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Cardiology in the Young Jul 2022There are several studies reporting the outcomes of hypoplastic aortic arch and aortic coarctation repair with combination of techniques. However, only few studies...
OBJECTIVES
There are several studies reporting the outcomes of hypoplastic aortic arch and aortic coarctation repair with combination of techniques. However, only few studies reported of aortic arch and coarctation repair using a homograft patch through sternotomy and circulatory arrest with retrograde cerebral perfusion. We report our experience and outcomes of this cohort of neonates and infants.
METHODS
We performed retrospective data collection for all neonates and infants who underwent aortic arch reconstruction between 2015 and 2020 at our institute. Data are presented as median and inter-quartile range (IQR).
RESULTS
The cohort included 76 patients: 49 were males (64.5%). Median age at operation was 16 days (IQR 9-43.25 days). Median weight was 3.5 kg (IQR 3.10-4 kg). There was no 30 days mortality. Three patients died in hospital after 30 days (3.95%), neurological adverse events occurred in only one patient (1.32%) and recurrent laryngeal nerve injury was noted in four patients (5.26%). Only three patients required the support of extracorporeal membrane oxygenation (ECMO) with a median ECMO run of 4 days. Median follow-up was 35 months (IQR 18.9-46.4 months); 5 years survival was 93.42% (n = 71). The rate of re-intervention on the aortic arch was 9.21% (n = 7).
CONCLUSION
Our experience shows excellent outcomes in repairing aortic arch hypoplasia with homograft patch under moderate to deep hypothermia with low in-hospital and 5 years mortality rates.
Topics: Aorta, Thoracic; Aortic Coarctation; Cardiac Surgical Procedures; Child; Female; Humans; Infant; Infant, Newborn; Male; Retrospective Studies; Treatment Outcome; Vascular Surgical Procedures
PubMed: 34521485
DOI: 10.1017/S1047951121003747 -
Journal of Cardiac Surgery May 2021
Topics: Aortic Dissection; Aorta, Thoracic; Aortic Aneurysm, Thoracic; Blood Vessel Prosthesis Implantation; Humans
PubMed: 33032367
DOI: 10.1111/jocs.15097 -
Innovations (Philadelphia, Pa.) 2022A patient with a history of surgery for type A acute aortic dissection was readmitted for aortic arch and descending aortic dissection with rupture at the isthmus and...
A patient with a history of surgery for type A acute aortic dissection was readmitted for aortic arch and descending aortic dissection with rupture at the isthmus and periaortic hematoma. Due to the high surgical risk, the aortic team chose an endovascular approach, and the patient successfully underwent emergency total arch exclusion with an off-the-shelf, bimodular, single-branch device. The main module was deployed in the aortic arch and in the brachiocephalic trunk, and the second module was deployed in the ascending aorta. Despite the good perioperative outcome with no cerebrovascular events, the patient died 20 days later because of sudden iliac rupture.
Topics: Aortic Dissection; Aorta, Thoracic; Aortic Aneurysm, Thoracic; Blood Vessel Prosthesis; Blood Vessel Prosthesis Implantation; Endovascular Procedures; Humans; Stents; Treatment Outcome
PubMed: 34970933
DOI: 10.1177/15569845211050388 -
The Journal of Thoracic and... Jun 2020
Topics: Aorta, Thoracic; Aortic Aneurysm, Thoracic; Blood Vessel Prosthesis Implantation; Heart Defects, Congenital; Humans
PubMed: 31014664
DOI: 10.1016/j.jtcvs.2019.03.086 -
Annual International Conference of the... Jul 2023Most cerebrovascular diseases (including strokes and aneurysms) are treated endovascularly with catheters that are navigated from the groin through the vessels to the...
Most cerebrovascular diseases (including strokes and aneurysms) are treated endovascularly with catheters that are navigated from the groin through the vessels to the brain. Many patients have complex anatomy of the aortic arch and supra-aortic vessels, which can make it difficult to select the best catheters for navigation, resulting in longer procedures and more complications or failures. To this end, we propose a framework dedicated to the analysis of the aortic arch and supra-aortic trunks. This framework can automatically compute anatomical and geometrical features from meshes segmented beforehand via CNN-based pipeline. These features such as arch type, tortuosity and angulations describe the navigational difficulties encountered during catheterization. Quantitative and qualitative validation was performed by experienced neuroradiologists, leading to reliable vessel characterization.Clinical relevance- This method allows clinicians to determine the type and the anatomy of the aortic arch and its supra-aortic trunks before endovascular procedures. This is essential in interventional neuroradiology, such as navigation with catheters in this complex area.
Topics: Humans; Blood Vessel Prosthesis Implantation; Stents; Treatment Outcome; Aorta; Aorta, Thoracic
PubMed: 38082844
DOI: 10.1109/EMBC40787.2023.10340921 -
Journal of Cardiac Surgery Sep 2022Kommerell's diverticulum (KD) is a rare congenital vascular abnormality due to the formation of an abnormal aortic arch, most commonly associated with dilatation at the...
Kommerell's diverticulum (KD) is a rare congenital vascular abnormality due to the formation of an abnormal aortic arch, most commonly associated with dilatation at the proximal part of the aberrant subclavian artery. This article describes an option of surgical treatment in a patient with KD. The proposed new technique of aortic arch surgical reconstruction with a stent-graft placement in the descending aorta reduces CPB time, aortic clamp and circulatory arrest time.
Topics: Aorta, Thoracic; Blood Vessel Prosthesis Implantation; Diverticulum; Heart Defects, Congenital; Humans; Subclavian Artery
PubMed: 35665965
DOI: 10.1111/jocs.16646 -
Academic Radiology Jul 2019Aortic arch (AA) variants and anomalies are important to recognize in patients with congenital heart disease (CHD) before surgery or intervention. The aim was to study...
RATIONALE AND OBJECTIVES
Aortic arch (AA) variants and anomalies are important to recognize in patients with congenital heart disease (CHD) before surgery or intervention. The aim was to study the prevalence of AA anomalies and variants in patients with CHD compared to a control group. The secondary outcome was to report the associations between common variations of AA and specific types of CHD.
MATERIALS AND METHODS
After institutional review board approval, computed tomography studies of 352 CHD patients and control group of 400 consecutive computed tomography scans of the thorax were evaluated. The AA was assigned to one of seven common types, and their distribution was compared between CHD and control. The distribution of the AA anomalies and variants was evaluated as regard specific types of CHD and the visceroatrial situs.
RESULTS
Normal three-vessel branching pattern was the commonest in both groups, but was present in only 50.5% in the CHD compared to 68.5% in the control group, p < 0.00001. Right AA and aberrant right subclavian artery were significantly more common in CHD than control group (18.1% versus 0.25%, p < 0.00001) and (4.5% versus 0.25%, p = 0.0001), respectively. Direct aortic origin of left vertebral artery was insignificantly more common in CHD group (4.2% versus 2.7%, p = 0.258). Brachiobicephalic trunk was significantly more common in control than CHD group (27.7% versus 19.3%, p = 0.007).
CONCLUSION
Normal three-vessel AA was significantly less common in CHD. AA anomalies (right arch and aberrant right subclavian) were more common in CHD than control, while AA variants (brachiobicephalic trunk and direct aortic origin of left vertebral artery) were not.
Topics: Aorta, Thoracic; Brachiocephalic Trunk; Cardiovascular Abnormalities; Case-Control Studies; Female; Heart Diseases; Humans; Infant; Male; Middle Aged; Subclavian Artery; Tomography, X-Ray Computed; Vertebral Artery
PubMed: 30266547
DOI: 10.1016/j.acra.2018.08.023 -
The Canadian Journal of Cardiology Jan 2023Total endovascular aortic arch repair (TEAAR) represents an emerging alternative for the treatment of aortic arch disease in patients at prohibitive risk for open... (Review)
Review
BACKGROUND
Total endovascular aortic arch repair (TEAAR) represents an emerging alternative for the treatment of aortic arch disease in patients at prohibitive risk for open surgery. A systematic review of TEAAR was performed to delineate early outcomes with this new technology.
METHODS
All studies (excluding single-patient case reports) of CE-certified "custom made" or "off-the-shelf" zone 0 stent graft deployments were included. The primary search of Medline, Embase, CINAHL, and the Cochrane CENTRAL registry was supplemented with searches of Web of Science, ClinicalTrials.gov, and conference abstracts (within last 3 years), and a hand search of citations within relevant articles. Articles underwent 2-stage screening by 2 independent reviewers before inclusion.
RESULTS
Fifteen relevant investigations were identified. Indications for TEAAR were chronic arch dissection with degenerative aneurysmal disease (54%, 148/273), pure arch aneurysm (41%, 112/273), penetrating atherosclerotic ulcer (2%, 5/273), and type IA endoleak from a zone 2 thoracic endograft (1%, 3/273). Double-branch (70%, 192/273), triple-branch (19%, 53/273), and single-branch (into innominate artery; 10%, 28/273) devices were used. Adjunct left carotid-subclavian bypass occurred in 90% of double- and single-branch procedures. Procedural success with TEAAR was 93% (95% CI 85.8%-96.3%). The proportion of all-cause mortality was 16% (95% CI 8%-26%), stroke 14% (8%-24%), peripheral vascular events 7% (1%-33%), and myocardial infarction 4% (2%-7%). Endoleaks were identified in 13% (7%-25%) of the study population.
CONCLUSIONS
TEAAR represents an emerging option for the management of aortic arch disease wth high procedural success rates and acceptable early outcomes in a high-risk patient population.
Topics: Humans; Aorta, Thoracic; Blood Vessel Prosthesis; Aortic Aneurysm, Thoracic; Blood Vessel Prosthesis Implantation; Aortic Dissection; Treatment Outcome; Endovascular Procedures; Stents; Retrospective Studies
PubMed: 36395997
DOI: 10.1016/j.cjca.2022.11.003 -
Anatomical Science International Jun 2024Variations in the arch of the aorta and aortic valves among fetal, cadaveric, and post-mortem specimens present a spectrum of anatomical configurations, posing...
Variations in the arch of the aorta and aortic valves among fetal, cadaveric, and post-mortem specimens present a spectrum of anatomical configurations, posing challenges in establishing a standard norm. While some variations hold surgical significance, many bear little functional consequence but provide insights into embryological origins. The aortic arch exhibits diverse branching patterns, including common trunks and different orders, relevant for endovascular surgeries. Meanwhile, malformations in the aortic valve, affecting the aorta, may lead to ischemia and cerebral infarction, warranting understanding of coexisting arch and valve anomalies to predict complications like aortic dissection. Studies in the Indian population mirror global variations, underscoring the need to explore embryological, clinical, and surgical implications for safer vascular surgeries involving the aortic arch and valves. The study's objectives included examining branching patterns, diameters, and distances between arch branches and exploring aortic valve variations. Employing a cross-sectional design, the study was conducted across Anatomy, Forensic Medicine, and Obstetrics and Gynecology departments. A sample of 100, comprising cadavers, fetuses, and postmortem specimens, were gathered. Specimens ranged from 14 weeks of intrauterine life to 85 years, with intact thoracic cages as inclusion criteria. Methodology involved dissection, specimen fixation, and macroscopic examination for variations and morphological parameters. Results showed aortic diameter increase with age, with significant gender differences. A statistically significant association between arch variations and anomalous valves was observed, suggesting mutual predictability. Individuals with valve anomalies should undergo comprehensive cardiology evaluation to avert complications like aortic dissection during endovascular surgeries. While atheromatous plaques were prevalent in younger groups, their frequency rose with age, necessitating vigilant vascular monitoring. Careful handling during surgeries is paramount, given potential adverse outcomes resulting from variations. Overall, the study underscores the importance of comprehensive anatomical understanding in clinical contexts, guiding effective management strategies and ensuring patient safety in vascular surgeries.
Topics: Humans; Female; Male; Aortic Valve; Aorta, Thoracic; Aged; Adult; Anatomic Variation; Cadaver; Middle Aged; Aged, 80 and over; Adolescent; Young Adult; Child; Infant; Child, Preschool; Fetus; Infant, Newborn; Cross-Sectional Studies
PubMed: 38758496
DOI: 10.1007/s12565-024-00777-3 -
Journal of Cardiovascular Medicine... Aug 2022Selective antegrade cerebral perfusion technique is a method of cerebral protection used worldwide during aortic arch surgery. This study was designed to identify a...
AIMS
Selective antegrade cerebral perfusion technique is a method of cerebral protection used worldwide during aortic arch surgery. This study was designed to identify a potential correlation between perfusion flows and the development of postoperative transient neurological dysfunctions.
METHODS
From January 2015 to May 2020, 175 patients underwent elective surgical replacement of the aortic arch using selective antegrade cerebral perfusion at the Cardiac Surgery Unit of Sant'Orsola Hospital in Bologna. Considering that patients who developed a permanent neurological dysfunction and those who died before a possible evaluation of neurological status were excluded, the study population included 160 patients. The perfusion flows were collected and analyzed. Univariate and multivariate analyses were performed to identify the statistical risk factors involved in the onset of transient neurological dysfunctions.
RESULTS
The study population was divided into two groups: 138 patients (86.3%) without and 22 (13.8%) with postoperative transient neurological complications. Among the intra-operative parameters collected in the study, the univariate analysis showed that the indexed medium perfusion flow of selective antegrade cerebral perfusion was significantly lower in the transient neurological dysfunctions group (11.63 ± 2.41 ml/kg/min vs 12.62 ± 2.39 ml/kg/min, P -value = 0.03). The multivariate logistic regression analysis showed that the female gender ( P = 0.004, OR = 4.816, IC = 1.636-14.174) was predictor of transient neurological dysfunctions.
CONCLUSION
The results of the study showed that lower perfusion flows seem to be related to a higher probability of developing transient neurological dysfunctions. However, the analysis of a wider population is required to confirm these preliminary data.
Topics: Aorta, Thoracic; Cerebrovascular Circulation; Female; Humans; Perfusion; Postoperative Complications; Retrospective Studies; Risk Factors; Treatment Outcome
PubMed: 35904991
DOI: 10.2459/JCM.0000000000001340