-
Journal of Nippon Medical School =... Mar 2023Neuroprotection is important in open aortic arch surgery because of the dependence of brain tissues on cerebral perfusion. Therefore, several techniques have been... (Review)
Review
Neuroprotection is important in open aortic arch surgery because of the dependence of brain tissues on cerebral perfusion. Therefore, several techniques have been developed to reduce cerebral ischemia and improve outcomes in open aortic arch surgery. In this review, I describe various neuroprotective strategies, such as profound and deep hypothermic circulatory arrest, selective antegrade cerebral perfusion, retrograde cerebral perfusion, and lower body circulatory arrest; compare their advantages and disadvantages, and discuss their evolution and current status by reviewing relevant literature.
Topics: Humans; Aorta, Thoracic; Temperature; Neuroprotection; Circulatory Arrest, Deep Hypothermia Induced; Perfusion; Cerebrovascular Circulation; Hypothermia, Induced
PubMed: 35644556
DOI: 10.1272/jnms.JNMS.2023_90-103 -
Seminars in Vascular Surgery Jun 2023Thoracic aortic emergencies involving the aortic arch are potentially fatal conditions that require the entire surgical repertoire of conventional surgery, such as... (Review)
Review
Thoracic aortic emergencies involving the aortic arch are potentially fatal conditions that require the entire surgical repertoire of conventional surgery, such as complete aortic arch replacement using the frozen-elephant-trunk technique, through hybrid procedures, to full surgical endovascular options with conventional or delivered/fenestrated stent-grafts. An interdisciplinary aortic team should choose the optimal treatment of the pathologies of the aortic arch, considering the morphology of the entire aorta, from the root to beyond the bifurcation, as well as the clinical comorbidities. The treatment goal is a complication-free postoperative result and lasting freedom from aortic reinterventions. Irrespective of the selected therapy method, patients should then be connected to a specialized aortic outpatient clinic. The aim of this review was to provide an overview of pathophysiology and current treatment options in emergencies of the thoracic aorta, also involving the aortic arch. We wanted to summarize the preoperative considerations, intraoperative settings, and strategies, as well the postoperative follow-up.
Topics: Humans; Aorta, Thoracic; Blood Vessel Prosthesis; Emergencies; Blood Vessel Prosthesis Implantation; Aorta; Aortic Aneurysm, Thoracic; Treatment Outcome; Retrospective Studies; Stents
PubMed: 37330229
DOI: 10.1053/j.semvascsurg.2023.04.016 -
Brazilian Journal of Cardiovascular... Feb 2023Minimally invasive methods have become more preferred in cardiac surgery today. In this study, the comparative results of patients who underwent an aortic root, arch or...
INTRODUCTION
Minimally invasive methods have become more preferred in cardiac surgery today. In this study, the comparative results of patients who underwent an aortic root, arch or hemiarch replacement by ministernotomy and full sternotomy in our clinic are presented.
METHODS
Between January 2017 and October 2019, a series of operations including aortic root, ascending aorta, and aortic arch replacements were performed on 278 patients. The ministernotomy technique was used in 25 of them. Twenty patients who underwent full sternotomy were selected and matched to this group for comparison.
RESULTS
The ministernotomy group had a longer cross-clamping time (128.3±30.8 vs. 104.7±23.4 min, P=0.007) but the total operating time was similar in the two groups (249.76±28.56 vs. 248.25±37.53 min, P=0.879). The number of red blood cell (RBC) transfusions per patient was higher in the full sternotomy group (4.65±3.74 vs. 2.44±1.85 unit, P=0.020). The ministernotomy group had shorter ventilation times (7.60±4.88 vs. 32.30±32.25 h, P<0.001) and shorter ICU stay (1.56±0.58 vs. 3.35±1.46 d, P<0.001). The 30-day mortality was 0% in the ministernotomy group.
CONCLUSION
Early results of our study show that, in combined or isolated aortic root, ascending aorta, and aortic arch surgeries, ministernotomy can be applied with relatively safety and low mortality and morbidity rates.
Topics: Humans; Aorta, Thoracic; Treatment Outcome; Minimally Invasive Surgical Procedures; Aorta; Cardiac Surgical Procedures; Sternotomy; Retrospective Studies; Aortic Valve; Heart Valve Prosthesis Implantation
PubMed: 36112739
DOI: 10.21470/1678-9741-2021-0372 -
The Journal of Cardiovascular Surgery Jun 2022
Topics: Aortic Dissection; Aorta, Thoracic; Aortic Aneurysm, Thoracic; Humans; Treatment Outcome
PubMed: 35343662
DOI: 10.23736/S0021-9509.22.12332-3 -
The Journal of Thoracic and... Nov 2020
Topics: Aorta; Aorta, Thoracic; Humans; Loeys-Dietz Syndrome; Marfan Syndrome
PubMed: 32811678
DOI: 10.1016/j.jtcvs.2020.07.075 -
Seminars in Vascular Surgery Jun 2023The most important descending thoracic aortic (DTA) pathologies are aneurysms, dissections, and traumatic injuries. In acute settings, these conditions can constitute a... (Review)
Review
The most important descending thoracic aortic (DTA) pathologies are aneurysms, dissections, and traumatic injuries. In acute settings, these conditions can constitute a significant risk of bleeding or ischemia of vital organs, resulting in a fatal outcome. Morbidity and mortality associated with aortic pathologies remain significant, despite improvements in medical therapy and endovascular techniques. In this narrative review, we present an overview of the transitions in the management of these pathologies and discuss current challenges and future perspectives. Diagnostic challenges include differentiating between thoracic aortic pathologies and cardiac diseases. Efforts have been made to identify a blood test that can rapidly differentiate these pathologies. Computed tomography is the cornerstone of diagnosing thoracic aortic emergencies. Our understanding of DTA pathologies has improved substantially due to the significant advancement in imaging modalities in the last 2 decades. On the basis of this understanding, the treatment of these pathologies has been revolutionized. Unfortunately, robust evidence from prospective and randomized studies is still lacking for the management of most DTA diseases. Medical management plays a crucial role in achieving early stability during these life-threatening emergencies. This includes intensive care monitoring, heart rate and blood pressure control, and considering permissive hypotension for patients presenting with ruptured aneurysms. Over the years, surgical management of DTA pathologies changed from open repair to endovascular repair with dedicated stent-grafts. Techniques in both spectrums have improved substantially.
Topics: Humans; Blood Vessel Prosthesis; Aortic Aneurysm, Thoracic; Blood Vessel Prosthesis Implantation; Stents; Emergencies; Prospective Studies; Endovascular Procedures; Treatment Outcome; Aorta, Thoracic
PubMed: 37330228
DOI: 10.1053/j.semvascsurg.2023.04.009 -
European Journal of Internal Medicine Jun 2021
Topics: Aorta, Thoracic; Deglutition Disorders; Esophageal Stenosis; Humans
PubMed: 33771419
DOI: 10.1016/j.ejim.2021.03.011 -
Stroke and the Bovine Aortic Arch: Incidental or Deliberate? A Comparative Study and our Experience.Neurology India 2022We aimed to find the prevalence of bovine aortic arch in stroke and non-stroke patients and to study the relationship between bovine aortic arch and the occurrence of...
AIM AND OBJECTIVES
We aimed to find the prevalence of bovine aortic arch in stroke and non-stroke patients and to study the relationship between bovine aortic arch and the occurrence of stroke.
MATERIALS AND METHODS
One hundred patients with and without stroke underwent computed tomography (CT) angiography of the thoracic aorta and its arch. Fifty diffusion-weighted magnetic resonance imaging (MRI)-confirmed anterior circulation stroke patients who had undergone digital subtraction angiography (DSA) afterward formed the case group. As controls, another 50 patients who had thoracic CT angiograms for disease other than stroke during this time period were randomly selected. Demographics and prevalence of bovine arch were compared between cases and controls. In the case group, demographics and prevalence of bovine arch variants and their relationship to stroke were studied.
RESULTS
Prevalence of bovine aortic arch variant in anterior circulation stroke was 22%, compared to 6% in non-stroke patients (P = 0.043). The bovine aortic arch was associated with the younger onset of stroke occurrence (P = 0.046). In the bovine arch group, the proportion of left-sided strokes (P = 0.022) and bilateral strokes (P < 0.00001) was significantly higher. As compared to type A (P = 0.140), type B bovine aortic arch had a better association (P = 0.092).
CONCLUSIONS
Bovine aortic arch is a risk factor for young-onset anterior circulation stroke. Bilateral and left-sided infarcts were more common. Endovascular procedures are difficult to perform through conventional routes, so brachioradial access is preferred.
Topics: Aorta, Thoracic; Carotid Artery Diseases; Computed Tomography Angiography; Endovascular Procedures; Humans; Retrospective Studies; Risk Factors; Stroke
PubMed: 35532632
DOI: 10.4103/0028-3886.344630 -
Journal of Cardiothoracic Surgery Feb 2023Acute aortic dissection type A (AADA) is associated with high perioperative morbidity and mortality. A novel non-covered hybrid prosthesis (AMDS, CryoLife, Kennesaw,...
BACKGROUND
Acute aortic dissection type A (AADA) is associated with high perioperative morbidity and mortality. A novel non-covered hybrid prosthesis (AMDS, CryoLife, Kennesaw, USA) can be easily implanted to stabilize the true lumen. However, the role of AMDS for patients requiring additional aortic root surgery has not been described.
METHODS
Between 2010 and 2020 a total of n = 370 patients underwent surgery for AADA in our department. Of those, n = 120 underwent treatment for aortic root in addition to proximal arch replacement without resection of the aorta beyond the innominate artery (Control, n = 111) and were compared to patients who received additional AMDS implantation (AMDS, n = 9).
RESULTS
Aortic valve repair was performed in 48.6% (Control) and in 55.6% of AMDS patients. Cardiopulmonary bypass (Control: 248 ± 76 min, AMDS: 313 ± 53 min, P < 0.01) time as well as circulatory arrest time of the lower body (Control: 30 ± 15 min, AMDS: 52 ± 12 min, P < 0.01) was prolonged in the AMDS group. Nevertheless, postoperative in-hospital morbidity such as dialysis (Control: 22.4%, AMDS: 11.1%, P = 0.68) and stroke (Control: 17.0%, AMDS: 22.2%, P = 0.65) were comparable. In-hospital death (Control: 21.8%, AMDS: 11.1%, P = 0.68) and the compound end-point MACCE (Control: 38.7%, AMDS: 44.4%, P = 0.74) did also not differ.
CONCLUSIONS
Addressing the arch by implantation of AMDS prolongs cardiopulmonary bypass and circulatory arrest time, however without relevant impairments of short-term outcome. Combining root surgery with replacement of the proximal aortic arch and AMDS implantation seems feasible and safe as it did not impair the early postoperative outcome.
Topics: Humans; Aortic Aneurysm, Thoracic; Hospital Mortality; Dissection, Thoracic Aorta; Blood Vessel Prosthesis Implantation; Stents; Treatment Outcome; Aortic Dissection; Aorta, Thoracic; Retrospective Studies
PubMed: 36765394
DOI: 10.1186/s13019-023-02154-z -
Interactive Cardiovascular and Thoracic... Feb 2022Aortic arch type is a readily recognizable and obtainable morphological feature of the aorta that does not require complex measurements. The goal of this study was to...
OBJECTIVES
Aortic arch type is a readily recognizable and obtainable morphological feature of the aorta that does not require complex measurements. The goal of this study was to evaluate whether aortic arch type is a comparable and alternative morphological parameter for predicting acute type B aortic dissection (aTBAD) by comparing the prognostic value of the aortic arch type with that of other morphological parameters such as aortic length, angulation and tortuosity index.
METHODS
The patients with aTBAD (n = 216) were matched 1:1 with a control group (n = 263) by propensity score matching. The morphological data of the ascending aorta and the aortic arch, which included diameter, length, angulation and tortuosity index, were collected on a three-dimensional aortic model using 3mensio Vascular software. The aortic arch type was identified by the vertical distance from the origin of the brachiocephalic trunk to the top of the arch. The binary logistic regression models were analysed to determine the independent geometric variables related to the aTBAD. The nonparametric approach was performed to assess whether there were statistical differences between the area under the receiver operating characteristic curves (AUC) of the models.
RESULTS
After propensity score matching, 151 matched pairs of patients were selected. The diameters at the sinotubular junction and the mid-ascending aorta, the ascending aorta length and the ascending aorta angulation in the aTBAD group were significantly greater than those of the controls. Compared with the control group, the diameters at the proximal aortic arch, mid-aortic arch and distal aortic arch, the angulation and the tortuosity index of the aortic arch were significantly greater in the aTBAD group. The proportion of the type III arch in the patients with aTBAD is higher than that of the type I arch and the type II arch (χ2 = 70.187; P < 0.001). Binary logistic regression analysis showed that the diameter at the mid-aortic arch, the ascending aorta length, the aortic arch angulation and the tortuosity index were independently related to the aTBAD with an AUC value of 0.887. Another binary logistic regression analysis indicated that the diameter at the mid-aortic arch and the aortic arch type were independent correlative variables associated with the aTBAD with an AUC of 0.874. No significant difference was observed in the prognostic value of receiver operating characteristic curves between the 2 models (P = 0.716).
CONCLUSIONS
The type III arch, which has the characteristics of aortic elongation, incremental angulation and tortuosity index, is a comparable and alternative identifier for patients at high risk for aTBAD.
Topics: Aortic Dissection; Aorta; Aorta, Thoracic; Aortic Aneurysm, Thoracic; Blood Vessel Prosthesis Implantation; Brachiocephalic Trunk; Humans; Retrospective Studies
PubMed: 34935037
DOI: 10.1093/icvts/ivab359