Large Intramural Aortic Hematoma with Intimal Tear

AbstractA 72-year-old man presented with excruciating epigastric pain. A chest computed tomography angiography revealed an aortic intramural hematoma. A filling defect within the distal ascending aorta was noted. Images of an intramular hematoma and surgical details of an ascending aortic replacement under deep hypothermic circulatory arrest are provided.

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Results of Proximal Arch Replacement Using Deep Hypothermia for Circulatory Arrest: Is Moderate Hypothermia Really Justifiable?

The American Surgeon ◽

10.1177/000313481107701129 ◽

2011 ◽

Vol 77 (11) ◽

pp. 1438-1444 ◽

Cited By ~ 19

Author(s):

Brian Lima ◽

Judson B. Williams ◽

S. Dave Bhattacharya ◽

Asad A. Shah ◽

Nicholas Andersen ◽

...

Keyword(s):

Renal Failure ◽

Cerebral Perfusion ◽

Circulatory Arrest ◽

Deep Hypothermic Circulatory Arrest ◽

Deep Hypothermia ◽

Aortic Root Replacement ◽

Moderate Hypothermia ◽

Selective Cerebral Perfusion ◽

Aortic Replacement ◽

Ascending Aortic Replacement

The use of selective cerebral perfusion with warmer temperatures during circulatory arrest has been increasingly used for arch replacement over concerns regarding the safety of deep hypothermic circulatory arrest (DHCA). However, little data actually exist on outcomes after arch replacement and DHCA. This study examines modern results with DHCA for proximal arch replacement to provide a benchmark for comparison against outcomes with lesser degrees of hypothermia. Between July 2005 and June 2010, 245 proximal arch replacements (“hemiarch”) were performed using deep hypothermia; mean minimum core and nasopharyngeal temperatures were 18.0 ± 2.1°C and 14.1 ± 1.6°C, respectively. Adjunctive cerebral perfusion was used in all cases. Concomitant ascending aortic replacement was performed in 41 per cent, ascending plus aortic valve replacement in 23 per cent, and aortic root replacement in 32 per cent. Mean age was 58 ± 14 years; 36 per cent procedures were urgent/emergent. Mean duration of DHCA was 20.4 ± 6.2 minutes. Thirty-day/in-hospital mortality was 2.9 per cent. Rates of stroke, renal failure, and respiratory failure were 4.1 per cent (0.8% for elective cases), 1.2 per cent, and 0.4 per cent, respectively. Deep hypothermia with adjunctive cerebral perfusion for circulatory arrest during proximal arch replacement affords excellent neurologic as well as nonneurologic outcomes. Centers using lesser degrees of hypothermia for arch surgery, the safety of which remains unproven, should ensure comparable results.

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Endovascular Stent-Graft Repair of the Ascending Aorta: Assessment of a Specific Novel Stent-Graft Design in Phantom, Cadaveric, and Clinical Application

CardioVascular and Interventional Radiology ◽

10.1007/s00270-021-02859-5 ◽

2021 ◽

Author(s):

Sven R. Hauck ◽

Alexander Kupferthaler ◽

Marlies Stelzmüller ◽

Wolf Eilenberg ◽

Marek Ehrlich ◽

...

Keyword(s):

Clinical Application ◽

Stent Graft ◽

Ascending Aorta ◽

The Novel ◽

Forward Movement ◽

Level Of Evidence ◽

Landing Zone ◽

Aortic Replacement ◽

Ascending Aortic Replacement ◽

Stent Graft Repair

Abstract Purpose To test a stent-graft specifically designed for the ascending aorta in phantom, cadaver, and clinical application, and to measure deployment accuracy to overcome limitations of existing devices. Methods A stent-graft has been designed with support wires to fixate the apices toward the inner curvature, thereby eliminating the forward movement of the proximal end which can happen with circumferential tip capture systems. The device was deployed in three aortic phantoms, and in four cadavers, deployment precision was measured. Subsequently, the device was implanted in a patient to exclude a pseudoaneurysm originating from the distal anastomosis after ascending aortic replacement. Results The stent-grafts were successfully deployed in all phantoms and cadavers. Deployment accuracy of the proximal end of the stent-graft was within 1 mm proximally and 14 mm distally to the intended landing zone on the inner curvature, and 2–8 mm distal to the intended landing zone on the outer curvature. In clinical application, the pseudoaneurysm could be successfully excluded without complications. Conclusion The novel stent-graft design promises accurate placement in the ascending aorta. The differential deployment of the apices at the inner and outer curvatures allows deployment perpendicular to the aortic axis. Level of Evidence No level of evidence.

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Moderate versus deep hypothermic circulatory arrest for ascending aorta and aortic arch surgeries using open distal anastomosis technique

Journal of the Egyptian Society of Cardio-Thoracic Surgery ◽

10.1016/j.jescts.2017.11.006 ◽

2017 ◽

Vol 25 (4) ◽

pp. 323-330 ◽

Cited By ~ 1

Author(s):

Ahmed Abdelgawad ◽

Heba Arafat

Keyword(s):

Aortic Arch ◽

Circulatory Arrest ◽

Deep Hypothermic Circulatory Arrest ◽

Ascending Aorta ◽

Hypothermic Circulatory Arrest ◽

Distal Anastomosis

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Deep hypothermic circulatory arrest and antegrade selective cerebral perfusion during ascending aorta-hemiarch replacement: A retrospective comparative study

Journal of Thoracic and Cardiovascular Surgery ◽

10.1067/mtc.2003.8 ◽

2003 ◽

Vol 125 (4) ◽

pp. 849-854 ◽

Cited By ~ 82

Author(s):

Marco Di Eusanio ◽

Ronald M.J. Wesselink ◽

Wim J. Morshuis ◽

Karl M. Dossche ◽

Marc A.A.M. Schepens

Keyword(s):

Comparative Study ◽

Cerebral Perfusion ◽

Circulatory Arrest ◽

Deep Hypothermic Circulatory Arrest ◽

Ascending Aorta ◽

Hypothermic Circulatory Arrest ◽

Selective Cerebral Perfusion ◽

Retrospective Comparative Study ◽

Hemiarch Replacement ◽

Antegrade Selective Cerebral Perfusion

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Outcomes after ascending aorta and proximal aortic arch repair using deep hypothermic circulatory arrest with retrograde cerebral perfusion: analysis of 207 patients

Interactive Cardiovascular and Thoracic Surgery ◽

10.1093/icvts/ivs252 ◽

2012 ◽

Vol 15 (3) ◽

pp. 456-461 ◽

Cited By ~ 12

Author(s):

K. Perreas ◽

G. Samanidis ◽

S. Dimitriou ◽

P. Kalogris ◽

M. Balanika ◽

...

Keyword(s):

Aortic Arch ◽

Cerebral Perfusion ◽

Circulatory Arrest ◽

Deep Hypothermic Circulatory Arrest ◽

Ascending Aorta ◽

Hypothermic Circulatory Arrest ◽

Retrograde Cerebral Perfusion ◽

Aortic Arch Repair

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Surgical Aortic Arch Intervention at the time of Extended Ascending Aortic Replacement is Associated with Increased Mortality

10.22541/au.162636839.91925221/v1 ◽

2021 ◽

Author(s):

Michael Bowdish ◽

Daniel Logsdon ◽

Ramsey Elsayed ◽

Wendy Mack ◽

Brittany Abt ◽

...

Keyword(s):

Aortic Arch ◽

Ascending Aorta ◽

Conservative Approach ◽

Factors Associated ◽

Aortic Replacement ◽

Ascending Aortic Replacement ◽

Aortic Arch Repair ◽

Multivariable Models ◽

Patch Technique

Objective: To compare outcomes of hemiarch versus total arch repair during extended ascending aortic replacement. Methods: Between 2004 and 2017, 261 patients underwent hemiarch (n=149, 57%) or total arch repair (aortic debranching or Carrell patch technique, n=112, 43%) in the setting of extended replacement of the ascending aorta. Median follow-up was 17.2 (IQR 4.2–39.1) months. Multivariable models considering preoperative and intraoperative factors associated with mortality and aortic reintervention were constructed. Results: Survival was 89.0, 81.3, and 73.5% vs. 76.4, 69.5, and 61.7% at 1, 3, and 5 years in the hemiarch versus total arch groups, respectively (log-rank p=0.010). After adjustment for preoperative and intraoperative factors, the presence of a total arch repair (adjusted HR 2.53, 95% CI 1.39 – 4.62, p=0.003), and increasing age (adjusted HR per 10 years of age, 1.76, 95% CI 1.37 – 2.28, p<0.001) were associated with increased mortality. The cumulative incidence of aortic reintervention with death as a competing outcome was 2.6, 2.6, and 4.4% and 5.0, 10.3, and 11.9% in the hemiarch and total arch groups, respectively. After adjustment, the presence of a total arch repair was significantly associated with need for aortic reintervention (SHR 3.21, 95% CI 1.01 – 10.2, p=0.047). Conclusions: Overall survival after aortic arch repair in the setting of extended ascending aortic replacement is excellent, however, total arch repair and increasing age are associated with higher mortality and reintervention rates. A conservative approach to aortic arch repair can be prudent, especially in those of advanced age.

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