Management of Ascending Aorta and Aortic Arch: Similarities and Differences Among Cardiovascular Guidelines

2021 ◽  
pp. 152660282110612
Author(s):  
Konstantinos Spanos ◽  
Petroula Nana ◽  
Yskert von Kodolitsch ◽  
Christian-Alexander Behrendt ◽  
George Kouvelos ◽  
...  
Keyword(s):  
Aortic Arch ◽  
Open Surgery ◽  
Surgical Techniques ◽  
Ascending Aorta ◽  
Cochrane Central Register ◽  
Endovascular Techniques ◽  
Level Of Evidence ◽  
Indications For Treatment ◽  
Evidence Level

Background: Ascending aorta and aortic arch diseases have an increasing interest among cardiovascular specialists regarding diagnosis and management. Innovations in endovascular surgery and evolution of open surgery have extended the indications for treatment in patients previously considered unfit for surgery. The aim of this systematic review of the literature was to present and analyze current cardiovascular guidelines for overlap and differences in their recommendations regarding ascending aorta and aortic arch diseases and the assessment of evidence. Methods: The English medical literature was searched using the MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials databases from January 2009 to December 2020. Recommendations on selected topics were analyzed, including issues from definitions and diagnosis (imaging and biomarkers) and indications for treatment to management, including surgical techniques, of the most important ascending aorta and aortic arch diseases. Results: The initial search identified 2414 articles. After exclusion of duplicate or inappropriate articles, the final analysis included 5 articles from multidisciplinary, cardiovascular societies published between 2010 and 2019. The definition of non-A-non-B aortic dissection is lacking from most of the guidelines. There is a disagreement regarding the class of recommendation and level of evidence for the diameter of ascending aorta as an indication. The indication for treatment of aortic disease may be individualized in specific cases while the growth rate may also affect the decision making. The role of endovascular techniques has not been established in current guidelines except by 1 society. Supportive evidence level in the management of aortic arch diseases remains limited. Conclusion: In current recommendations of cardiovascular societies, the ascending aorta and aortic arch remain a domain of open surgery despite the introduction of endovascular techniques. Recommendations of the included societies are mostly based on expert opinion, and the role of endovascular techniques has been highlighted only from 1 society. The chronological heterogeneity apparent among guidelines and the inconsistency in evidence level should be also acknowledged. More data are needed to develop more solid recommendations for the ascending aorta and aortic arch diseases.

scholarly journals A Case of Type I Debranching Complicated by Anastomotic Pseudoaneurysm: Do Not Ask Too Much of the Ascending Aorta

Aorta ◽  
2019 ◽  
Vol 07 (02) ◽  
pp. 063-066
Author(s):  
Davide Carino ◽  
Alberto Molardi ◽  
Tiziano Gherli ◽  
Francesco Nicolini ◽  
Andrea Agostinelli
Keyword(s):  
Aortic Arch ◽  
Open Surgery ◽  
Ascending Aorta ◽  
Type I ◽  
Hybrid Procedures ◽  
Aortic Repair ◽  
Anastomotic Pseudoaneurysm ◽  
Risk Patients ◽  
Arch Aneurysm ◽  
Aorta Diameter

AbstractTreatment of aortic arch aneurysm with standard open surgery is technically demanding, and associated morbidity and mortality are not insignificant. In high-risk patients, hybrid procedures with debranching and reimplantation or bypass of the aortic arch vessel followed by thoracic endovascular aortic repair (TEVAR) in the aortic arch represent a valid alternative to open surgery. However, when the ascending aorta is mildly dilated, the risk of retrograde dissection increases sharply. Here, we report a case of thoracic aortic aneurysm, with normal ascending aorta diameter, treated with Type I debranching and anterograde TEVAR complicated by anastomotic pseudoaneurysm and acute endocarditis, treated ultimately with ascending aortic repair and aortic valve replacement.

scholarly journals Surgical Approaches to Upper Limb Spasticity in Adult Patients: A Literature Review

2021 ◽  
Vol 2 ◽  
Author(s):  
Mahdis Hashemi ◽  
Nadine Sturbois-Nachef ◽  
Marry Ann Keenan ◽  
Paul Winston
Keyword(s):  
Systematic Reviews ◽  
Upper Limb ◽  
Surgical Techniques ◽  
Adult Patients ◽  
Surgical Approaches ◽  
Cochrane Central Register ◽  
Level Of Evidence ◽  
Cochrane Database ◽  
Limb Deformities ◽  
Almost All

Introduction: Spasticity is the main complication of many upper motor neuron disorders. Many studies describe neuro-orthopedic surgeries for the correction of joint and limb deformities due to spasticity, though less in the upper extremity. The bulk of care provided to patients with spasticity is provided by rehabilitation clinicians, however, few of the surgical outcomes have been summarized or appraised in the rehabilitation literature.Objective: To review the literature for neuro-orthopedic surgical techniques in the upper limb and evaluate the level of evidence for their efficacy in adult patients with spasticity.Method: Electronic databases of MEDLINE, EMBASE, CINAHL, Cochrane Central Register of Controlled Trials, and Cochrane Database of Systematic Reviews were searched for English, French as well as Farsi languages human studies from 1980 to July 2, 2020. After removing duplicated articles, 2,855 studies were screened and 80 were found to be included based on the criteria. The studies were then divided into two groups, with 40 in each trial and non-trial. The results of the 40 trial articles were summarized in three groups: shoulder, elbow and forearm, and wrist and finger, and each group was subdivided based on the types of intervention.Results: The level of evidence was evaluated by Sackett's approach. There were no randomized control trial studies found. About, 4 studies for shoulder, 8 studies for elbow and forearm, 26 studies for wrist and finger (including 4 for the thumb in palm deformity), and 2 systematic reviews were found. Around, two out of 40 trial articles were published in the rehabilitation journals, one systematic review in Cochrane, and the remaining 38 were published in the surgical journals.Conclusion: Most surgical procedures are complex, consisting of several techniques based on the problems and goals of the patient. This complexity interferes with the evaluation of every single procedure. Heterogenicity of the participants and the absence of clinical trial studies are other factors of not having a single conclusion. This review reveals that almost all the studies suggested good results after the surgery in carefully selected cases with goals of reducing spasticity and improvement in function, pain, hygiene, and appearance. A more unified approach and criteria are needed to facilitate a collaborative, evidence-based, patient referral, and surgical selection pathway.

Four-Corner Arthrodesis: Comparative Analysis of Open Technique Versus Percutaneous Technique with Arthroscopic Assistance

2021 ◽  
Author(s):  
Camila Azócar ◽  
Juan J. Lecaros ◽  
Nazira Bernal ◽  
Miguel Sanhueza ◽  
Rodrigo Liendo ◽  
...  
Keyword(s):  
Open Surgery ◽  
Surgical Techniques ◽  
Score Function ◽  
Control Group ◽  
Percutaneous Technique ◽  
Case Group ◽  
Retrospective Case ◽  
Level Of Evidence ◽  
Therapeutic Study ◽  
Clinical Records

Abstract Introduction Four-corner arthrodesis is a salvage technique for patients with carpal advanced osteoarthritis. Nowadays, percutaneous techniques with arthroscopic assistance have been described, achieving favorable results with minimally invasive techniques advantages over open surgery. Objective To compare functional and radiological results in patients with SLAC or SNAC wrists operated with open surgical technique versus percutaneous surgery with arthroscopic assistance. Materials and Methods Retrospective case-control study of clinical records and radiological images of patients with carpal advanced osteoarthritis operated with both surgical techniques. We studied demographic variables, pain with visual analog scale (VAS) score, function in ranges of mobility, time of consolidation, and correction of DISI deformity. Results A total of 22 male patients with an average age of 32.5 years were studied. Thirteen patients in the case group (percutaneous technique with arthroscopic assistance) and nine patients in the control group (open surgery). Pain score in VAS at discharge was 3 for cases and 5 in controls (p = 0.008), and at 30 days postoperatively, it was 0 and 3 respectively (p = 0.00). The extension and flexion ranges were 52.6°and 38.7° in the cases and 35.7° and 32.4° in the control group (p = 0.119 and 0.0016, respectively). The capitolunate angle was 10°in the controls and 5°in the cases (p = 0.0008). The time of consolidation was 8.8 weeks in cases and 12.5 weeks in controls (p = 0.039). Conclusions The percutaneous technique with arthroscopic assistance for the 4-courner arthrodesis is a reproducible technique and is effective in achieving consolidation, pain reduction and preservation of wrist motion. In the present study, we demonstrate superiority of this technique over the open surgery. Level of Evidence This is a Level III, therapeutic study.

scholarly journals The Role of Bicuspid Aortic Valve in Aortic Aneurysm Occurrence and Development

2021 ◽  
Vol 27 (1) ◽  
Author(s):  
Vitaliy Kravchenko ◽  
Ivan Kravchenko ◽  
Olha Pantas ◽  
Valentyna Zakharova
Keyword(s):  
Surgical Treatment ◽  
Aortic Valve ◽  
Aortic Aneurysm ◽  
Aortic Arch ◽  
Histological Examination ◽  
Bicuspid Aortic Valve ◽  
Ascending Aorta ◽  
Aortic Aneurysms ◽  
Ascending Aortic Aneurysm

The paper presents the data on the diagnosis of bicuspid aortic valve (BAV) disease in the patients operated for ascending aortic (AA) aneurysm. A brief historical review of the study of the BAV problem is presented; the data on the BAV incidence in the development of ascending aortic aneurysm and its dissection, the results of surgical treatment of BAV disease in patients with AA aneurysm are displayed. The objective of the research was to study the role of the bicuspid aortic valve in the occurrence (dissection) of ascending aortic aneurysms. Materials and methods The retrospective analysis of the patients operated at the institute during the period of 1.01.2013 to 1.01.2019 for ascending aortic aneurysm or aneurysms of both ascending aorta and aortic arch confirmed that aneurysm occurrence (dissection) was caused by the presence of bicuspid valve. During this time, 1120 patients were operated on for ascending aortic aneurysm or aneurysms of both ascending aorta and aortic arch. 340 (30.4%) patients with diagnosed and confirmed BAV disease were included in the analysis. BAV diagnosis was based on echocardiography with obligatory intraoperative confirmation and on the basis of histological examination. Histological examination of the fragments of the aortic wall and aortic valve taken during operations was performed in 68 (20.0%) patients. Results and discussion BAV is the most common of all cardiac failures with a prevalence of up to 2% in the population constituting up to 30-50% of cases among the patients with aortal disorders. Two-dimensional echocardiography gives better results and provides an opportunity to detect BAV in 95% of cases, which was confirmed by our studies. According to our research, cases with BAV included 30.4% of all possible aneurysm causes, and BAV as a cause of dissection was noted in 46 (13.5%) of all dissecting aneurysms. Regarding the results of the surgical treatment, 2 patients out of 340 operated at the hospital stage died constituting 0.6%. Conclusions Among all ascending aortic aneurysms or aneurysms of both ascending aorta and aortic arch, BAV was determined as their cause in 30.4% of cases. Dissection (rupture) of the aortic aneurysm occurred in 13.5% of patients with aneurysm and bicuspid valve and thus required an urgent surgery.  Patients with BAV require lifelong care.

scholarly journals Prospective, observational, multicenter study on minimally invasive gastrectomy for gastric cancer: robotic, laparoscopic and open surgery compared on operative and follow-up outcomes - IMIGASTRIC II study protocol: IMIGASTRIC II

2019 ◽  
Vol 1 (1) ◽  
pp. 9-15
Author(s):  
Jacopo Desiderio ◽  
Jian-Xian Lin ◽  
Enrique Norero ◽  
Felice Borghi ◽  
Alessandra Marano ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Minimally Invasive Surgery ◽  
Minimally Invasive ◽  
Invasive Surgery ◽  
Open Surgery ◽  
Data Repository ◽  
Time Data ◽  
Level Of Evidence

Background: Several meta-analyses have tried to defi ne the role of minimally invasive approaches. However, further evidence to get a wider spread of these methods is necessary. Current studies describe minimally invasive surgery as a possible alternative to open surgery but deserving further clarifi cation. However, despite the increasing interest, the difficulty of planning prospective studies of adequate size accounts for the low level of evidence, which is mostly based on retrospective experiences. A multi-institutional prospective study allows the collection of an impressive amount of data to investigate various aspects of minimally invasive procedures with the opportunity of developing several subgroup analyses. A prospective data collection with high methodological quality on minimally invasive and open gastrectomies can clarify the role of diff erent procedures with the aim to develop specifi c guidelines. Methods and analysis: a multi-institutional prospective database will be established including information on surgical, clinical and oncological features of patients treated for gastric cancer with robotic, laparoscopic or open approaches and subsequent follow-up. The study has been shared by the members of the International study group on Minimally Invasive surgery for GASTRIc Cancer (IMIGASTRIC) The database is designed to be an international electronic submission system and a HIPPA protected real time data repository from high volume gastric cancer centers. Ethics: This study is conducted in compliance with ethical principles originating from the Helsinki Declaration, within the guidelines of Good Clinical Practice and relevant laws/regulations. Trial registration number: NCT02751086

Dilatation of the entire thoracic aorta in patients with bicuspid aortic valve: a magnetic resonance angiography study

VASA ◽  
2005 ◽  
Vol 34 (3) ◽  
pp. 181-185 ◽  
Author(s):  
Westhoff-Bleck ◽  
Meyer ◽  
Lotz ◽  
Tutarel ◽  
Weiss ◽  
...  
Keyword(s):  
Magnetic Resonance ◽  
Magnetic Resonance Angiography ◽  
Aortic Valve ◽  
Pulmonary Artery ◽  
Aortic Arch ◽  
Thoracic Aorta ◽  
Aortic Root ◽  
Ascending Aorta ◽  
Descending Aorta ◽  
Severe Aortic Regurgitation

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.

Treatment of an asymptomatic penetrating aortic ulcer in a young patient

VASA ◽  
2010 ◽  
Vol 39 (2) ◽  
pp. 175-179
Author(s):  
Hakimi ◽  
Geisbüsch ◽  
Gross ◽  
Hyhlik-Dürr ◽  
Hausser ◽  
...  
Keyword(s):  
Electron Microscopy ◽  
Connective Tissue ◽  
Aortic Arch ◽  
Open Surgery ◽  
Open Repair ◽  
Thoracic Endovascular Aortic Repair ◽  
Concomitant Disease ◽  
Connective Tissue Disorders ◽  
Penetrating Aortic Ulcer ◽  
Pathological Analysis

We want to report and discuss the indication for open surgery for an asymptomatic penetrating aortic ulcer (PAU) in the era of thoracic endovascular aortic repair (TEVAR). A 31-year-old female presented with the diagnosis of an aneurysm in the distal aortic arch. With respect to the patient’s young age, the controversial status of connective tissue disorders and in the absence of concomitant disease, open repair was indicated. There was no proof of a mycotic plaque or connective tissue disease in the microbiological-, pathological analysis and at electron-microscopy. The patient was discharged on the thirteenth postoperative day. In spite of good preliminary results of TEVAR in PAU, in selective cases there is still an indication for open surgery.

Surgery of the ascending aorta and the aortic arch through partial upper sternotomy

2010 ◽  
Vol 58 (S 01) ◽  
Author(s):  
H Deschka ◽  
M Machner ◽  
S El Dsoki ◽  
A Alken ◽  
G Wimmer-Greinecker
Keyword(s):  
Aortic Arch ◽  
Ascending Aorta
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