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Kardiologia Polska 2022
Topics: Aorta, Thoracic; Aortic Coarctation; Heart Septal Defects, Ventricular; Humans; Infant; Treatment Outcome
PubMed: 34981826
DOI: 10.33963/KP.a2022.0003 -
Annals of Surgery Jun 1984Aneurysm of the thoracic aorta is a serious form of disease because it may be extensive or associated with a more distant aneurysm. This manifestation occurs in about...
Aneurysm of the thoracic aorta is a serious form of disease because it may be extensive or associated with a more distant aneurysm. This manifestation occurs in about one-third of the cases. The actuarial 5-year survival of nontreated patients is only 13% with many patients dying from aortic rupture. The 5-year survival of our patients with aneurysm of the descending thoracic aorta treated by graft replacement is 58% with the two most common causes of late death being myocardial infarction and rupture of another aortic aneurysm. Effective treatment consists of initial total aortic examination, continued follow-up examination, and total replacement of disease. Aneurysmal disease that involves the entire aortic arch is especially prone to extensive involvement because it is due to diffuse aortic dissection or medial degenerative disease in most cases. The latter is most common, being present in 63 of our 81 patients requiring total arch replacement. The disease was extensive in all cases with degenerative medial disease and required extensive graft replacement. In fact, the entire thoracic aorta was involved in ten, the entire thoracic aorta and substantial segments of abdominal aorta in ten, and the entire aorta in 12 patients. Most of these patients were women (84%) over 65 years of age (63%) or older, ten (37%) were over 70 years. Associated pulmonary disease was frequent, aortic valvular insufficiency was present in 12 (38%), and symptoms were present in most. Treatment consisted of removing the disease when possible in stages, the arch in one and the remaining disease in another with the sequence and interval depending upon indications and condition of the patient. A total of 53 operations were performed in these 32 patients, the arch replaced in 29, the descending thoracic aorta in eight, and the thoracoabdominal aortic segment in 16 patients. All of the disease was replaced in 21, including the entire aorta in eight and incompletely replaced in 11 patients. Sixteen (76%) of the former are still alive 4 months to 6 1/3 years. Six (55%) of those in whom operation was limited to replacement of the symptomatic aortic segment because of limited risk are still alive. Of the ten deaths occurring during the study period, four (40%) and perhaps five (50%) were due to natural rupture of unresected disease which indicates its progressive nature and suggests the need for aggressive surgical treatment.
Topics: Adult; Aged; Aorta, Abdominal; Aorta, Thoracic; Aortic Aneurysm; Aortic Valve; Blood Vessel Prosthesis; Female; Follow-Up Studies; Heart Valve Diseases; Humans; Male; Middle Aged
PubMed: 6732315
DOI: 10.1097/00000658-198406000-00013 -
The Korean Journal of Internal Medicine Sep 2021
Topics: Aorta, Thoracic; Humans; Immunoglobulin G; Tomography, X-Ray Computed
PubMed: 33076635
DOI: 10.3904/kjim.2020.536 -
The Journal of Cardiovascular Surgery Jun 2023A modified aortic arch "island anastomosis" with a stent graft technique was used in 33 patients with acute type A aortic dissection. We retrospectively reviewed our...
BACKGROUND
A modified aortic arch "island anastomosis" with a stent graft technique was used in 33 patients with acute type A aortic dissection. We retrospectively reviewed our experience of this procedure and the short-term follow-up results.
METHODS
This retrospective analysis included 33 patients with acute type A aortic dissection undergoing the modified aortic arch island anastomosis with stent graft procedure. Postoperatively, computed tomography angiography images were obtained before discharge and at 12 months.
RESULTS
All patients underwent successful surgery without intraoperative death. Three patients received dialysis because of postoperative renal insufficiency, 1 patient received tracheotomy because of postoperative respiratory insufficiency, and 5 patients had postoperative delirium. Surgery caused stroke in 1 patient. No paraplegia was found, and no re-exploration for bleeding was performed. One patient died in the hospital due to multiple organ failure, and the other patients were discharged as expected. Only 1 patient had a proximal endoleak, and the patient was stable under close follow-up. The diameter of the descending thoracic aorta was smaller at 12 months postoperatively than preoperatively (34.5±2.5 mm versus 36.7±2.9 mm, P<0.05). The average diameter of the true lumen of the descending thoracic aorta was larger at 12 months postoperatively than preoperatively (24.1±3.1 mm versus 14.9±2.3 mm, P<0.05).
CONCLUSIONS
The modified aortic arch island anastomosis with stent graft technique is a feasible and safety surgical strategy for acute type A aortic dissection. Short-term outcomes are satisfactory.
Topics: Humans; Aorta, Thoracic; Retrospective Studies; Aortic Aneurysm, Thoracic; Blood Vessel Prosthesis Implantation; Treatment Outcome; Aortic Dissection; Stents; Anastomosis, Surgical
PubMed: 37078983
DOI: 10.23736/S0021-9509.23.12123-9 -
Medicina (Kaunas, Lithuania) Oct 2021The frozen elephant trunk technique (FET) requires the use of a pre-assembled hybrid prosthesis consisting of a standard Dacron vascular portion to replace the aortic...
The frozen elephant trunk technique (FET) requires the use of a pre-assembled hybrid prosthesis consisting of a standard Dacron vascular portion to replace the aortic arch and a stent graft component, which is placed into the proximal descending thoracic aorta (DTA) anterogradely in the proximal descending thoracic aorta. In Europe, two hybrid prostheses are available: the E-evita Open Plus hybrid stent graft system provided by JOTEC (Hechingen, Germany) and the ThoraflexTM Hybrid (Vascutek, Inchinnan Scotland). Recommendations for use are extensive pathologies of the arch in case of acute and chronic aortic dissection, degenerative aneurysm and intramural hematoma. The FET approach allows the replacement of the whole arch in one stage with the option of direct treatment of the proximal descending thoracic aorta based on the stent component, creating a safe landing zone for further endovascular treatment more distally. The remarkable feature of this technique is the possibility to perform more proximally (from zone 3 to zone 0) the distal anastomosis in to the arch. This allows for an easier distal anastomosis, reduced hypothermic circulatory arrest time and decreased risk of paraplegia (<5%). Early results are promising and according to the most recent series the rate of developing post-operative renal insufficiency ranges from 3 to 10%, the risk of stroke from 3% to 8% and mortality from 8-15%. The aim of the article will be to provide some knowledge about the use and application of FET procedures in different aortic situations.
Topics: Aortic Dissection; Aorta, Thoracic; Blood Vessel Prosthesis; Blood Vessel Prosthesis Implantation; Humans; Stents; Treatment Outcome
PubMed: 34684127
DOI: 10.3390/medicina57101090 -
The Journal of Thoracic and... Mar 2013The aim of this study was to assess the short-term and midterm results after hemi-aortic arch debranching for hybrid aortic arch repair by sequential transposition of...
OBJECTIVE
The aim of this study was to assess the short-term and midterm results after hemi-aortic arch debranching for hybrid aortic arch repair by sequential transposition of the left common carotid artery and of the left subclavian artery.
METHODS
From November 1998 to August 2011, 11 patients underwent a hybrid technique with supra-aortic debranching (by sequential transposition of the left common carotid artery and of the left subclavian) and simultaneous endovascular stent grafting for zone 1 lesions. There were 8 men and 3 women (mean age, 62.9 ± 20.9 years; range, 15-89 years). Aortic arch lesions treated included 4 complicated aortic dissections, 3 degenerative aneurysms, 2 postcoarctectomy aortic pseudoaneurysms, 1 mycotic aneurysm, and 1 traumatic transection of the arch. Four (36%) operations were performed in an emergency setting.
RESULTS
Endovascular exclusion success was achieved in 90.9% of the patients (type I endoleak: 1/11). One iliac artery rupture occurred intraoperatively. The 30-day mortality rate was 0%. Overall actuarial survival was 82% and 71.8% at 1 and 2 years. Mean follow-up is 31 ± 25 months (range, 3-72 months). No instance of permanent cerebral or spinal cord ischemia was observed. Two type II endoleaks are currently observed. There was no device migration.
CONCLUSIONS
Hybrid aortic arch repair by sequential transposition of the left common carotid artery and of the left subclavian artery for zone 1 lesions provides an attractive alternative for treating hemi-aortic arch lesions in high-risk patients with minimal atherosclerotic disease in the aorta and great vessels with acceptable primary results and encouraging midterm efficacy to prevent rupture. This hybrid strategy avoiding prosthetic bypass offers several advantages over conventional repair, including the potential to treat patients who are not candidates for open repair and single-stage treatment of some pathologic conditions previously requiring 2-stage repair.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Aorta, Thoracic; Aortic Diseases; Blood Vessel Prosthesis; Blood Vessel Prosthesis Implantation; Carotid Artery, Common; Female; Humans; Male; Middle Aged; Stents; Subclavian Artery; Tomography, X-Ray Computed; Treatment Outcome
PubMed: 22480885
DOI: 10.1016/j.jtcvs.2012.03.012 -
Journal of Visualized Experiments : JoVE Mar 2017Minimally invasive transverse aortic constriction (MTAC) is a more desirable method for the constriction of the transverse aorta in mice than standard open-chest...
Minimally invasive transverse aortic constriction (MTAC) is a more desirable method for the constriction of the transverse aorta in mice than standard open-chest transverse aortic constriction (TAC). Although transverse aortic constriction is a highly functional method for the induction of high pressure in the left ventricle, it is a more difficult and lengthy procedure due to its use of artificial ventilation with tracheal intubation. TAC is oftentimes also less survivable, as the newer method, MTAC, neither requires the cutting of the ribs and intercostal muscles nor tracheal intubation with a ventilation setup. In MTAC, as opposed to a thoracotomy to access to the chest cavity, the aortic arch is reached through a midline incision in the anterior neck. The thyroid is pulled back to reveal the sternal notch. The sternum is subsequently cut down to the second rib level, and the aortic arch is reached simply by separating the connective tissues and thymus. From there, a suture can be wrapped around the arch and tied with a spacer, and then the sternal cut and skin can be closed. MTAC is a much faster and less invasive way to induce left ventricular hypertension and enables the possibility for high-throughput studies. The success of the constriction can be verified using high-frequency trans-thoracic echocardiography, particularly color Doppler and pulsed-wave Doppler, to determine the flow velocities of the aortic arch and left and right carotid arteries, the dimension of the blood vessels, and the left ventricular function and morphology. A successful constriction will also trigger significant histopathological changes, such as cardiac muscle cell hypertrophy with interstitial and perivascular fibrosis. Here, the procedure of MTAC is described, demonstrating how the resulting flow changes in the carotid arteries can be examined with echocardiography, gross morphology, and histopathological changes in the heart.
Topics: Animals; Aorta, Thoracic; Carotid Arteries; Constriction, Pathologic; Disease Models, Animal; Echocardiography; Echocardiography, Doppler; Heart; Heart Failure; Heart Ventricles; Male; Mice; Mice, Inbred C57BL; Minimally Invasive Surgical Procedures; Ultrasonography, Doppler, Color; Vascular Surgical Procedures
PubMed: 28362400
DOI: 10.3791/55293 -
Pediatric Cardiology Dec 2021Left ventricular outflow tract obstruction is an important complication after interrupted aortic arch repair and subsequent interventions may adversely affect survival.... (Review)
Review
Left ventricular outflow tract obstruction is an important complication after interrupted aortic arch repair and subsequent interventions may adversely affect survival. Identification of patients at risk for obstruction is important to facilitate clinical decision-making and monitoring during follow-up. The aim of this review is to summarize reported risk factors for left ventricular outflow tract obstruction after corrective surgery for interrupted aortic arch. A systematic search of the literature was performed across the PubMed and EMBASE databases. Studies that reported echocardiographic and/or clinical predictors for left ventricular outflow tract obstruction in infants that underwent biventricular repair of interrupted aortic arch were included. From the 44 potentially relevant studies, eight studies met the inclusion criteria. Postoperative left ventricular outflow tract obstruction requiring an intervention was common, with an incidence ranging between 14 and 38%. Manifestation of postoperative left ventricular outflow tract obstruction was associated with a smaller pre-operative size of the aortic root (sinus of Valsalva), sinotubular junction, and aortic annulus. Anatomic and surgical risk factors for left ventricular outflow tract obstruction were the presence of an aberrant right subclavian artery, use of a pulmonary homograft or polytetrafluoroethylene interposition graft for aortic arch repair, and the presence of a small- or medium-sized ventricular septal defect. In patients with a borderline left ventricular outflow tract that undergo a primary repair, these (pre-) operative predictors can provide guidance for optimal surgical decision-making and for close monitoring during follow-up of patients at increased risk for developing left ventricular outflow tract obstruction after corrective surgery.
Topics: Aorta, Thoracic; Aortic Coarctation; Follow-Up Studies; Heart Defects, Congenital; Heart Septal Defects, Ventricular; Humans; Infant; Ventricular Outflow Obstruction
PubMed: 34338828
DOI: 10.1007/s00246-021-02689-9 -
The Journal of Thoracic and... Dec 2015
Comparative Study
Topics: Aorta, Thoracic; Aortic Diseases; Endovascular Procedures; Humans; Stents
PubMed: 26573344
DOI: 10.1016/j.jtcvs.2015.09.040 -
European Heart Journal Aug 2022
Topics: Aorta, Thoracic; Aortic Aneurysm; Aortic Aneurysm, Thoracic; Blood Vessel Prosthesis Implantation; Endovascular Procedures; Humans; Stents; Treatment Outcome
PubMed: 35706411
DOI: 10.1093/eurheartj/ehac326