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Aortic arch replacement

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https://www.readbyqxmd.com/read/28168983/changes-in-operative-strategy-for-patients-enrolled-in-the-international-registry-of-acute-aortic-dissection-interventional-cohort-program
#1
Neil Parikh, Santi Trimarchi, Thomas G Gleason, Arnoud V Kamman, Marco di Eusanio, Truls Myrmel, Amit Korach, Hersh Maniar, Takeyoshi Ota, Ali Khoynezhad, Daniel G Montgomery, Nimesh D Desai, Kim A Eagle, Christoph A Nienaber, Eric M Isselbacher, Joseph Bavaria, Thoralf M Sundt, Himanshu J Patel
OBJECTIVE: Advancements in cardiothoracic surgery prompted investigation into changes in operative management for acute type A aortic dissections over time. METHODS: One thousand seven hundred thirty-two patients undergoing surgery for type A aortic dissection were identified from the International Registry of Acute Aortic Dissection Interventional Cohort Database. Patients were divided into time tertiles (T) (T1: 1996-2003, T2: 2004-2010, and T3: 2011-2016). RESULTS: Frequency of valve sparing procures increased (T1: 3...
January 9, 2017: Journal of Thoracic and Cardiovascular Surgery
https://www.readbyqxmd.com/read/28165556/complicated-thoraco-abdominal-aortic-dissection-presenting-with-lower-limb-ischemia-in-a-patient-with-bovine-arch-and-arteria-lusoria
#2
G-R Joliat, C Dubuis, S Déglise
We report the case of a 58-year-old man who presented with thoraco-abdominal pain and right lower limb ischemia due to type B aortic dissection. Moreover, the patient was discovered to have several concomitant aortic arch anomalies (bovine arch, arteria lusoria, and left vertebral artery arising from the aortic arch). Taking into account this complex anatomy, emergent femoral exploration with fenestration and thrombectomy was performed. The blood flow to the right lower limb was restored. A few days later the aortic dissection spread proximally, and the aortic arch dilatation enlarged...
January 2017: European Review for Medical and Pharmacological Sciences
https://www.readbyqxmd.com/read/28163181/treatment-of-an-aortic-arch-aneurysm-with-scalloped-and-fenestrated-thoracic-stent-graft-and-left-carotid-to-subclavian-artery-bypass
#3
Cheow Soon Chia, Luke Tay Hsien Tsung, John Wang Chaw Chian, Tze Tec Chong, Kiang Hiong Tay, Edward Choke Tieng Chek
We report a successful treatment of thoracic arch aneurysm using a combination of hybrid approach and a customized stent graft in a frail patient with challenging anatomy and concomitant large retrosternal goiter. The patient is an 82-year-old lady with multiple comorbidities who presented to her general practitioner for anorexia and significant weight loss. She was incidentally found to have a 6.6 cm saccular distal aortic arch aneurysm, a 5.5 cm infrarenal abdominal aortic aneurysm, and a large goiter adjacent to the left common carotid artery with retrosternal extension...
February 2, 2017: Annals of Vascular Surgery
https://www.readbyqxmd.com/read/28134010/noteworthy-cardiac-surgical-literature-2016
#4
Muhammad Aftab, Joseph C Cleveland, T Brett Reece
Cardiac surgical care of patients continued to evolve rapidly in 2016. In this article, 3 topics of considerable change are discussed based on recent publications. The first topic reviews the potential risks and benefits of newly instituted low-risk percutaneous aortic valve replacement. The second topic reviews the increasing utilization of more extensive arch replacements in acute type A dissection. The final topic reviews current trends and justification for changes in patterns of use of cardioplegia options...
January 1, 2017: Seminars in Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/28131431/the-standardized-concept-of-moderate-to-mild-%C3%A2-28%C3%A2-c-systemic-hypothermia-during-selective-antegrade-cerebral-perfusion-for%C3%A2-all-comers-in-aortic-arch-surgery-single-center-experience-in-587-consecutive-patients-over-a-15-year-period
#5
Ali El-Sayed Ahmad, Nestoras Papadopoulos, Petar Risteski, Anton Moritz, Andreas Zierer
BACKGROUND: Whether selective antegrade cerebral perfusion (ACP) during moderate-to-mild systemic hypothermia (≥28°C) is applicable to aortic arch surgery without restrictions including the emergency setting of an acute type A aortic dissection or extensive total arch procedures such as elephant and frozen elephant trunk techniques is an ongoing subject of controversy. METHODS: Between January 2000 and January 2015, 587 consecutive all-comers underwent aortic arch surgery at our institution uniformly applying selective ACP (unilateral: n = 393 [67%]; bilateral: n = 194 [33%]) during moderate-to-mild systemic hypothermia (28...
January 25, 2017: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/28119407/blood-flow-competition-after-aortic-valve-bypass-an-evaluation-using-computational-fluid-dynamics
#6
Koji Kawahito, Naoyuki Kimura, Kenji Komiya, Masanori Nakamura, Yoshio Misawa
OBJECTIVES: Aortic valve bypass (AVB) (apico-aortic conduit) remains an effective surgical alternative for patients in whom surgical aortic valve replacement or transcatheter aortic valve implantation is not feasible. However, specific complications include thrombus formation, possibly caused by stagnation arising from flow competition between the antegrade and retrograde flow, but this has not been fully investigated. The aim of this study was to analyse flow characteristics after AVB and to elucidate mechanisms of intra-aortic thrombus using computational fluid dynamics (CFD)...
January 24, 2017: Interactive Cardiovascular and Thoracic Surgery
https://www.readbyqxmd.com/read/28109683/incidence-and-risk-factors-of-delirium-in-patients-after-type-a-aortic-dissection-surgery
#7
Zhengqin Liu, Xinyan Pang, Xiquan Zhang, Guangqing Cao, Changcun Fang, Shuming Wu
OBJECTIVE: To study the incidence and related risk factors for postoperative delirium after type-A aortic dissection in patients who underwent Sun's procedure (total arch replacement using a tetrafurcate graft with stented elephant trunk implantation). DESIGN: A retrospective study. SETTING: A cardiac surgical intensive care unit. PARTICIPANTS: The study comprised 100 patients admitted to the intensive care unit for type-A aortic dissection...
November 3, 2016: Journal of Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/28109395/hybrid-repair-of-ruptured-arch-aneurysm-without-sternotomy-through-an-unusual-extraanatomic-bypass
#8
Chung-Lin Tsai, Chih-Chun Yang, Takuya Fujikawa, Shih-Rong Hsieh
A 42-year-old man experienced a complex aortic arch aneurysm rupture. He had previously undergone an operation for type A dissection and had extremely poor cardiac performance as well as deep sternal infection after the first procedure. The conventional open repair was considered to be a high risk for this patient. We therefore performed an alternative hybrid aortic procedure. The supraarch vessels were perfused through an extraanatomic bypass from an unusual and remote route, namely, the abdominal aorta. Then, stent grafts were implanted in the previously replaced aortic prostheses to exclude the aortic aneurysm...
February 2017: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/28109393/a-modified-and-less-invasive-procedure-in-aortic-arch-replacement
#9
Feng Gao, Jing Chen, Qian Zeng, Fangming Lin
Circulation arrest is widely used during total aortic arch replacement. However, the conventional procedures have high morbidity and mortality. We modified the hybrid procedure by optimizing the sequence of anastomosis between the graft and aorta. As a result, the time of extracorporeal circulation was obviously shortened, and cardiac arrest was needed only during the two anastomoses of the aorta with aorta graft main body. In addition, both circulation arrest and deep hypothermia were avoided. Leakage was also prevented by creating a lengthened sealing zone for stent graft deployment...
February 2017: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/28109377/antineutrophil-cytoplasmic-antibody-associated-multiple-giant-saccular-aortic-aneurysms
#10
Ryoji Kinoshita, Tomohiro Mizuno, Tsuyoshi Hachimaru, Keiji Oi, Masafumi Yashima, Eiki Nagaoka, Tatsuki Fujiwara, Hidehito Kuroki, Dai Tasaki, Hirokuni Arai
We describe a very rare case of a 67-year-old man with multiple saccular aortic aneurysms throughout the entire aorta due to antineutrophil cytoplasmic antibody-associated vasculitis (AAV). The patient underwent staged aortic surgical procedures, including stent-graft insertion for a left iliac artery aneurysm, thoracic endovascular aortic repair for a descending aortic aneurysm, and total replacement of the ascending aorta and aortic arch with the use of high-dose steroids to control inflammation. The histologic findings demonstrated that the damage to the vasa vasorum of the adventitia resulting from AAV caused ischemia of the media, resulting in the formation of saccular aneurysmal changes...
February 2017: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/28109108/-brachiocephalic-artery-sparing-aortic-arch-repair-combined-with-stent-graft-elephant-trunk-technique-for-stanford-type-a-aortic-dissection-analysis-of-23-cases
#11
Song-Lin DU, Jun Wan, Wu-Jun Wang, Kai-Can Cai, Ya-Xiang Liu, Xiang-Hui Mao
OBJECTIVE: To assess the clinical outcomes of brachiocephalic artery-sparing aortic arch repair combined with stent-graft elephant trunk technique for treatment of Stanford type A aortic dissection. METHODS: Twenty-three patients with Stanford type A aortic dissection requiring arch replacement underwent brachiocephalic artery-sparing aortic arch repair combined with stent-graft elephant trunk technique. The operations were performed within 72 h (20 cases) or 3-14 days (3 cases) after the onset of aortic dissection...
January 20, 2017: Nan Fang Yi Ke da Xue Xue Bao, Journal of Southern Medical University
https://www.readbyqxmd.com/read/28108567/role-of-the-frozen-elephant-trunk-procedure-for-chronic-aortic-dissection
#12
Eric E Roselli, Faisal G Bakaeen, Douglas R Johnston, Edward G Soltesz, Michael Z Tong
OBJECTIVES: Considering the chronic and progressive nature of aortic dissection, operative planning must anticipate the need for later interventions. We have increasingly used a modified version of the frozen elephant trunk repair operation to treat these patients. We review the indications, considerations for planning, and important operative details for performing frozen elephant trunk repair for chronic aortic dissection. METHODS: Frozen elephant trunk repair is performed using selective antegrade brain perfusion, direct placement of commercially available stent grafts with suture fixation in the aortic arch, and proximal aortic replacement...
January 2017: European Journal of Cardio-thoracic Surgery
https://www.readbyqxmd.com/read/28108566/total-aortic-arch-replacement-with-the-frozen-elephant-trunk-procedure-in-acute-debakey-type-i-aortic-dissections
#13
Malakh Shrestha, Axel Haverich, Andreas Martens
OBJECTIVES: In patients with acute aortic dissection involving the arch and the descending aorta (AADA DeBakey type I), performing a total aortic arch replacement with the frozen elephant trunk (FET) procedure for supposedly better long-term results is still controversial. METHODS: From February 2004 to April 2016, 94 patients with AADA DeBakey type I had an FET procedure (80% men, age 58 ± 12 years). During the early period (Group 1, 2004-10), the FET technique was performed using non-branched grafts...
January 2017: European Journal of Cardio-thoracic Surgery
https://www.readbyqxmd.com/read/28108564/technical-details-making-aortic-arch-replacement-a-safe-procedure-using-the-thoraflex%C3%A2-hybrid-prosthesis
#14
REVIEW
Martin Czerny, Bartosz Rylski, Fabian A Kari, Maximilian Kreibich, Julia Morlock, Johannes Scheumann, Stoyan Kondov, Michael Südkamp, Matthias Siepe, Friedhelm Beyersdorf
SummaryThe development of new devices to improve treatment and to explore new indications that have not yet been adequately addressed is a natural consequence of the clinical demand for solutions to as yet unmet needs. The frozen elephant trunk technique was one of the major steps within the last 15 years to improve on existing treatments as well as to explore new indications. The goal of this article is to provide technical details about advances in implantation techniques for the treatment of acute and chronic thoracic aortic pathological conditions...
January 2017: European Journal of Cardio-thoracic Surgery
https://www.readbyqxmd.com/read/28108563/patient-management-in-aortic-arch-surgery%C3%A2
#15
REVIEW
Sven Peterss, Maximilian Pichlmaier, Alexander Curtis, Maximilian Luehr, Frank Born, Christian Hagl
SummaryAortic arch surgery requires complex patient management beyond the manual replacement of the diseased vessel. These procedures include (i) a thorough and pathologically adjusted preoperative evaluation, (ii) initiation and control of cardiopulmonary bypass, (iii) cerebral protection strategies and (iv) techniques to protect the abdominal end organs during prolonged operations. Due to the complexity of aortic arch procedures, multimodal real-time surveillance is required during all stages of the operation...
January 2017: European Journal of Cardio-thoracic Surgery
https://www.readbyqxmd.com/read/28105641/innominate-artery-cannulation-for-arterial-perfusion-during-aortic-arch-surgery
#16
Gaku Uchino, Keiji Yunoki, Naoya Sakoda, Munehiro Saiki, Kunikazu Hisamochi, Hideo Yoshida
OBJECTIVE: Antegrade cerebral perfusion during aortic arch surgery plays an important role in improving postoperative neurological outcomes. We report our experience using innominate artery cannulation for arterial perfusion during aortic arch surgery. METHODS: From January 2008 to December 2015, 159 patients underwent aortic arch surgery using innominate artery perfusion and were included in the study analysis (mean age, 71.4 ± 9.1 years; male, 120). RESULTS: Total arch replacement was performed in 84...
January 20, 2017: Journal of Cardiac Surgery
https://www.readbyqxmd.com/read/28100966/total-arch-versus-hemiarch-replacement-for-type-a-acute-aortic-dissection-a-single-center-experience
#17
Antonio Lio, Francesca Nicolò, Emanuele Bovio, Andrea Serrao, Jacob Zeitani, Antonio Scafuri, Luigi Chiariello, Giovanni Ruvolo
We retrospectively evaluated early and intermediate outcomes of aortic arch surgery in patients with type A acute aortic dissection (AAD), investigating the effect of arch surgery extension on postoperative results. From January 2006 through July 2013, 201 patients with type A AAD underwent urgent corrective surgery at our institution. Of the 92 patients chosen for this study, 59 underwent hemiarch replacement (hemiarch group), and 33 underwent total arch replacement (total arch group) in conjunction with ascending aorta replacement...
December 2016: Texas Heart Institute Journal
https://www.readbyqxmd.com/read/28076961/total-arch-replacement-through-a-median-sternotomy-for-kommerell-s-diverticulum
#18
Yoshihiro Goto, Yutaka Koyama, Soh Hosoba, Shinji Ogawa, Shunsuke Fukaya, Yasuhide Okawa
Kommerell's diverticulum with a right aortic arch and aberrant left subclavian artery is a rare anomaly, and the optimal operative strategy has not yet been established. In particular, the approach to the diverticulum is controversial, with the greatest concern being whether or not to add a right thoracotomy to the median sternotomy for distal anastomosis. We successfully performed total arch replacement through a median sternotomy only, by referring to preoperative computed tomography. We think that if the aneurysm is in a shallow position from the tracheal bifurcation, total arch replacement is possible with a midline incision only...
January 1, 2017: Asian Cardiovascular & Thoracic Annals
https://www.readbyqxmd.com/read/28043468/outcomes-of-truncus-arteriosus-repair-in-children-35-years-of-experience-from-a-single-institution
#19
Phillip S Naimo, Tyson A Fricke, Matthew S Yong, Yves d'Udekem, Andrew Kelly, Dorothy J Radford, Andrew Bullock, Robert G Weintraub, Christian P Brizard, Igor E Konstantinov
We evaluated the long-term outcomes following repair of truncus arteriosus (TA) from a single institution. We conducted a retrospective review of children (n = 171) who underwent TA repair between 1979 and 2014. Early mortality rate was 11.7% (20/171). There were 19 late deaths. Most deaths (74%, 29/39) occurred within the first year following surgery. The 1-year mortality rate in 1979-2004 was 18% (25/136) and decreased to 11% (4/35) in 2005-2014. The overall survival rate was 73.6% at 30 years. Multivariate analysis identified postoperative extracorporeal membrane oxygenation (P = 0...
July 2016: Seminars in Thoracic and Cardiovascular Surgery
https://www.readbyqxmd.com/read/28040765/classification-and-outcomes-of-extended-arch-repair-for-acute-type-a-aortic-dissection-a-systematic-review-and-meta-analysis
#20
REVIEW
Holly N Smith, Munir Boodhwani, Maral Ouzounian, Richard Saczkowski, Alexander J Gregory, Eric J Herget, Jehangir J Appoo
OBJECTIVES: Distal extent of repair in patients undergoing surgery for acute Type A aortic dissection (ATAAD) is controversial. Emerging hybrid techniques involving open and endovascular surgery have been reported in small numbers by select individual centres. A systematic review and meta-analysis was performed to investigate the outcomes following extended arch repair for ATAAD. A classification system is proposed of the different techniques to facilitate discussion and further investigation...
December 31, 2016: Interactive Cardiovascular and Thoracic Surgery
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