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Aortic arch replacement

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https://www.readbyqxmd.com/read/28797584/long-term-outcomes-of-frozen-elephant-trunk-for-type-a-aortic-dissection-in-patients-with-marfan-syndrome
#1
Wei-Guo Ma, Wei Zhang, Jun-Ming Zhu, Bulat A Ziganshin, Ai-Hua Zhi, Jun Zheng, Yong-Min Liu, John A Elefteriades, Li-Zhong Sun
OBJECTIVE: The use of the frozen elephant trunk (FET) technique for repair of type A aortic dissection (TAAD) in Marfan syndrome (MFS) is controversial. We seek to evaluate the efficacy of FET and total arch replacement (TAR) for TAAD in patients with MFS. METHODS: The early and long-term outcomes were analyzed for 106 patients with MFS (mean age, 34.5 ± 9.7 years) undergoing FET + TAR for TAAD. RESULTS: Operative mortality was 6.6% (7 of 106)...
June 16, 2017: Journal of Thoracic and Cardiovascular Surgery
https://www.readbyqxmd.com/read/28790269/-brain-protection-for-shaggy-aorta-during-aortic-arch-surgery
#2
Kenji Okada
Although short and long-term outcomes of aortic surgeries have been improving over the past decade, the procedure is likely to be asscociated with life-threatening complications such as neurological deficits caused by suboptimal brain protection or heavily diseased aorta. Contemporary strategies for brain protection are deep hypothermic arrest with or without retrograde cerebral perfusion retrograde cerebral perfusion or selective antegrade cerebral perfusion. At the moment, majority of evidences failed to show the superiority of selective antegrade cerebral perfusion to retrograde one...
July 2017: Kyobu Geka. the Japanese Journal of Thoracic Surgery
https://www.readbyqxmd.com/read/28790248/-concomitant-operations-for-thoracic-aortic-aneurysm-and-myasthenia-gravis-report-of-a-case
#3
Hayato Konishi, Takahiro Katsumata, Yoshikazu Motohashi, Hiroaki Uchida, Eiki Woo, Tomoyasu Sasaki, Shigetoshi Mieno, Hideki Ozawa, Masahiro Daimon, Shintaro Nemoto
A 77-year-old man, who had been under medical treatment for myasthenia gravis without thymoma, was diagnosed with aortic arch aneurysm. He underwent total aortic arch replacement and total resection of the thymus through median sternotomy. His symptoms relating to myasthenia gravis dramatically disappeared after the surgery. The serum anti-acetyl chorine receptor antibody decreased from 2.7 to 0.7 nmol/l (N<0.2) with the reduction of oral predonisolone from 12.5 to 5 mg/day at 4 years after the surgery. The concomitant operations significantly improved his quality of life...
August 2017: Kyobu Geka. the Japanese Journal of Thoracic Surgery
https://www.readbyqxmd.com/read/28780362/predictors-of-prolonged-mechanical-ventilation-in-adults-after-acute-type-a-aortic-dissection-repair
#4
Mu Jin, Wei-Guo Ma, Shiyao Liu, Junming Zhu, Lizhong Sun, Jiakai Lu, Weiping Cheng
OBJECTIVES: Prolonged mechanical ventilation (PMV) after surgical repair of acute type-A aortic dissection (ATAAD) is associated with an increased risk for mortality and morbidity. The goal of this study was to evaluate the influence of PMV on early and late outcomes and to identify the risk factors for PMV after ATAAD repair. DESIGN, SETTING, AND PARTICIPANTS: This study was a retrospective analysis of prospectively collected data, which resulted from a prior clinical trial...
March 28, 2017: Journal of Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/28760465/elective-aortic-arch-repair-factors-influencing-neurologic-outcome-in-791-patients
#5
Mariano Cefarelli, Giacomo Murana, Giuseppina G Surace, Sebastiano Castrovinci, Giuliano Jafrancesco, Johannes Christiaan Kelder, Patrick Klein, Uday Sonker, Wim J Morshuis, Robin H Heijmen
BACKGROUND: The aim of this study was to determine perioperative factors influencing neurologic outcome in a single-center cohort of patients undergoing elective aortic arch operations. METHODS: From January 2005 to June 2015, 791 consecutive patients received open aortic arch operations with either antegrade selective cerebral perfusion (ASCP) (636 patients [80.4%]) or deep hypothermic circulatory arrest (DHCA) (155 patients [19.6%]). Main indications were degenerative aneurysm (85%) and chronic postdissection aneurysm (9...
July 28, 2017: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/28759544/minimally-invasive-access-aortic-arch-surgery
#6
Nora Goebel, Daniel Bonte, Schahriar Salehi-Gilani, Ragi Nagib, Adrian Ursulescu, Ulrich F W Franke
OBJECTIVE: Median sternotomy is still the standard approach for aortic arch surgery. Minimally invasive techniques promise faster recovery with shorter hospital stay due to thoracic stability, reduced pain, and superior cosmetic results. However, safety is a concern in complex aortic surgery. The aim of our study was to demonstrate that aortic arch surgery via partial upper sternotomy is viable, safe, and equivalent to standard procedure both in terms of its safety and the risk of major adverse cardiac and cerebrovascular events...
July 28, 2017: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery
https://www.readbyqxmd.com/read/28758558/acute-debakey-type-i-dissection-repair-using-frozen-elephant-trunk-the-cleveland-clinic-technique
#7
Muhammad Aftab, Ryan Plichta, Eric E Roselli
Over the past 3 decades, the standard surgical management for acute DeBakey type I aortic dissection has not significantly changed. Most patients undergo ascending aortic replacement with an interposition graft under hypothermic circulatory arrest with selective root replacement. Nevertheless, with the improvement in overall patient care, acute surgical outcomes continue to improve. The frozen elephant trunk (FET) technique was introduced as a modification to conventional elephant trunk to treat extensive degenerative and chronic dissecting aneurysms involving the aortic arch and the proximal descending aorta...
September 2017: Seminars in Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/28740717/hybrid-repair-of-aortic-arch-aneurysms-a-comprehensive-review
#8
REVIEW
Steve Xydas, Christos G Mihos, Roy F Williams, Angelo LaPietra, Maurice Mawad, S Howard Wittels, Orlando Santana
Open total arch replacement (TAR) has become safer with refinements in cerebral protection techniques. The frequent extension of aortic arch aneurysms into the descending thoracic aorta customarily requires a two-staged conventional elephant trunk procedure, carrying relatively high mortality and morbidity risks and high rates of rupture in the interval between the two open surgeries. The technical demands and invasive nature of TAR has therefore precluded many high-risk patients from being surgical candidates for aneurysm repair...
June 2017: Journal of Thoracic Disease
https://www.readbyqxmd.com/read/28740694/successful-management-of-a-giant-dissecting-aortic-aneurysm-in-a-patient-with-behcet-s-disease
#9
Zhiqi Zhang, Kanhua Yin, Yi Lin, Changfa Guo, Yongxin Sun, Chunsheng Wang
Thoracic aortic aneurysm with subsequent dissection is a very rare but dangerous complication of Behcet's disease, which is a systemic syndrome that can involve blood vessels of all sizes. Surgical experience in dealing with this complication in patients with Behcet's disease has been limited. We report a 20-year-old patient with Behcet's disease who presented with a giant dissecting thoracic aortic aneurysm. The patient was successfully treated with an aortic root and arch replacement using a frozen elephant trunk technique...
June 2017: Journal of Thoracic Disease
https://www.readbyqxmd.com/read/28711965/efficacy-of-an-extracellular-matrix-in-systemic-loading-conditions-in-congenital-heart-surgery
#10
Adeel Ashfaq, Amit Iyengar, Oh Jin Kwon, Mohammad S Soroya, Son Nguyen, Ryan Ou, Brian Reemtsen
Extracellular matrices (ECM) are commonly used to repair congenital heart defects; however, there is a lack of literature pertaining to outcomes with ECM use in high-pressure conditions. Between 2011 and 2014, a total of 202 patients underwent congenital heart disease repair using the ECM placed in a systemic pressure condition. The operative sites included: defects in the ventricular septum, mitral valve, aortic valve, ascending aorta, and aortic arch. Patients were followed and evaluated for mortality and reoperations due to loss of ECM integrity...
July 15, 2017: Pediatric Cardiology
https://www.readbyqxmd.com/read/28705446/a-novel-sax-stent-method-in-treatment-of-ascending-aorta-and-aortic-arch-aneurysms-evaluated-by-finite-element-simulations
#11
M C Arokiaraj, M De Beule, G De Santis
OBJECTIVES: A novel stent method to simplify treatment of proximal ascending aorta and aortic arch aneurysms was developed and investigated by finite element analysis. Therapy of ascending aortic and aortic arch aneurysms is difficult and challenging and is associated with various complications. METHODS: A 55mm wide×120mm long stent was designed without the stent graft and the stent was deployed by an endovascular method in a virtual patient-specific aneurysm model...
February 2017: J Med Vasc
https://www.readbyqxmd.com/read/28698420/-intravascular-hemolysis-caused-by-stenosis-of-an-elephant-trunk-report-of-a-case
#12
Rikako Takamaru, Koji Kawahito, Kei Aizawa, Yoshio Misawa
Symptomatic intravascular hemolysis after prosthetic aortic graft replacement is rare. It is primarily attributed to mechanical injury of red blood cells caused by stenosis of the vascular graft. A 50-year-old man presented with hemolytic anemia, 5 years after total arch replacement with an elephant trunk for type A aortic dissection. The hemolysis was caused by graft stenosis of the elephant trunk. Endovascular treatment for the stenotic elephant trunk was successfully performed. The postoperative course was uneventful, and the hemolysis was resolved immediately after operation...
July 2017: Kyobu Geka. the Japanese Journal of Thoracic Surgery
https://www.readbyqxmd.com/read/28693049/hybrid-repair-techniques-for-complex-aneurysms-and-dissections-involving-the-aortic-arch-and-thoracic-aorta
#13
Rami Tadros, Scott R Safir, Peter L Faries, Daniel K Han, Sharif Ellozy, Rajiv K Chander, James F McKinsey, Michael L Marin, Allan S Stewart
Aortic aneurysms involving the ascending aorta, aortic arch, and descending thoracic aorta have been a challenging entity to surgically treat for over 60 years. Despite the mortality of the disease, early open surgical procedures also had significant morbidity and mortality. The inherent risk in treating multiple anatomic segments simultaneously led to the innovation of the staged elephant trunk (ET) approach by Borst in 1983. To avoid the thoracotomy and associated complications related to the second stage of the procedure, an endovascular completion paradigm was begun by Volodos in 1991...
July 25, 2017: Surgical Technology International
https://www.readbyqxmd.com/read/28689951/spot-stenting-of-supra-aortic-branch-vessels-for-residual-type-a-dissection
#14
Ciro Ferrer, Raffaele Grande, Luigi Venturini, Valerio Scarano Catanzaro, Gabriele Maritati, Luca di Marzo
of this report is to describe the exclusion of the false lumen in a residual type A aortic dissection (TAAD) by the deployment of two covered stents: one in the right common carotid artery (RCCA) and one in the left subclavian artery (LSA). A 77-year-old female, already treated with ascending aorta replacement for acute TAAD, was referred to our center for a 97-mm post-dissection arch aneurysm. A computed tomography angiography (CTA) showed false lumen patency by reperfusion from secondary tears located at level of RCCA and LSA...
July 6, 2017: Annals of Vascular Surgery
https://www.readbyqxmd.com/read/28683997/is-less-more-or-is-more-less
#15
EDITORIAL
Leonard N Girardi, Lucas B Ohmes
Although aortic hemiarch replacement without the use of deep hypothermic circulatory arrest may be feasible in experienced centers, manipulation of the aortic arch and great vessels is of concern. Additional research is necessary before widespread adoption of this technique.
April 2017: Seminars in Thoracic and Cardiovascular Surgery
https://www.readbyqxmd.com/read/28683996/an-alternative-technique-for-hemiarch-replacement-without-using-deep-hypothermic-circulatory-arrest
#16
Michael Scott Halbreiner, Michael Yamashita, Ryan Plichta, Lars G Svensson
We describe an alternate technique to perform a replacement of the aortic hemiarch without the need for hypothermic circulatory arrest by axillary cannulation and arch vessel isolation. In 2015, 3 patients underwent hemiarch reconstructions for ascending aortic aneurysms that extended into the arch. Each was performed using right axillary cannulation, isolation and clamping of the innominate artery with isolation, and tangential clamping of the aorta distal to the innominate. There were no neurologic events and no perioperative morbidity or mortality...
April 2017: Seminars in Thoracic and Cardiovascular Surgery
https://www.readbyqxmd.com/read/28683913/neuroprotection-strategies-in-aortic-surgery
#17
REVIEW
Edward J Bergeron, Matthew S Mosca, Muhammad Aftab, George Justison, Thomas Brett Reece
Neurologic injury is a potentially devastating complication of aortic surgery. The methods used in aortic surgery, including systemic cooling, initiation of circulatory arrest, and rewarming during the replacement of the aortic arch, are the most complex circulatory management and surgical procedures performed in modern-day surgery. Despite the plethora of published literature, neuroprotection in aortic surgery is largely based on observational studies and institutional-based practices. This article summarizes the current evidence and emerging strategies for neuroprotection in aortic arch operations...
August 2017: Cardiology Clinics
https://www.readbyqxmd.com/read/28683908/aortic-arch-pathology-surgical-options-for-the-aortic-arch-replacement
#18
REVIEW
Giorgio Zanotti, Thomas Brett Reece, Muhammad Aftab
Aortic arch surgery remains one of the most technically challenging procedures in cardiac surgery. It demands consideration of myocardial, brain, spinal cord, and lower body protection and rigorous surgical technique. Novel surgical approaches and refinements in brain and end organ protection strategies, liberal use of antegrade cerebral perfusion and moderate hypothermia have made arch repair safer. As endovascular technology and open surgical techniques evolve, aortic surgeons will need to continue to learn and incorporate these methods into practice in order to improve outcomes...
August 2017: Cardiology Clinics
https://www.readbyqxmd.com/read/28683905/acute-type-a-aortic-dissection
#19
REVIEW
Ramsey S Elsayed, Robbin G Cohen, Fernando Fleischman, Michael E Bowdish
Type A aortic dissection is a surgical emergency occurring when an intimal tear in the aorta creates a false lumen in the ascending aorta. Prompt diagnosis and surgical treatment are imperative to optimize outcomes. Surgical repair requires replacement of the ascending aorta with or without aortic root or aortic arch replacement. Surgical outcomes for this highly lethal diagnosis have improved, with contemporary survival to discharge at Centers of Excellence of 85% to 90%. Survival is related to prompt treatment, preexisting medical comorbidities, presence or absence of end organ malperfusion, extent of aortic repair required, and the development of postoperative complications...
August 2017: Cardiology Clinics
https://www.readbyqxmd.com/read/28673709/patient-tailored-aortic-root-repair-in-adult-marfanoid-patients-surgical-considerations-and-outcomes
#20
Paul P Urbanski, Atanas Jankulowski, Aleksandra Morka, Vadim Irimie, Xiaochun Zhan, Michael Zacher, Anno Diegeler
OBJECTIVE: The aim of the study was to evaluate the operative and functional results after individual, patient-tailored aortic root repair in marfanoid patients. METHODS: Among 518 patients who underwent operation between 2002 and January 2016, using patient-tailored aortic root repair with isolated sinus replacement, 42 patients fulfilled the original Ghent criteria. None/trivial, mild, moderate, and severe insufficiency grades were present in 5, 16, 10, and 11 patients, respectively...
June 13, 2017: Journal of Thoracic and Cardiovascular Surgery
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