Ascending aortic arch replacement with aortic valve resuspension under deep hypothermic arrest combined with endoluminal stenting of the descending thoracic aorta and the entire abdominal aorta

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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Treating the patient with acute rupture of penetrating atherosclerotic ulcer of the thoracic aorta

Kazan medical journal ◽

10.17750/kmj2015-377 ◽

2015 ◽

Vol 96 (3) ◽

pp. 377-380

Author(s):

I R Yagafarov ◽

R R Sayfullin ◽

M M Iskhakov ◽

N V Gazizov ◽

M G Khatypov ◽

...

Keyword(s):

Aortic Arch ◽

Thoracic Aorta ◽

Spontaneous Rupture ◽

Open Surgery ◽

Intraoperative Complications ◽

Long Term Results ◽

Safe Procedure ◽

Descending Thoracic Aorta ◽

Prosthetic Repair ◽

Penetrating Atherosclerotic Ulcer

Spontaneous rupture of the aorta - a violation of the integrity of the aortic wall which is not caused by an aneurysm, trauma, dissection or disintegrating tumor process, and is an acute life-threatening condition. According to some authors, the main cause of spontaneous rupture of the aorta is a penetrating atherosclerotic ulcer of the aorta, which is an ulceration of aortic atherosclerotic plaque leading to penetration of the internal elastic plate in media. We present a case of successful hybrid surgical treatment of patient with spontaneous rupture of the descending thoracic aorta with the formation of para-aortic hematoma and left-sided hemothorax. The patient underwent a hybrid operation - aortic arch and descending thoracic aorta prosthetic repair, subclavian bypass with left subclavian artery ligation, left-sided thoracotomy, and pleural cavity sanitation. No intraoperative complications were observed, the patient was taken off the ventilator on day 2. The control computed tomography performed on day 10, revealed correct and stable stent graft position with no signs of continued bleeding, endoleak. The patient was discharged in satisfactory condition on day 14. Due to the high hospital mortality of open surgery on the thoracic aorta in case of penetrating atherosclerotic ulcers, as well as the predominance of elderly patients with severe comorbidities that contraindicate open surgery using cardiopulmonary bypass, endovascular and hybrid technologies, which are minimally invasive and traumatic, come to the fore. Endovascular prosthetic repair in case of penetrating atherosclerotic ulcer of aortic arch and descending thoracic aorta is an effective and safe procedure in patients at high risk, showing encouraging long-term results.

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Biphasic Doppler Pattern of the Descending Thoracic Aorta: A New Echocardiographic Finding in Patients with Aortic Valve Stenosis

Journal of the American Society of Echocardiography ◽

10.1016/j.echo.2005.01.022 ◽

2005 ◽

Vol 18 (8) ◽

pp. 860-864 ◽

Cited By ~ 5

Author(s):

W HANSEN

Keyword(s):

Aortic Valve ◽

Thoracic Aorta ◽

Aortic Valve Stenosis ◽

Descending Thoracic Aorta ◽

Echocardiographic Finding

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Intraoperative video showing the sequence of the operation highlighting the removal of the stent and infected material and further reconstruction of the aortic arch, proximal descending thoracic aorta and supra-aortic trunks using a Thoraflex PlexusTM (Terumo Aortic, Vascutek) with cardiopulmonary bypass, moderate hypothermic circulatory arrest and antegrade cerebral perfusion.

ASVIDE ◽

10.21037/asvide.2021.367 ◽

2021 ◽

Vol 8 ◽

pp. 367-367

Author(s):

Ana Lopez-Marco ◽

Saleem Jahangeer ◽

Benjamin Adams ◽

Aung Ye Oo

Keyword(s):

Cardiopulmonary Bypass ◽

Aortic Arch ◽

Thoracic Aorta ◽

Cerebral Perfusion ◽

Circulatory Arrest ◽

Hypothermic Circulatory Arrest ◽

Descending Thoracic Aorta ◽

Infected Material ◽

Antegrade Cerebral Perfusion

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From the descending thoracic aorta to orthotopic position: a pivotal step for aortic valve surgery

The Journal of Cardiovascular Surgery ◽

10.23736/s0021-9509.21.11921-4 ◽

2021 ◽

Vol 62 (5) ◽

Author(s):

Marco PICICHÈ

Keyword(s):

Aortic Valve ◽

Thoracic Aorta ◽

Valve Surgery ◽

Aortic Valve Surgery ◽

Descending Thoracic Aorta

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Late Outcome after Surgery for Type-A Aortic Dissection

Journal of Clinical Medicine ◽

10.3390/jcm9092731 ◽

2020 ◽

Vol 9 (9) ◽

pp. 2731

Author(s):

Mikko Jormalainen ◽

Peter Raivio ◽

Fausto Biancari ◽

Caius Mustonen ◽

Hannu-Pekka Honkanen ◽

...

Keyword(s):

Aortic Dissection ◽

Thoracic Aorta ◽

Abdominal Aorta ◽

Cumulative Incidence ◽

Type I ◽

Descending Thoracic Aorta ◽

Late Outcome ◽

Type A Aortic Dissection ◽

Primary Surgery ◽

All Cause Mortality

The aim of this study was to evaluate all-cause mortality and aortic reoperations after surgery for Stanford type A aortic dissection (TAAD). We evaluated the late outcome of patients who underwent surgery for acute TAAD from January 2005 to December 2017 at the Helsinki University Hospital, Finland. We studied 309 patients (DeBakey type I TAAD: 89.3%) who underwent repair of TAAD. Aortic root repair was performed in 94 patients (30.4%), hemiarch repair in 264 patients (85.4%) and partial/total aortic arch repair in 32 patients (10.4%). Hospital mortality was 13.6%. At 10 years, all-cause mortality was 34.9%, and the cumulative incidence of aortic reoperation or late aortic-related death was 15.6%, of any aortic reoperation 14.6%, reoperation on the aortic root 6.6%, on the aortic arch, descending thoracic and/or abdominal aorta 8.7%, on the descending thoracic and/or abdominal aorta 6.4%, and on the abdominal aorta 3.8%. At 10 years, cumulative incidence of reoperation on the distal aorta was higher in patients with a diameter of the descending thoracic aorta ≥35 mm at primary surgery (cumulative incidence in the overall series: 13.2% vs. 4.0%, SHR 3.993, 95%CI 1.316–12.120; DeBakey type I aortic dissection: 13.6% vs. 4.5%, SHR 3.610, 95%CI 1.193–10.913; patients with dissected descending thoracic aorta: 15.8% vs. 5.9%, SHR 3.211, 95%CI 1.067–9.664). In conclusion, surgical repair of TAAD limited to the aortic segments involved by the intimal tear was associated with favorable survival and a low rate of aortic reoperations. However, patients with enlarged descending thoracic aorta at primary surgery had higher risk of late reoperation. Half of the distal aortic reinterventions were performed on the abdominal aorta.

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