Dissection of an allograft ascending aorta after aortic root replacement

1996 ◽  
Vol 61 (3) ◽  
pp. 1011-1012 ◽  
Author(s):  
Julian A. Smith ◽  
Timothy C. McKenzie ◽  
Bruce B. Davis
Keyword(s):  
Aortic Root ◽  
Ascending Aorta ◽  
Aortic Root Replacement

scholarly journals Geometric changes in aortic root replacement using Freestyle prosthesis

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Anja Osswald ◽  
Alina Zubarevich ◽  
Arian Arjomandi Rad ◽  
Robert Vardanyan ◽  
Konstantin Zhigalov ◽  
...  
Keyword(s):  
Aortic Root ◽  
Ascending Aorta ◽  
Aortic Root Replacement ◽  
Aortic Annulus ◽  
Strongly Correlated ◽  
Root Volume ◽  
Concomitant Surgery ◽  
Valve Size ◽  
Operative Planning ◽  
Geometric Changes

Abstract Background The Medtronic Freestyle prosthesis has proven to be a promising recourse for aortic root replacement in various indications. The present study aims to evaluate clinical outcomes and geometric changes of the aorta after Freestyle implantation. Methods Between October 2005 and November 2020, the computed tomography angiography (CTA) data of 32 patients were analyzed in a cohort of 68 patients that underwent aortic root replacement using Freestyle prosthesis. The minimum and maximum diameters and areas of the aortic annulus, aortic root, ascending aorta, and the proximal aortic arch were measured at a plane perpendicular to the long axis of the aorta using 3D multiplanar reconstruction in both the preoperative (n = 32) and postoperative (n = 10) CTAs. Moreover, volumetric changes of the aortic root and ascending aorta were quantified. Results Mean age was 64.6 ± 10.6 years. Indications for surgery using Freestyle prosthesis were combined aortic valve pathologies, aortic aneurysm or dissection, and endocarditis, with concomitant surgery occurring in 28 out of 32 patients. In-hospital mortality was 18.6%. Preoperative diameter and area measurements of the aortic annulus strongly correlated with the implanted valve size (p < 0.001). Bicuspid valve was present in 28.1% of the patients. Diameter and areas of the aortic root decreased after freestyle implantation, resulting in a reduction of the aortic root volume (45.6 ± 26.3 cm3 to 18.7 ± 4.5 cm3, p = 0.029). Volume of the aortic root and the ascending aorta decreased from 137.3 ± 65.2 cm3 to 54.5 ± 21.1 cm3 after Freestyle implantation (p = 0.023). Conclusion Implantation of the Freestyle prosthesis presents excellent results in restoring the aortic geometry. Preoperative CTA measurements are beneficial to the surgical procedure and valve selection and therefore, if available, should be considered in pre-operative planning.

scholarly journals The use of innominate artery cannulation for antegrade cerebral perfusion in aortic dissection

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Eden C. Payabyab ◽  
Jonathan M. Hemli ◽  
Allan Mattia ◽  
Alex Kremers ◽  
Sohrab K. Vatsia ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Aortic Root ◽  
Cerebral Perfusion ◽  
Innominate Artery ◽  
Type A ◽  
Ascending Aorta ◽  
Aortic Root Replacement ◽  
Artery Cannulation ◽  
Selective Antegrade Cerebral Perfusion ◽  
Antegrade Cerebral Perfusion

Abstract Background Direct cannulation of the innominate artery for selective antegrade cerebral perfusion has been shown to be safe in elective proximal aortic reconstructions. We sought to evaluate the safety of this technique in acute aortic dissection. Methods A multi-institutional retrospective review was undertaken of patients who underwent proximal aortic reconstruction for Stanford type A dissection between 2006 and 2016. Those patients who had direct innominate artery cannulation for selective antegrade cerebral perfusion were selected for analysis. Results Seventy-five patients underwent innominate artery cannulation for ACP for Stanford Type A Dissections. Isolated replacement of the ascending aorta was performed in 36 patients (48.0%), concomitant aortic root replacement was required in 35 patients (46.7%), of whom 7 had a valve-sparing aortic root replacement, ascending aorta and arch replacement was required in 4 patients (5%). Other procedures included frozen elephant trunk (n = 11 (14.7%)), coronary artery bypass grafting (n = 20 (26.7%)), and peripheral arterial bypass (n = 4 (5.3%)). Mean hypothermic circulatory arrest time was 19 ± 13 min. Thirty-day mortality was 14.7% (n = 11). Perioperative stroke occurred in 7 patients (9.3%). Conclusions This study is the first comprehensive review of direct innominate artery cannulation through median sternotomy for selective antegrade cerebral perfusion in aortic dissection. Our experience suggests that this strategy is a safe and effective technique compared to other reported methods of cannulation and cerebral protection for delivering selective antegrade cerebral perfusion in these cases.

scholarly journals Development of Multiple Aortic Mycotic Aneurysms After Cardiac Catheterization

2017 ◽  
Vol 5 (4) ◽  
pp. 232470961774090
Author(s):  
Desiree A. Steimer ◽  
John J. Squiers ◽  
J. Michael DiMaio ◽  
Katherine B. Harrington
Keyword(s):  
Cardiac Catheterization ◽  
Aortic Root ◽  
Coronary Artery Bypass Surgery ◽  
Bypass Surgery ◽  
Artery Bypass ◽  
Ascending Aorta ◽  
Aortic Root Replacement ◽  
Past Medical History ◽  
History Of ◽  
Mycotic Aneurysms

A 71-year-old male with a past medical history of coronary artery bypass surgery developed multiple, infected pseudoaneurysms of the ascending aorta and aortic root 1 year after cardiac catheterization. He underwent aortic root replacement with a 24-mm homograft. Tissue culture from operative specimens revealed invasive Aspergillus fumigatus infection. He was treated with voriconazole for 3 months. After 1 year, he had no recurrence of symptoms, pseudoaneurysm, or fungal infection.

scholarly journals Transfusion in Elective Proximal Aortic Reconstruction: Where Do We Currently Stand?

2021 ◽  
Author(s):  
Stevan S. Pupovac ◽  
Jonathan M. Hemli ◽  
S Jacob Scheinerman ◽  
Alan R. Hartman ◽  
Derek R. Brinster
Keyword(s):  
Aortic Root ◽  
Ascending Aorta ◽  
Aortic Root Replacement ◽  
Aortic Reconstruction ◽  
Risk Of Death ◽  
Increased Risk ◽  
Aorta Replacement ◽  
Group 3 ◽  
Group 2 ◽  
Ascending Aorta Replacement

Abstract Background Aortic procedures are associated with higher risks of bleeding, yet data regarding perioperative transfusion in this patient population are lacking. We evaluated transfusion patterns in patients undergoing proximal aortic surgery to provide a benchmark against which future standards can be assessed. Methods Between June 2014 and July 2017, 247 patients underwent elective aortic reconstruction for aneurysm. Patients with acute aortic syndrome, endocarditis, and/or prior cardiac surgery were excluded. Transfusion data were analyzed by type of operation: ascending aorta replacement ± aortic valve procedure (group 1, n = 122, 49.4%); aortic root replacement with a composite valve–graft conduit ± ascending aorta replacement (group 2, n = 93, 37.7%); valve-sparing aortic root replacement (VSARR) ± ascending aorta replacement (group 3, n = 32, 13.0%). Results Thirty-day mortality for the entire cohort was 2.02% (5 deaths). Overall, 75 patients (30.4%) did not require any transfusion of blood or other products. Patients in groups 1 and 3 were significantly more likely to avoid transfusion than those in group 2. Mean transfusion volume for any individual patient was modest; those who underwent VSARR (group 3) required less intraoperative red blood cells (RBC) than others. Intraoperative transfusion of RBC was independently associated with an increased risk of death at 30 days. Conclusions Elective proximal aortic reconstruction can be performed without the need for excessive utilization of blood products. Composite root replacement is associated with a greater need for transfusion than either VSARR or isolated replacement of the ascending aorta.

scholarly journals Aortic Root Replacement after Aortic Valve or Ascending Aorta Surgery

2010 ◽  
Vol 5 (3) ◽  
pp. 22-30
Author(s):  
Jos A. Bekkers ◽  
Loes M.A. Klieverik ◽  
Goris Bol Raap ◽  
Johanna J.M. Takkenberg ◽  
Ad J.J.C. Bogers
Keyword(s):  
Aortic Valve ◽  
Aortic Root ◽  
Ascending Aorta ◽  
Aortic Root Replacement

scholarly journals Aortic root replacement after previous surgical intervention on the aortic valve, aortic root, or ascending aorta

2006 ◽  
Vol 131 (3) ◽  
pp. 601-608 ◽  
Author(s):  
E.W. Matthias Kirsch ◽  
N. Costin Radu ◽  
Armand Mekontso-Dessap ◽  
Marie-Line Hillion ◽  
Daniel Loisance
Keyword(s):  
Aortic Valve ◽  
Aortic Root ◽  
Surgical Intervention ◽  
Ascending Aorta ◽  
Aortic Root Replacement

scholarly journals Aortic root surgery: Early postoperative results of different surgical techniques

Medicina ◽  
2009 ◽  
Vol 45 (3) ◽  
pp. 197 ◽  
Author(s):  
Rimantas Benetis ◽  
Eglė Ereminienė ◽  
Povilas Jakuška ◽  
Dainius Karčiauskas ◽  
Šarūnas Kinduris ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Root ◽  
Surgical Techniques ◽  
Ascending Aorta ◽  
Aortic Root Replacement ◽  
Postoperative Results ◽  
Aortic Root Surgery ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

The aim of the study was to evaluate early postoperative results of different surgical techniques of aortic root surgery. Material and methods. Between January 2004 and November 2007, a cohort of 83 patients underwent aortic root surgery in the Heart Center, Hospital of Kaunas University of Medicine. Patients were divided into three groups: Group 1 (18 patients) – reimplantation of the aortic valve within a vascular graft (David operation), Group 2 (48 patients) – replacement of the ascending aorta and aortic valve using a valved conduit (Bentall de Bono operation), and Group 3 (17 patients) – biological aortic root replacement. Study protocol included clinical data, operative data, and postoperative major adverse effects: reoperations for bleeding, stroke and lethal outcomes. Results. Patients undergoing biological aortic root replacement were older as compared with other groups. The mean age in the Group 1 was 50.3±3.5 years vs. 57±2.0 years in the Group 2 and 67.8±3.3 years in the Group 3 (P<0.05). The main indication for the aortic root surgery was the aneurysm of the aortic root and ascending aorta in the Group 1 and 2 patients (64.7% and 72%), while in the Group 3, the main indication was fibrocalcinosis of aortic valve, aortic annulus, and ascending aorta (61.1%). The 30-day hospital mortality rates were as follows: 5.8% (n=1), in the Group 1; 10.4% (n=5), in the Group 2; 5.5% (n=1), in the Group 3. In the early postoperative period, 11 reoperations were performed due to bleeding events: in the Group 1, after planned/emergency surgery (n=2/2), and in the Group 2 (n=1/6), respectively. The function of aortic valve improved significantly in all groups of patients early after surgery. In the Group 1, the degree of aortic regurgitation decreased from 2.5±0.8 to 1.1±0.6 (P<0.05); in the Groups 2 and 3, the mean gradient through the aortic valve decreased from 39.9±7.5 to 17.1±5.3 mm Hg and from 48.8±18.0 to 20.1±11.0 mm Hg, respectively (P<0.05). No reoperation for aortic valve failure before the discharge was required in all groups of patients, and neither thromboembolic complications nor stroke events were noted in any group. Conclusions. Different aortic root surgery techniques showed similar postoperative results. New aortic root surgery methods such as aortic root-preserving/sparing procedures and concurrent aortic valve leaflet repair or aortic root replacement with the bioprosthesis can be selected for a diverse class of aortic root pathology with low perioperative mortality rates and good early postoperative results.

Sign in / Sign up

Export Citation Format

Share Document