scholarly journals Rethinking the Paradigm: Modern Approach to Proximal Aortic Reconstruction Demonstrates Excellent Outcomes

2017 ◽  
Vol 20 (3) ◽  
pp. 092 ◽  
Author(s):  
Jonathan M Hemli ◽  
Edward R. R. DeLaney ◽  
Kush R. Dholakia ◽  
Dror Perk ◽  
Nirav C. Patel ◽  
...  
Keyword(s):  
Surgical Intervention ◽  
Elective Surgery ◽  
Circulatory Arrest ◽  
Aortic Surgery ◽  
Ascending Aorta ◽  
Aortic Root Replacement ◽  
Aortic Aneurysms ◽  
Moderate Hypothermia ◽  
Modern Approach ◽  
Modern Era

Background: Techniques for aortic surgery continue to evolve. A real-world snapshot of patients undergoing elective surgery for aneurysm in the modern era is helpful to assist in deciding the appropriate timing for intervention. We herein describe our experience with 100 consecutive patients who underwent primary elective surgery for aneurysm of the proximal thoracic aorta over a two-year period at a single institution.Methods: The majority of our patients were male, mean age 61.19 ± 13.33 years. Two patients had Marfan syndrome. Twenty-eight patients had bicuspid aortic valve. Thirty-four patients underwent aortic root replacement utilizing a composite valve/graft conduit; 23 had valve-sparing root replacements. The ascending aorta was replaced in 89 patients; 80 (89.9%) of these included a period of circulatory arrest at moderate hypothermia utilizing unilateral selective antegrade cerebral perfusion.Results: Thirty-day mortality was zero. Perioperative stroke occurred in 2 patients, both of whom completely recovered prior to discharge. No patients required re-exploration for bleeding. One patient developed a sternal wound infection. Fifteen patients required readmission to hospital within thirty days of discharge.Conclusion: Elective surgery for aneurysm of the proximal aorta is safe, reproducible, and is associated with outcomes that are superior to those seen in an acute aortic syndrome. It may be appropriate to offer surgery to younger patients with proximal aortic aneurysms at smaller diameters, even if their aortic dimensions do not yet meet traditional guidelines for surgical intervention.

Sex-Specific Outcome after Ascending Aortic Surgery in Moderate Hypothermic Circulatory Arrest

2019 ◽  
Author(s):  
Christine Friedrich ◽  
Miriam Freundt ◽  
Mohamed Ahmed Salem ◽  
Bernd Panholzer ◽  
Katharina Huenges ◽  
...  
Keyword(s):  
Heart Surgery ◽  
Elective Surgery ◽  
Circulatory Arrest ◽  
Aortic Surgery ◽  
Female Gender ◽  
Gender Disparity ◽  
Ascending Aorta ◽  
Hypothermic Circulatory Arrest ◽  
Short Term Mortality ◽  
Specific Outcome

Abstract Background Historically, female patients had worse outcome undergoing heart surgery. No recent data exist on gender-specific outcome after moderate hypothermic circulatory arrest (MHCA). The aim of this large retrospective analysis was to investigate gender disparity in patients undergoing elective surgery of ascending aorta in MHCA at 24°C. Methods We conducted a retrospective review of 905 (33.3% female) cases of elective heart surgery in MHCA for ascending aortic aneurysm (90.9%) or severely calcified aorta (12.5%) between 2001 and 2015. Furthermore, 299 female and 299 male patients matched by propensity score were compared. Patients with dissection of the aorta were excluded. Results Women were older (68.4 ± 9.9 vs. 65.8 ± 11.6 years; p = 0.002), had higher logistic EuroSCORE I (18.4 [11.7; 29.2] vs. 12.3% [7.4; 22.6]; p < 0.001), and significantly shorter cardiopulmonary bypass (CPB) time (132 [105; 175] vs. 150 [118; 192] minutes; p < 0.001), while mean MHCA time was longer (15 [13; 19] vs. 14 [12; 17] minutes; p = 0.003). Surgical procedures were less complex in women and they were treated more frequently by isolated supracoronary ascending aorta replacement (61 vs. 54%; p = 0.046). Postoperatively, men showed a higher incidence of neurologic complications (7.0 vs. 3.3%; p = 0.03). The 30-day mortality (women 4.9% vs. men 3.9%; p = 0.48) did not differ significantly, likewise after statistical matching (4.7 vs. 2.3%; p = 0.120). Age, CPB time, and blood transfusion, but not female gender, were risk factors for mortality in multivariable regression analysis. Conclusion This study supports the hypothesis that female gender is not associated with increased short-term mortality or perioperative adverse events in elective aortic surgery in MHCA.

scholarly journals Does deeper hypothermia reduce the risk of acute kidney injury after circulatory arrest for aortic arch surgery?

2021 ◽  
Author(s):  
Andrew M Vekstein ◽  
Babtunde A Yerokun ◽  
Oliver K Jawitz ◽  
Julie W Doberne ◽  
Jatin Anand ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Circulatory Arrest ◽  
Aortic Surgery ◽  
Multivariable Analysis ◽  
Kidney Injury ◽  
Deep Hypothermia ◽  
Moderate Hypothermia ◽  
Bladder Temperature ◽  
Increased Risk ◽  
The Impact

Abstract OBJECTIVES The impact of hypothermic circulatory arrest (HCA) temperature on postoperative acute kidney injury (AKI) has not been evaluated. This study examined the association between circulatory arrest temperatures and AKI in patients undergoing proximal aortic surgery with HCA. METHODS A total of 759 consecutive patients who underwent proximal aortic surgery (ascending ± valve ± root) including arch replacement requiring HCA between July 2005 and December 2016 were identified from a prospectively maintained institutional aortic surgery database. The primary outcome was AKI as defined by Risk, Injury, Failure, Loss, End Stage Renal Disease (ESRD) criteria. The association between minimum nasopharyngeal (NP) and bladder temperatures during HCA and postoperative AKI was assessed, adjusting for patient-level factors using multivariable logistic regression. RESULTS A total of 85% (n = 645) of patients underwent deep hypothermia (14.1–20.0°C), 11% (n = 83) low-moderate hypothermia (20.1–24.0°C) and 4% (n = 31) high-moderate hypothermia (24.1–28.0°C) as classified by NP temperature. When analysed by bladder temperature, 59% (n = 447) underwent deep hypothermia, 22% (n = 170) low-moderate, 16% (n = 118) high-moderate and 3% mild (n = 24) (28.1–34.0°C) hypothermia. The median systemic circulatory arrest time was 17 min. The incidence of AKI did not differ between hypothermia groups, whether analysed using minimum NP or bladder temperature. In the multivariable analysis, the association between degree of hypothermia and AKI remained non-significant whether analysed as a categorical variable (hypothermia group) or as a continuous variable (minimum NP or bladder temperature) (all P &gt; 0.05). CONCLUSIONS In patients undergoing proximal aortic surgery including arch replacement requiring HCA, degree of systemic hypothermia was not associated with the risk of AKI. These data suggest that moderate hypothermia does not confer increased risk of AKI for patients requiring circulatory arrest, although additional prospective data are needed.

Obstructive sleep apnea and the progression of thoracic aortic aneurysm: a prospective cohort study

2020 ◽  
pp. 2003322
Author(s):  
Thomas Gaisl ◽  
Protazy Rejmer ◽  
Maurice Roeder ◽  
Patrick Baumgartner ◽  
Noriane A. Sievi ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Risk Factor ◽  
Sleep Apnea ◽  
Elective Surgery ◽  
Positive Association ◽  
Ascending Aorta ◽  
Aortic Aneurysms ◽  
Apnea Hypopnea Index ◽  
Aortic Sinus ◽  
Obstructive Sleep

BackgroundObstructive sleep apnea (OSA) is associated with an increased prevalence of aortic aneurysms, and it has also been suggested that severe OSA furthers aneurysm expansion in the abdomen. We evaluated whether OSA is a risk factor for the progression of ascending thoracic aortic aneurysms (TAA).MethodsPatients with TAA underwent yearly standardised echocardiographic measurements of the ascending aorta over 3 years, and two level-III sleep studies. The primary outcome was the expansion rate of TAA in relation to the apnea-hypopnea-index (AHI). Secondary outcomes included surveillance for aortic events (composite endpoints of rupture, dissection, elective surgery, and death).ResultsBetween July 2014 and March 2020, 230 patients (median age 70 years, 78% male) participated in the cohort. At baseline, 34.8% of patients had an AHI of ≥15 events·h−1. There was no association between TAA diameters and the AHI at baseline. After 3 years mean expansion rates were 0.55±1.25 mm at the aortic sinus and 0.60±1.12 mm at the ascending aorta. In the regression analysis, after controlling for baseline diameter and cardiovascular risk factors, there was strong evidence for a positive association of TAA expansion with AHI (aortic sinus estimate 0.025 mm [95%CI 0.009 to 0.040], p<0.001; ascending aorta estimate 0.026 mm [95%CI 0.011 to 0.041], p=0.001). Twenty participants (8%) experienced an aortic event, however, there was no association with OSA severity.ConclusionOSA may be a modest but independent risk factor for faster TAA expansion and thus potentially contributes to life-threatening complications in aortic disease.

scholarly journals Pseudoaneurysm of Ascending Aorta with Sternal Erosion after Double Valve Replacement—A Case Report

2019 ◽  
Vol 04 (02) ◽  
pp. 092-094
Author(s):  
Ravi Kumar Kathi ◽  
Amaresh Rao Malempati ◽  
Goutham Kollapalli ◽  
Chaitra Krishna Batt ◽  
Sayyad Sohail Tarekh
Keyword(s):  
Rare Complication ◽  
Circulatory Arrest ◽  
Aortic Surgery ◽  
Muscle Flap ◽  
Ascending Aorta ◽  
Hypothermic Circulatory Arrest ◽  
Chronic Hypertension ◽  
Pulsatile Mass ◽  
Fatal Hemorrhage ◽  
Femorofemoral Bypass

AbstractPseudoaneurysm of ascending aorta is a rare complication after aortic surgery. Predisposing factors can be infection, chronic hypertension, connective tissue disorders, or dissection. Chest pain, sternal erosion, dysphagia, or stridor can be the modes of presentation. It can also present as a pulsatile mass. Redo sternotomy in a case of pseudoaneurysm of aorta can cause fatal hemorrhage or air embolism. In such a scenario, femorofemoral bypass and hypothermic circulatory arrest help to simplify the approach to the pseudoaneurysm. The authors present a case of a 23-year-old female with pseudoaneurysm of the ascending aorta causing sternal erosion. Ascending aortic repair was done using Dacron patch with femorofemoral bypass and hypothermic circulatory arrest. Sternum was repaired using pectoralis major muscle flap.

scholarly journals Giant Aortic Pseudoaneurysm with Stanford Type A Aortic Dissection after Aortic Valve Replacement

2012 ◽  
Vol 2012 ◽  
pp. 1-3 ◽  
Author(s):  
Mertay Boran ◽  
Ali İhsan Parlar ◽  
Ertay Boran
Keyword(s):  
Aortic Valve ◽  
Aortic Dissection ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Aortic Surgery ◽  
Type A ◽  
Ascending Aorta ◽  
Aortic Aneurysms ◽  
Type A Aortic Dissection ◽  
Aortic Pseudoaneurysm

Giant pseudoaneurysm of the ascending aorta is a rare but dreadful complication occurring several months or years after aortic surgery. Thoracic aortic aneurysms tend to be asymptomatic and were previously often diagnosed only after a complication such as dissection or rupture. We present a rare case of giant ascending aneurysm with Stanford type A aortic dissection occurring 6 years after aortic valve replacement and also illustrate the potential dimensions the ascending aorta may reach by a pseudoaneurysm and dissection after AVR.

scholarly journals INNOMINATE ARTERY CANNULATION FOR PROXIMAL AORTIC SURGERY

2020 ◽  
Author(s):  
Bülent Mert ◽  
kamil boyacıoğlu ◽  
Hakan Sacli ◽  
Berk Özkaynak ◽  
Ibrahim Kara ◽  
...  
Keyword(s):  
Cardiopulmonary Bypass ◽  
Cerebral Perfusion ◽  
Circulatory Arrest ◽  
Aortic Surgery ◽  
Innominate Artery ◽  
Arterial Injury ◽  
Ascending Aorta ◽  
Artery Cannulation ◽  
The Mean ◽  
Antegrade Cerebral Perfusion

Background. The aim of this study was to evaluate the efficacy and safety of innominate artery cannulation strategy with side graft technique in proximal aortic pathologies. Methods. A total of 70 patients underwent innominate artery cannulation with a side graft for surgery on the proximal aorta from 2012 to 2020. There were 46 men and 24 women with an avarage age of 56 ±13 years. The indications of surgery were type A aortic dissection in 17 patients (24.3%), aortic aneurysm in 52 patients (74.3%) and ascending aorta pseudoaneurysm in 1 patient (1.4%). The innominate artery was free of disease in all patients. Hypothermic circulatory arrest with antegrade cerebral perfusion was utilized in 60 patients (85.7%). 3 patients had previous sternotomy (4.2%). The most common surgical procedure was ascending aorta and hemiarch replacement in 34 patients (48.5%). Results. The mean cardiac ischemia and cardiopulmonary bypass times were 116+46 minutes and164+56 minutes, respectively. The mean antegrade cerebral perfusion time was 27+14 minutes. The patients were cooled between 22’C and 30’C during surgery. 30-day mortality rate was 7.1% with 5 patients. 1 patient (1.4%) had stroke, 1 patient (1.4%) had temporary neurologic deficit and 8 patients (11.4%) had confusion and agitation that resolved completely in all cases. There was no local complication or arterial injury was encounterd. Conclusions. Cannulation of the innominate artery with side graft is safe and effective for both cardiopulmonary bypass and antegrade cerebral perfusion. This technique provides excellent neurologic outcomes for proximal aortic surgery.

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

2011 ◽  
Vol 77 (11) ◽  
pp. 1438-1444 ◽  
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.

scholarly journals Aortic Arch Replacement without Deep Hypothermic Circulatory Arrest

2021 ◽  
Vol 2021 ◽  
pp. 1-3
Author(s):  
Zviad Bakhutashvili ◽  
Lia Janelidze ◽  
Kakhaber Beria ◽  
Simon Matikashvili ◽  
Eduard Limonjiani
Keyword(s):  
Aortic Valve ◽  
Aortic Arch ◽  
Circulatory Arrest ◽  
Artery Bypass ◽  
Deep Hypothermic Circulatory Arrest ◽  
Ascending Aorta ◽  
Hypothermic Circulatory Arrest ◽  
Moderate Hypothermia ◽  
Aortic Arch Replacement ◽  
Valve Insufficiency

A 60-year-old man presented with a thoracic aortic aneurysm without rupture accompanied by severe nonrheumatic aortic valve insufficiency and unstable angina. Surgery was performed and included several steps: (1) resection and reconstruction of ascending aorta and aortic arch using a tube graft, (2) replacement of aortic valve using a biological prosthesis, and (3) coronary artery bypass grafting was performed with two distal anastomoses. All of these procedures were performed with total cardiopulmonary bypass without deep hypothermic circulatory arrest under conditions of moderate hypothermia using dual concurrent cannulation of the subclavian and femoral arteries.

scholarly journals Aortic root replacement after previous surgical intervention on the aortic valve, aortic root, or ascending aorta

2006 ◽  
Vol 131 (3) ◽  
pp. 601-608 ◽  
Author(s):  
E.W. Matthias Kirsch ◽  
N. Costin Radu ◽  
Armand Mekontso-Dessap ◽  
Marie-Line Hillion ◽  
Daniel Loisance
Keyword(s):  
Aortic Valve ◽  
Aortic Root ◽  
Surgical Intervention ◽  
Ascending Aorta ◽  
Aortic Root Replacement

PROTECTION OF CENTRAL AND PERIPHERAL ORGANS IN AORTIC SURGERY

2020 ◽  
pp. 19-23
Author(s):  
Olha Volodymyrivna Buchnieva
Keyword(s):  
Circulatory Arrest ◽  
Aortic Surgery ◽  
Original Method ◽  
Moderate Hypothermia ◽  
Organ Protection ◽  
Results Of Treatment ◽  
Post Surgery ◽  
Visceral Arteries ◽  
Systemic Hypothermia ◽  
Selective Perfusion

The introduction into clinical practice of hypothermic circulatory arrest, both in the non−perfusion version and with an artificial circulation, was the beginning of active use of systemic hypothermia as an effective element of cerebral and visceral protection during combined cardiac surgeries, including in aorta pathology. To evaluate ways of protecting visceral organs and spinal cord, namely the "no perfusion" technique with drainage of cerebrospinal fluid, lateral aortic compression, left−atrial−femoral bypass, deep hypothermia with cardiac arrest, i.e. hypothermic circulatory arest, bypass grafting, artificial blood circulation and moderate hypothermia in surgery for acute aortic syndrome the results of treatment of the patients with acute bundle aortic aortic abdominal localization were analyzed. There was characterized the proposed and implemented in practice original method of protection, consisting in an access to aorta, which is pressed above the aneurysm at the level of bifurcation, and selective perfusion into the mouth of vessels supplying the internal organs with a custodiol solution with a temperature of 3−4°. All the patients with combined occlusion−stenotic lesions of different arterial pools have aortic prostheses with the inclusion of visceral arteries into bloodstream in different variants. The tendency of the more favorable post−surgery period in the patients to whom the implemented methods of protection were applied. Key words: aortic aneurysm, surgical treatment, organ protection.

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