Concomitant replacement of the aortic root and aortic arch with or without secondary thoracoabdominal aorta replacement

Background: The presence of a bicuspid aortic valve (BAV) might be associated with a progressive dilatation of the aortic root and ascending aorta. However, involvement of the aortic arch and descending aorta has not yet been elucidated. Patients and methods: Magnetic resonance angiography (MRA) was used to assess the diameter of the ascending aorta, aortic arch, and descending aorta in 28 patients with bicuspid aortic valves (mean age 30 ± 9 years). Results: Patients with BAV, but without significant aortic stenosis or regurgitation (n = 10, mean age 27 ± 8 years, n.s. versus control) were compared with controls (n = 13, mean age 33 ± 10 years). In the BAV-patients, aortic root diameter was 35.1 ± 4.9 mm versus 28.9 ± 4.8 mm in the control group (p < 0.01). The diameter of the ascending aorta was also significantly increased at the level of the pulmonary artery (35.5 ± 5.6 mm versus 27.0 ± 4.8 mm, p < 0.001). BAV-patients with moderate or severe aortic regurgitation (n = 18, mean age 32 ± 9 years, n.s. versus control) had a significant dilatation of the aortic root, ascending aorta at the level of the pulmonary artery (41.7 ± 4.8 mm versus 27.0 ± 4.8 mm in control patients, p < 0.001) and, furthermore, significantly increased diameters of the aortic arch (27.1 ± 5.6 mm versus 21.5 ± 1.8 mm, p < 0.01) and descending aorta (21.8 ± 5.6 mm versus 17.0 ± 5.6 mm, p < 0.01). Conclusions: The whole thoracic aorta is abnormally dilated in patients with BAV, particularly in patients with moderate/severe aortic regurgitation. The maximum dilatation occurs in the ascending aorta at the level of the pulmonary artery. Thus, we suggest evaluation of the entire thoracic aorta in patients with BAV.

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Management of infected dacron grafts in aortic root/aortic arch position with cryopreserved homografts

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-0029-1246951 ◽

2010 ◽

Vol 58 (S 01) ◽

Author(s):

N Khaladj ◽

S Peterss ◽

M Shrestha ◽

C Hagl ◽

A Haverich ◽

...

Keyword(s):

Aortic Arch ◽

Aortic Root

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Thoracoabdominal aorta replacement for a patient with Marfan syndrome with poor left ventricular function

JTCVS Techniques ◽

10.1016/j.xjtc.2021.01.022 ◽

2021 ◽

Author(s):

Masahiko Ando ◽

Haruo Yamauchi ◽

Yasuhiro Hoshino ◽

Minoru Ono

Keyword(s):

Left Ventricular Function ◽

Ventricular Function ◽

Marfan Syndrome ◽

Left Ventricular ◽

Thoracoabdominal Aorta ◽

Poor Left Ventricular Function ◽

Aorta Replacement

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Should the transverse aortic arch be replaced simultaneously with aortic root replacement for annuloaortic ectasia in marfan syndrome?

Journal of Thoracic and Cardiovascular Surgery ◽

10.1016/j.jtcvs.2004.01.009 ◽

2004 ◽

Vol 127 (5) ◽

pp. 1373-1380 ◽

Cited By ~ 24

Author(s):

Osamu Tagusari ◽

Hitoshi Ogino ◽

Junjiro Kobayashi ◽

Ko Bando ◽

Kenji Minatoya ◽

...

Keyword(s):

Aortic Arch ◽

Marfan Syndrome ◽

Aortic Root ◽

Aortic Root Replacement ◽

Annuloaortic Ectasia

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A case report of asymptomatic long-segmental aortic dissection diagnosed by transthoracic echocardiography

10.21203/rs.2.17293/v1 ◽

2019 ◽

Author(s):

Jiwei Wang ◽

Bin Lai ◽

Cai Yao ◽

Yongbing Wu ◽

Yanna Liu

Keyword(s):

Aortic Dissection ◽

Aortic Arch ◽

Aortic Root ◽

Transthoracic Echocardiography ◽

Aortic Rupture ◽

Target Organ Damage ◽

Common Symptom ◽

Descending Aorta ◽

Left Common Iliac Artery ◽

Cardiovascular Evaluation

Abstract Background: Aortic dissection (AD) is a life-threatening disease with high mortality rate. Severe pain in chest, back or abdomen is the most common symptom. Painless, but with a variety of other symptoms, also happened in some AD patients. Asymptomatic AD is exceptionally rare and often under-recognized. Case presentation: A 51-year-old man presented to cardiovascular department accompanied with an exaggerated low DBP and widened PP when measuring routine BP. Blood pressure was 124/36 mmHg (PP 88mmHg) in his right arm and 108/32 mmHg (PP 76mmHg) in his left arm. Transthoracic echocardiography was scheduled and showed that dissection intimal flaps are visualized in the aortic root, aortic arch and descending aorta. Subsequent CT angiography (CTA) was performed and demonstrated that a long-segmental AD occurred from aortic root to left common iliac artery. The patient underwent replacement of the aortic root, ascending aorta, and aortic arch with endovascular stent-graft placement into the descending aorta. At three months of follow-up, he was asymptomatic and with no signs of target organ damage. Conclusions: A careful TTE scan is particularly important for asymptomatic AD patient because it most likely as a routine imaging technique used for cardiovascular evaluation. If miss-diagnosed and under-recognized by clinician, untreated patients with prolonged dissection will become highly susceptible to an aortic rupture or ischemia to organs and leads to mortality.

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Ascending aorta and aortic root replacement in an infant: a case report

Patologiya krovoobrashcheniya i kardiokhirurgiya ◽

10.21688/1681-3472-2021-3-83-93 ◽

2021 ◽

Vol 25 (3) ◽

pp. 83

Author(s):

V. A. Mironenko ◽

V. S. Rasumovsky ◽

A. A. Svobodov ◽

S. V. Rychin

Keyword(s):

Carotid Artery ◽

Aortic Arch ◽

Subclavian Artery ◽

Aortic Root ◽

Common Carotid Artery ◽

Left Subclavian Artery ◽

Vascular Prosthesis ◽

Ascending Aorta ◽

Left Common Carotid Artery ◽

Brachiocephalic Trunk

We herein report the first clinical case of prosthetic replacement of the ascending aorta and aortic arch to repair a giant aneurysm in a 7-month-old child. The ascending aorta and arch replacement to the level of left subclavian artery was performed using a no. 16 Polymaille prosthesis, the brachiocephalic trunk was reimplanted into the vascular prosthesis and the kinked section of the left common carotid artery was removed, followed by reimplanting the left common carotid artery into the left subclavian artery. First, proximal anastomosis with the vascular prosthesis was created using a no. 16 Polymaille prosthesis and the vascular suture was strengthened with a Teflon strip. During circulatory arrest, the aortic arch was crossed between the orifice of the left common carotid artery and left subclavian artery, with the cut extended to the isthmus region along the small curvature of the arch. The brachiocephalic trunk was aligned and brought down, with subsequent implantation into the ascending aorta prosthesis 2 cm below the initial fixation point. In the final stage, the kinked section of the left common carotid artery was resected and the aligned left carotid artery was directly reimplanted into the left subclavian artery using end-to-side anastomosis. The patient developed tracheobronchitis and moderate heart failure during the postoperative period. The duration of mechanical ventilation was 16 hours. Infusion and antibacterial therapy were discontinued on postoperative day 8. On postoperative day 13, the patient was discharged and referred to the outpatient centre for further treatment and rehabilitation. A sufficiently large-sized prosthesis allows for further development in paediatric patients. This is facilitated by the preservation of the native aortic root with restored valve function and the formation of a bevelled distal anastomosis with a small unchanged aortic section in the isthmus region, which maintains growth potential. This first reported case of an infant demonstrates the possibility of combination interventions on the aortic arch and brachiocephalic artery during the first year of life.Received 30 January 2021. Revised 24 March 2021. Accepted 29 March 2021.Funding: The study did not have sponsorship.Conflict of interest: The authors declare no conflicts of interests.Contribution of the authors: The authors contributed equally to this article.

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P3111Empagliflozin, a SGLT2 inhibitor, attenuates endothelial dysfunction and atherogenesis by inhibiting inflammatory responses in the vasculature and adipose tissue in diabetic apolipoprotein E-deficient

European Heart Journal ◽

10.1093/eurheartj/ehz745.0186 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

B Ganbaatar ◽

D Fukuda ◽

S Yagi ◽

K Kusunose ◽

H Yamada ◽

...

Keyword(s):

Endothelial Dysfunction ◽

Apolipoprotein E ◽

Aortic Arch ◽

Atherosclerotic Plaque ◽

Aortic Root ◽

Untreated Group ◽

Lipid Deposition ◽

Underlying Mechanisms ◽

Inflammatory Molecules

Abstract Background Inflammation and oxidative stress associated with hyperglycemia are major causes of vascular dysfunction and cardiovascular complications in diabetes. Recent studies reported that cardioprotective effects of sodium glucose co-transporter 2 (SGLT2) inhibitors, however underlying mechanisms are still obscure. Purpose The aim of this study was to investigate whether empagliflozin attenuates atherogenesis and endothelial dysfunction in diabetic apolipoprotein E-deficient (ApoE−/−) mice and investigated underlying mechanisms. Methods ApoE−/− mice were injected with streptozotocin (75 mg/kg) for 3 consecutive days. One week after last injection, a western type diet and administration of empagliflozin (20 mg/kg/day) or vehicle via oral gavage were started. Atherosclerotic plaque area was examined by en face Sudan IV staining. Lipid deposition and inflammatory features of atherosclerotic plaques was examined on lesions in the aortic root by immunohistochemical analysis. Vascular function was assessed by isometric tension recording. mRNA or protein expression level was examined by quantitative RT-PCR (qPCR) or western blot analysis, respectively. In in vitro experiments, murine macrophage cell line, RAW264.7, was used. Results Treatment with empagliflozin for 12 weeks significantly decreased atherosclerotic plaque size in the aortic arch compared with untreated group (p<0.01). Empagliflozin reduced blood glucose (p<0.001) and plasma lipid levels. Results of histological analyses revealed that empagliflozin decreased lipid deposition, macrophage accumulation, and the expression of inflammatory molecules in the aortic root. Empagliflozin treatment for 8 weeks significantly attenuated endothelial dysfunction as determined by vascular response to acetylcholine. qPCR results demonstrated that empagliflozin reduced the expression of inflammatory molecules such as MCP-1 (p<0.05), ICAM-1 (p<0.05) and Nox-2 (p<0.05), a major NADPH oxidase subunit, in the aorta compared with the untreated group. Furthermore, empagliflozin significantly mitigated the expression of these inflammatory molecules in fat tissues around the aortic arch as determined by qPCR. In in vitro studies, methylglyoxal (MGO), a precursor of AGEs, increased the expression of inflammatory molecules (e.g., MCP-1, IL-1b and TNF-a (p<0.05, respectively)) in RAW264.7 cells. MGO also significantly induced activation of JNK and p38 MAP kinase (p<0.001, respectively) in this cell-type. Conclusions Empagliflozin attenuated endothelial dysfunction and atherogenesis in diabetic ApoE−/− mice. Reduction of inflammation in the vasculature and peri-vascular adipose tissues may have a role as underlying mechanisms at least partially.

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P6496Endovascular reconstruction from aortic valve to aortic arch by one-piece valved-fenestrated-bifurcated endografting in animal experiments

European Heart Journal ◽

10.1093/eurheartj/ehz746.1086 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

Z P Jing ◽

J X Feng ◽

X H Bao ◽

T Li ◽

Y Zhao ◽

...

Keyword(s):

Aortic Valve ◽

Aortic Arch ◽

Aortic Root ◽

Animal Experiments ◽

Proximal Part ◽

Minimal Invasive ◽

Left Ventricular ◽

Technical Success Rate

Abstract Aims The possibility of endovascular reconstruction of aortic valve, sinus of Valsalva, and ascending aorta by a minimal-invasive single endograft has not been proven in vivo. Combining our own long-term experiences from transcatheter aortic valve replacement (TAVR) and Thoracic Endovascular Repair (TEVAR) for ascending and arch dissection, we designed the special endo-graft: a novel one-piece valved-fenestrated-bifurcated endografting, and tried to endovascularly reconstruct the area from Left ventricular outflow tract to aortic arch in animal experiments. Methods and results For 20 healthy adult female pigs weighed between 62.3±2.2 kilograms, we did aortic compute tomography angiography (CTA) examinations and measured morphologic parameters of aortic root. Then we accordingly customized the valved-fenestrated-bifurcated endograft. The endograft was delivered through transapical access and endovascularly reconstructed the segment from aortic valve to proximal part of aortic arch. The overall technical success rate was 95% because of one case of delivery system failure. Instant transesophageal echography (TEE) and aortic CTA confirmed ideal position of the endograft, satisfactory function of aortic valve, and the patency of coronary arteries in all subjects. During follow-up, 12 subjects were sacrificed according to the plan and seven were followed up for 8.1±3.6 months. There was one unplanned death of cardiac infection (unplanned mortality: 5.3%). Follow-up re-examinations (aortic CTA, cardiac ultrasound, and electrocardiogram) found no adverse events. Among 12 sacrificed subjects, there was no evidence of fenestrations alignment lost and no myocardial ischemia according to the pathological analysis. Conclusion The novel one-piece valved-fenestrated-bifurcated endografting might be feasible for minimal-invasive reconstruction of aortic root in animal models, thus provided a prospect to simultaneously treat pathologies involving aortic valve and aortic root in endovascular way.

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Combined Fenestrated/Branched Endovascular Repair of the Aortic Arch and the Thoracoabdominal Aorta

European Journal of Vascular and Endovascular Surgery ◽

10.1016/j.ejvs.2019.09.343 ◽

2019 ◽

Vol 58 (6) ◽

pp. e772-e773

Author(s):

Nikolaos Tsilimparis ◽

Konstantinos Spanos ◽

Stephan Haulon ◽

Fiona Rohlffs ◽

Franziska Heidemann ◽

...

Keyword(s):

Aortic Arch ◽

Endovascular Repair ◽

Thoracoabdominal Aorta

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Stent erosion after treatment of coarctation of right-sided aorta and successful surgical management

European Journal of Cardio-Thoracic Surgery ◽

10.1093/ejcts/ezz281 ◽

2019 ◽

Vol 57 (5) ◽

pp. 1007-1008

Author(s):

Andreas Rukosujew ◽

Raluca Weber ◽

Bernd Kasprzak ◽

Angelo Maria Dell’Aquila

Keyword(s):

Aortic Arch ◽

Subclavian Artery ◽

Septal Defect ◽

Artery Bypass ◽

Previous History ◽

Second Step ◽

Descending Aorta ◽

History Of ◽

Aorta Replacement ◽

The Right

Abstract We present a case of surgical treatment of a pseudoaneurysm of the right-sided aortic arch after stent implantation for primary coarctation in a 36-year-old woman with a previous history of ventricle septal defect closure in early childhood. As a first step, she underwent a left carotid to subclavian artery bypass for an aberrant left subclavian artery and as a second step a ‘beating heart’ aortic arch and descending aorta replacement via resternotomy. The postoperative course was uneventful.

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