmuck, Rohit Philip Thomas, Steffen Saupe, Malte Book, Alexander Weymann
BACKGROUND: Type A Dissection in pregnancy is a devastating medical condition with 2 lives at stake and unclear strategy at early gestational stages. We describe a successful outcome, clearly dependent on the coordination of all involved disciplines. CASE PRESENTATION: This case history describes a 28 year old female with a 24th week pregnancy gravida 2 para 0 with a DeBakey Type I aortic dissection, diagnosed via ultrasound. Surgery was perfomed on the day of diagnosis...
May 2, 2018: Journal of Cardiothoracic Surgery
https://www.readbyqxmd.com/read/29707342/aortic-arch-repair-under-moderate-hypothermic-circulatory-arrest-with-or-without-antegrade-cerebral-perfusion-based-on-the-extent-of-repair
#16
Sung Jun Park, Bo Bae Jeon, Hee Jung Kim, Joon Bum Kim
Background: For aortic-arch repair, moderate hypothermic circulatory arrest (HCA) have shown favorable outcomes over conventional deep HCA when coupled with antegrade cerebral perfusion (ACP); however, recent studies have shown that ACP may not be essential when circulatory arrest time is less than 30 minutes. This study aims to evaluate the stratified arch repair strategy of moderate HCA with or without ACP based on the extent of procedure. Methods: Consecutive 138 patients (63 female; mean age, 60...
March 2018: Journal of Thoracic Disease
https://www.readbyqxmd.com/read/29705559/open-thoracic-and-thoraco-abdominal-aortic-repair-after-prior-endovascular-therapy
#17
Paula R Keschenau, Shirley Ketting, Barend Mees, Mohammad E Barbati, Jochen Grommes, Alexander Gombert, Geert Willem H Schurink, Drosos Kotelis, Michael J Jacobs
OBJECTIVE: The aim was to present current results of open thoracic and thoraco-abdominal aortic repair as secondary procedure after prior endovascular therapy. METHODS: This was a retrospective cross border single centre study. From 2006 to July 2017 45 open thoracic aortic (TAA) or thoraco-abdominal aortic aneurysm (TAAA) operations were performed on 44 patients (median age 58 [15-80] years) as secondary surgery after previous endovascular therapy comprising TEVAR (n = 38; 86%), EVAR (n = 3; 7%), fenestrated EVAR (n = 1; 2%) and TEVAR plus EVAR (n = 1; 2%)...
April 25, 2018: European Journal of Vascular and Endovascular Surgery
https://www.readbyqxmd.com/read/29705370/clinical-outcomes-of-vasoring-connector-in-patients-with-acute-type-a-aortic-dissection
#18
I-Ming Chen, Po-Lin Chen, Shih-Hsien Weng, Chiao-Po Hsu, Chun-Che Shih, Hsiao-Huang Chang, Jeng Wei
BACKGROUND: Outcomes of acute type A aortic dissection (TAAD) repair may be improved when VasoRing connectors (VRC) are employed to facilitate aortic anastomosis. In the present study, we compared the results of acute TAAD repair using VRC and conventional suture technique. METHODS: A total of 68 patients who underwent acute TAAD repair by total arch replacement and antegrade frozen elephant trunk procedure at our institution were enrolled. Records of patients receiving aorta anastomosis with VRC (n = 33) and conventional suture (n =35) were retrospectively compared...
April 26, 2018: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/29701403/hostile-thoracic-aortic-aneurysm-treated-by-fenestrated-thoracic-stentgraft-with-proximal-sealing-in-ishimaru-zone-0
#19
Joel Sousa, João Neves, Vicente Riambau, José Teixeira
INTRODUCTION: Thoracic endovascular aortic aneurysm repair (TEVAR) is an established treatment for thoracic aortic disease in both the acute and elective setting, with such a widespread use that almost 50% of all thoracic aortic surgery in Europe is performed by these means. Nonetheless, the feasibility of TEVAR is determined by several anatomic factors, and the suitability of the proximal and distal landing zones remain one of the main limitations to its use. The advent of custom-made thoracic stent grafts widened the endovascular options in some challenging anatomies...
July 2017: Revista Portuguesa de Cirurgia Cardio-torácica e Vascular
https://www.readbyqxmd.com/read/29701399/predictors-of-prognosis-in-patients-with-type-b-aortic-dissection
#20
Marina Dias-Neto, Filipa Poleri, Sérgio Sampaio
INTRODUCTION: Type B aortic dissection (TBAD) affects mostly men with an estimated annual incidence between 2.9 and 4.0 per 100,000, and it appears to be increasing. DISSECT classification was published in 2013 aiming to reunite clinical and anatomical characteristics of interest to clinicians involved in TBAD management. In Portugal, the incidence of the condition, as well as its characteristics and outcomes, are not well documented. The aim of this paper is to describe the reality of a tertiary institution with a referral area of about 0,6 million habitants...
July 2017: Revista Portuguesa de Cirurgia Cardio-torácica e Vascular
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