Clinical outcome of acute thoracic aortic syndrome in nonagenarians

2020 ◽  
Vol 28 (9) ◽  
pp. 577-582
Author(s):  
Mamoru Arakawa ◽  
Homare Okamura ◽  
Atsushi Miyagawa ◽  
Yuichiro Kitada ◽  
Hideo Adachi
Keyword(s):  
Decision Making ◽  
Thoracic Aorta ◽  
Surgical Repair ◽  
Survival Rates ◽  
Median Sternotomy ◽  
Aortic Disease ◽  
Open Surgical Repair ◽  
Clinical Frailty Scale ◽  
The Mean ◽  
Surgical Group

Background Decision-making regarding the operability of thoracic aortic disease in nonagenarian patients remains controversial because outcomes of open surgical repair of the thoracic aorta are unclear. We investigated the surgical and nonsurgical outcomes of acute thoracic aortic syndrome treatment in nonagenarians. Methods After evaluating data in our institute from April 2016 to March 2020, we included 10 nonagenarians who needed surgical intervention on the thoracic aorta via a median sternotomy for acute thoracic aortic syndrome. The mean age of the cohort was 91.9 ± 2.1 years. Five patients underwent open surgical repair of the thoracic aorta (surgical group), and 5 refused surgery (nonsurgical group). All patients in the surgical group performed activities of daily living independently, with a mean clinical frailty scale of 3.2 ± 0.4. The surgical group included 4 patients with type A aortic dissection and one with a ruptured thoracic aortic aneurysm. Hemiarch replacement was performed in 3 patients and total arch replacement in 2. The mean follow-up period was 17.8 ± 5.1 months. Results Hospital mortality rates were 0% in the surgical and 80% in the nonsurgical group. The mean length of hospitalization was 28.4 ± 6.7 days in the surgical group. The 1-year survival rates were 100% in the surgical group and 20% in the nonsurgical group. Conclusion Open surgical repair for acute thoracic aortic syndrome via median sternotomy is a reasonable treatment option even in nonagenarians. Involvement of family members is important for decision-making to devise the optimal treatment strategy (surgical vs. medical).

scholarly journals Various Endoluminal Approaches Available for Treating Pathologies of the Aortic Arch

2020 ◽  
Vol 43 (12) ◽  
pp. 1756-1769
Author(s):  
Muzaffar A. Anwar ◽  
Mohammad Hamady
Keyword(s):  
Aortic Arch ◽  
Surgical Repair ◽  
Hybrid Approach ◽  
Aortic Disease ◽  
Open Surgical Repair ◽  
Neurological Sequelae ◽  
Aortic Stent Graft ◽  
Custom Made ◽  
Term Data

Abstract Open surgical repair of the aortic arch for degenerative aortic disease in an unfit patient is associated with significant morbidity and mortality. Endoluminal techniques have advanced over the last decade. Contemporary endovascular options including a hybrid approach (supra-aortic debranching and aortic stent graft), inner branched endograft, chimney stents, and scallop or fenestrated endografts are being used frequently as an alternative to open surgical arch repair. Understanding of the available endoluminal technology along with careful planning and effective teamwork is required to minimise complications associated with the endoluminal techniques, particularly neurological ones. Custom made techniques are superior to chimney or parallel technology in terms of their complications and durability. Integration of the protective devices such as embolic protection filters into stent design may reduce the risk of poor neurological sequelae. Long-term data are needed to assess the durability of these devices.

scholarly journals Outcomes of Open Surgical Repair of Descending Thoracic Aortic Disease

2014 ◽  
Vol 47 (3) ◽  
pp. 255-261
Author(s):  
Won-Young Lee ◽  
Jae Suk Yoo ◽  
Joon Bum Kim ◽  
Sung-Ho Jung ◽  
Suk Jung Choo ◽  
...  
Keyword(s):  
Surgical Repair ◽  
Aortic Disease ◽  
Open Surgical Repair ◽  
Thoracic Aortic Disease

Open and endovascular treatment options in thoracic aortic surgery

2018 ◽  
pp. 111-134
Author(s):  
Ourania Preventza ◽  
Joseph S. Coselli
Keyword(s):  
Aortic Aneurysm ◽  
Thoracic Aorta ◽  
Thoracic Aortic Aneurysm ◽  
Aortic Surgery ◽  
Treatment Options ◽  
Median Sternotomy ◽  
Aortic Disease ◽  
Transverse Arch ◽  
Abdominal Aortic ◽  
Thoracoabdominal Approach

Open endovascular and hybrid repairs have recently emerged as a method for treating the different segments of the thoracic aorta. A full or upper-mini median sternotomy is the usual approach for proximal aortic disease and proximal and transverse arch repairs. Other approaches, such as minimally invasive right thoracotomy, have also emerged. Until recently, a left thoracotomy and thoracoabdominal approach has been the sole approach for treating lesions of the descending and thoracoabdominal thoracic aorta. In the 1980s, the first aortic repair with a self-fixing endoprosthesis was performed. In subsequent years, the technique of using a stent graft to treat an abdominal aortic aneurysm, and subsequently thoracic aortic aneurysm, was popularized, followed by extensive development of this technology. The different techniques and modalities for treatment are discussed in this chapter.

scholarly journals Anomalous Right Subclavian Artery-Esophageal Fistulae

2018 ◽  
Vol 2018 ◽  
pp. 1-5
Author(s):  
Courtney Brooke Shires ◽  
Michael J. Rohrer
Keyword(s):  
Subclavian Artery ◽  
Surgical Repair ◽  
Bleeding Episode ◽  
Median Sternotomy ◽  
Covered Stent ◽  
Aberrant Right Subclavian Artery ◽  
Massive Hemoptysis ◽  
Stent Grafts ◽  
Open Surgical Repair ◽  
Aortic Arch Anomaly

An aberrant right subclavian artery (ARSA) is the most common aortic arch anomaly, but only 19 previous cases of ARSA-esophageal fistula have been reported. Six patients have survived their bleeding episode. We describe the case of a 44-year-old woman who developed massive hemoptysis. Laryngoscopy, bronchoscopy, head and neck angiogram, and median sternotomy did not reveal what was presumed initially to be a tracheoinnominate fistula. Contrasted CT showed an anomalous subclavian artery posterior to the esophagus. Given the technical challenge of approaches for this pathology, the patient was unfit for open surgical repair. Therefore, endovascular covered stent grafts were deployed spanning the segment of the subclavian artery in continuity with the esophagus, via a right brachial artery approach. Unfortunately, the patient died after successful placement of the grafts.

scholarly journals Stent-graft versus open-surgical repair of the thoracic aorta: Mid-term results

2006 ◽  
Vol 44 (6) ◽  
pp. 1188-1197 ◽  
Author(s):  
David H. Stone ◽  
David C. Brewster ◽  
Christopher J. Kwolek ◽  
Glenn M. LaMuraglia ◽  
Mark F. Conrad ◽  
...  
Keyword(s):  
Thoracic Aorta ◽  
Stent Graft ◽  
Surgical Repair ◽  
Open Surgical Repair ◽  
Mid Term Results

scholarly journals Laparoscopic vs. Open Surgical Repair of Subxiphoidal Hernia Following Median Sternotomy for Coronary Bypass - Analysis of the Herniamed Registry

2020 ◽  
Vol 7 ◽  
Author(s):  
Hendrik C. Albrecht ◽  
Mateusz Trawa ◽  
Ferdinand Köckerling ◽  
Martin Hukauf ◽  
Stephan Gretschel
Keyword(s):  
Surgical Repair ◽  
Median Sternotomy ◽  
Coronary Bypass ◽  
Open Surgical Repair

Simultaneous Presentation of Coarctation of the Thoracic Aorta and Aneurysm of the Superior Mesenteric Artery

2009 ◽  
Vol 4 (2) ◽  
pp. 113-116
Author(s):  
Riyad Karmy-Jones ◽  
Robert Bloch ◽  
M. Alan Martin
Keyword(s):  
Superior Mesenteric Artery ◽  
Thoracic Aorta ◽  
Stent Graft ◽  
Mesenteric Artery ◽  
Surgical Repair ◽  
Simultaneous Presentation ◽  
Open Surgical Repair

A 34-year-old woman presented with both coarctation of the thoracic aorta and aneurysm of the superior mesenteric artery. The former was managed by open surgical repair, the latter by stent-graft. This case illustrates the need for facility with both percutaneous and open approaches to diseases of the aorta and its branches.

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