Hybrid Repair with Reversed Sequence Supra-aortic Debranching in Ruptured Arch Aneurysm

2021 ◽  
Author(s):  
Akira Marumoto ◽  
Kazuhiro Yoneda ◽  
Kenji Tanaka ◽  
Katsukiyo Kitabayashi
Keyword(s):  
Aortic Arch ◽  
Ascending Aorta ◽  
Emission Computed Tomography ◽  
Unique Challenge ◽  
Oxygen Saturation Level ◽  
Aortic Replacement ◽  
Sternal Osteomyelitis ◽  
Alternative Treatment Option ◽  
Ascending Aortic Replacement ◽  
Arch Aneurysm

AbstractAortic arch pathology in a high-risk patient in whom the resternotomy approach is unfeasible due to treated mediastinitis after ascending aortic replacement presents a unique challenge for hybrid arch repair (HAR) because of the need for supra-aortic debranching from unusual inflow sites other than the ascending aorta. This report describes a “reversed sequence” extra-anatomical supra-aortic debranching procedure as a salvage technique performed to enable HAR. An 83-year-old woman with a history of ascending aortic replacement for type A aortic dissection, mediastinitis complicated by sternal osteomyelitis, and a chest wall reconstructed with a rectus abdominis myocutaneous flap presented with chest pain because of a contained dissecting arch aneurysm rupture. The patient underwent supra-aortic debranching from the bilateral common femoral arteries and thoracic endovascular aortic repair to the ascending aorta under cerebral near-infrared spectroscopy (NIRS) monitoring. Completion imaging by angiography demonstrated successful exclusion of the ruptured aneurysm. The regional cerebral oxygen saturation level, monitored by NIRS, did not change markedly during surgery. The patient was neurologically intact with adequate cerebral blood flow assessed postoperatively by 123I-IMP single photon emission computed tomography. Total debranching of the supra-aortic vessels from the common femoral artery for inflow is feasible and provides adequate cerebral perfusion. This procedure may offer an alternative treatment option in patients with complex conditions involving aortic arch pathology.

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

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.

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

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.

scholarly journals 506 Uneventful pseudoaneurysm of the ascending aorta with sternal erosion in pregnancy

2020 ◽  
Vol 22 (Supplement_N) ◽  
pp. N142-N145
Author(s):  
Alice Benedetti ◽  
Alvise Del Monte ◽  
Maurizio Rubino ◽  
Daniela Mancuso
Keyword(s):  
Aortic Valve ◽  
Aortic Arch ◽  
Left Ventricular ◽  
Ascending Aorta ◽  
Aortic Arch Aneurysm ◽  
Elective Cesarean Section ◽  
Elephant Trunk ◽  
Severe Aortic Regurgitation ◽  
Intimal Flap ◽  
Arch Aneurysm

Abstract A 36-year-old woman at 31 weeks’ gestation presented with exertional dyspnoea and palpitations. She had a history of bicuspid aortic valve treated with surgical aortic valvotomy for severe stenosis, followed by ascending aorta replacement for type A acute aortic dissection and Bentall operation with a mechanical valve for severe aortic regurgitation. Eight years after the last surgery, magnetic resonance angiography showed aortic arch aneurysm (49 mm) with a small intimal flap. Thereafter, the patient was lost to follow-up until the current admission. She was hemodynamically stable on presentation and physical examination was unremarkable apart from a mechanical second heart sound. The electrocardiogram showed sinus rhythm with left bundle branch block (Panel A). Transthoracic echocardiography revealed severe left ventricular dilation (EDV 90 ml/m2) with mild dysfunction (EF 50%), normal prosthetic aortic valve function, and aortic arch dilation (50 mm) (Panel B and C). After a multidisciplinary evaluation, elective cesarean section was performed at 34 weeks’ gestation. A post-delivery aortic computed tomography angiography revealed aortic arch aneurysm (52 mm) with intimal flap and two pseudoaneurysms of the anterior aortic wall causing sternal erosion (Panel D, E, F and G). Subsequently, the patient underwent ascending aorta and aortic arch replacement by Frozen Elephant Trunk technique with a 24 x130 mm prosthesis between the aortic root and the descending aorta. The postoperative course was uneventful, and the patient was discharged to a cardiac rehabilitation centre.

Reoperations for Aneurysmal Disease of the Ascending Aorta, Aortic Arch, and Descending Aorta: Their Causes and Operative Results

1994 ◽  
Vol 2 (2) ◽  
pp. 95-100 ◽  
Author(s):  
Shigeaki Aoyagi ◽  
Hidetoshi Akashi ◽  
Keiichiro Tayama ◽  
Yuji Hanamoto ◽  
Kazunari Yamana ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Aortic Arch ◽  
Ascending Aorta ◽  
Aortic Arch Aneurysm ◽  
Definitive Treatment ◽  
Initial Operation ◽  
Annuloaortic Ectasia ◽  
Pseudoaneurysm Formation ◽  
Aortic Pathology ◽  
Arch Aneurysm

Between 1984 and 1993, 20 patients underwent reoperation for the thoracic aorta or ascending aorta and aortic valve. There were 14 male and 6 female patients who ranged in age from 28 to 70 years with a mean of 53.2 years. The mean interval between initial operation and the 2nd operation was 70.4 months. Of the 20 patients, 6 had stigmata of Marfan's syndrome. The primary aortic pathology requiring initial operation was annuloaortic ectasia in 10 patients, aortic valvular disease in 5, aortic dissection in 3, and mega aorta syndrome, aortic aneurysm in multiple segments, or aortic arch aneurysm in 1 each. Cause of reoperation was pseudoaneurysm formation at suture lines in the ascending aorta in 6 patients, new or progressive dilatation in the remaining aortic segment in 5, new or persistent aortic dissection in 4, graft infection in 2, and recurrent aortic arch aneurysm in 1. The remaining 2 patients received a planned two-stage operation for multiple aneurysms or mega aorta syndrome. Six patients died early after reoperation, yielding a hospital mortality rate of 30%; however, 3 of the 6 deaths were related to a compromised preoperative clinical condition and 1 to perioperative contamination. Two operative deaths (10%) were related to operative techniques. Results suggest application of separate grafts for coronary artery reattachment, as in the Cabrol or Piehler techniques, or the aortic button technique for aortic root replacement, may help eliminate pseudoaneurysm formation, which is one of the major complications after operations on the ascending aorta. It is also suggested that early diagnosis and prompt operative treatment for recurrent or residual aneurysmal diseases of the aorta may be essential for successful definitive treatment.

scholarly journals A 52-year-old man with asymptomatic giant thoracic-abdominal aortic aneurysm

2021 ◽  
Author(s):  
Jianying Deng ◽  
Wei Liu
Keyword(s):  
Abdominal Aortic Aneurysm ◽  
Aortic Aneurysm ◽  
Aortic Arch ◽  
Clinical Symptoms ◽  
Ascending Aorta ◽  
Local Hospital ◽  
Replacement Surgery ◽  
Aortic Replacement ◽  
Abdominal Aortic ◽  
Risk Of Rupture

A 52-year-old man was admitted to our hospital for “CT-diagnosed thoracic-abdominal aortic aneurysm”. One week ago, the patient had repeated dry coughs and went to the local hospital for treatment. A chest radiograph revealed a huge mass in the left thoracic cavity. A further chest CT examination revealed a thoracic-abdominal aortic aneurysm and was transferred to our hospital for surgical treatment.The patient is almost healthy, with no fever, no severe chest and abdomen pain, no dyspnea, no dysphagia or other clinical symptoms. Ten years ago, the patient underwent “ascending aorta and total aortic arch replacement surgery” in another cardiovascular hospital due to aortic dissection involving the ascending aorta and aortic arch (Debakey I).The patient’s thoracic-abdominal aortic aneurysm is huge and has a high risk of rupture. Recently, the patient has undergone thoracic-abdominal aortic replacement surgery and is recovering well.

scholarly journals Large Intramural Aortic Hematoma with Intimal Tear

Aorta ◽  
2020 ◽  
Vol 08 (04) ◽  
pp. 118-120
Author(s):  
Frédéric Jacques ◽  
Michel Gingras ◽  
Valérie Lafrenière-Bessi ◽  
Jean Perron ◽  
François Dagenais
Keyword(s):  
Epigastric Pain ◽  
Circulatory Arrest ◽  
Intramural Hematoma ◽  
Filling Defect ◽  
Deep Hypothermic Circulatory Arrest ◽  
Ascending Aorta ◽  
Chest Computed Tomography ◽  
Aortic Replacement ◽  
Ascending Aortic Replacement ◽  
Aortic Intramural Hematoma

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.

scholarly journals Cerebral and visceral organ protection during aortic arch surgery. Intraoperative tactics and monitoring details

2016 ◽  
Vol 20 (4) ◽  
pp. 34 ◽  
Author(s):  
Yu. V. Belov ◽  
E. R. Charchyan ◽  
B. A. Akselyrod ◽  
D. A. Gusykov ◽  
S. V. Fedulova ◽  
...  
Keyword(s):  
Aortic Arch ◽  
Core Temperature ◽  
Conflict Of Interest ◽  
Cerebral Perfusion ◽  
Circulatory Arrest ◽  
Organ Protection ◽  
Aortic Arch Surgery ◽  
Aortic Replacement ◽  
Ascending Aortic Replacement ◽  
Antegrade Cerebral Perfusion

<p><strong>Aim.</strong> The study is aimed at presenting the protocol of intraoperative organ protection, analyzing its effectiveness during aortic arch surgery and evaluating the rate of postoperative complications in this group of patients. <br /><strong>Methods.</strong> The study included 141 patients. In the first group (n=70) patients underwent aortic arch surgery with hypothermic circulatory arrest (target core temperature 26 °C) and antegrade cerebral perfusion. Patients of the second group (n=71) underwent ascending aortic replacement using cardiopulmonary bypass with moderate hypothermia (target core temperature 32 °C). Cerebral and tissue oxygenation monitoring was performed in all the cases. In the first group transcranial Doppler monitoring was also performed. 33 patients in the first group and 34 patients in the second group underwent testing before and after surgery in order to evaluate cognitive function. Patients’ condition was evaluated during the in-hospital period that was about 15.97±20.54 days. <br /><strong>Results.</strong> In-hospital mortality rate was 4,2 % in the first group and 0% in the second one (p=0.12). Stroke was observed in 1.4 and 0 % of cases respectively. The rate of encephalopathy (as the leading symptom) was 7.1 and 5.6 % in 1st and 2nd groups respectively. Multimodal monitoring enabled to dynamically adjust the flow rate of antegrade cerebral perfusion. As a result, cerebral SctO2 and linear velocity were maintained within the acceptable range.<br /><strong>Conclusion.</strong> The presented protocol proved to be effective, it allows to perform aortic arch surgery with the same postoperative neurological complications’ rate as after ascending aortic replacement. We recommend performing reconstructive aortic arch surgery by using moderate hypothermic circulatory arrest (26-28 °С) and selective antegrade cerebral perfusion. In this modality, it is important to perform the distal anastomosis quickly and start patient’s rewarming (this will significantly shorten the duration of cardiopulmonary bypass and, as a result, decrease the rate of postoperative complications) and to carry out both precise intraoperative monitoring of the brain condition (by using cerebral oxymetry and transcranial Doppler) and central core temperature.</p><p>Received 21 June 2016. Accepted 21 October 2016.</p><p><strong>Funding:</strong> The study had no sponsorship.<br /><strong>Conflict of interest:</strong> The authors declare no conflict of interest.<br /><strong>Author contributions</strong><br />Conceptualization and study design: Belov Yu.V., Charchyan E.R., Akselrod B.A.<br />Material acquisition and analysis: Khachatryan Z.R., Oystrakh A.S., Medvedeva L.A., Guskov D.A., Fedulova S.V.<br />Statistical data processing: Khachatryan Z.R., Guskov D.A., Skvortsov A.A.<br />Article writing: Akselrod B.A., Khachatryan Z.R., Skvortsov A.A. <br />Review &amp; editing: Charchyan E.R., Akselrod B.A., Eremenko A.A., Belov Yu.V.</p>

scholarly journals Clinical case of hybrid treatment for a saccular aneurysm of the aortic arch

2021 ◽  
Vol 36 (3) ◽  
pp. 161-165
Author(s):  
G. G. Nasrashvili ◽  
M. S. Kuznetsov ◽  
D. S. Panfilov ◽  
B. N. Kozlov
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Aortic Arch ◽  
Clinical Case ◽  
Artery Bypass ◽  
Treatment Options ◽  
Ascending Aorta ◽  
Bypass Grafting ◽  
Hybrid Treatment ◽  
Arch Aneurysm

The article presents a clinical case of a staged hybrid treatment for an aortic arch aneurysm in patient who previously underwent coronary artery bypass grafting and exoplasty of the ascending aorta. Possible alternative treatment options for this pathology are reviewed, and the features of surgical and endovascular treatment are also described.

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