Trans-catheter closure of aortic anastomosis leak after aortic replacement: classifications and techniques

Left ventricular assist device (LVAD) implantation is frequently complicated by intraoperative and postoperative bleeding, particularly at the aortic anastomosis site. Many modifications of the anastomosis have been attempted. We describe a simple method to anastomose the LVAD outflow tract to the ascending aorta with minimal bleeding and a short anastomosis time.

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Epigenetic Profiling Identifies Novel Genes for Ascending Aortic Aneurysm Formation with Bicuspid Aortic Valves

The Heart Surgery Forum ◽

10.1532/hsf.1247 ◽

2015 ◽

Vol 18 (4) ◽

pp. 134 ◽

Cited By ~ 12

Author(s):

Asad A Shah

Keyword(s):

Gene Expression ◽

Aortic Aneurysm ◽

Methylation Status ◽

Aortic Aneurysms ◽

Aortic Valves ◽

Ascending Aortic Aneurysm ◽

Novel Genes ◽

Aneurysm Formation ◽

Aortic Replacement ◽

Bicuspid Aortic Valves

Background: Bicuspid aortic valves predispose to ascending aortic aneurysms, but the mechanisms underlying this aortopathy remain incompletely characterized. We sought to identify epigenetic pathways predisposing to aneurysm formation in bicuspid patients.Methods: Ascending aortic aneurysm tissue samples were collected at the time of aortic replacement in subjects with bicuspid and trileaflet aortic valves. Genome-wide DNA methylation status was determined on DNA from tissue using the Illumina 450K methylation chip, and gene expression was profiled on the same samples using Illumina Whole-Genome DASL arrays. Gene methylation and expression were compared between bicuspid and trileaflet individuals using an unadjusted Wilcoxon rank sum test. Results: Twenty-seven probes in 9 genes showed significant differential methylation and expression (P<5.5x10-4). The top gene was protein tyrosine phosphatase, non-receptor type 22 (PTPN22), which was hypermethylated (delta beta range: +15.4 to +16.0%) and underexpressed (log 2 gene expression intensity: bicuspid 5.1 vs. trileaflet 7.9, P=2x10-5) in bicuspid patients, as compared to tricuspid patients. Numerous genes involved in cardiovascular development were also differentially methylated, but not differentially expressed, including ACTA2 (4 probes, delta beta range: -10.0 to -22.9%), which when mutated causes the syndrome of familial thoracic aortic aneurysms and dissectionsConclusions: Using an integrated, unbiased genomic approach, we have identified novel genes associated with ascending aortic aneurysms in patients with bicuspid aortic valves, modulated through epigenetic mechanisms. The top gene was PTPN22, which is involved in T-cell receptor signaling and associated with various immune disorders. These differences highlight novel potential mechanisms of aneurysm development in the bicuspid population.

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3D model-guided trans-catheter closure of a complex aortic paravalvular leak

Journal of Cardiovascular Medicine ◽

10.2459/jcm.0000000000001082 ◽

2020 ◽

Vol Publish Ahead of Print ◽

Author(s):

Magdalena Cuman ◽

Giuseppe Santoro ◽

Katia Capellini ◽

Emanuele Gasparotti ◽

Alessandra Pizzuto ◽

...

Keyword(s):

3D Model ◽

Paravalvular Leak ◽

Catheter Closure

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Faculty Opinions recommendation of Effects of fibrinogen concentrate as first-line therapy during major aortic replacement surgery: a randomized, placebo-controlled trial.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.717969618.793470234 ◽

2013 ◽

Author(s):

Philippe Van der Linden ◽

Yannick Ciccarella

Keyword(s):

Controlled Trial ◽

Fibrinogen Concentrate ◽

First Line ◽

Replacement Surgery ◽

First Line Therapy ◽

Line Therapy ◽

Aortic Replacement

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Faculty Opinions recommendation of The fate of aortic root and aortic regurgitation after supracoronary ascending aortic replacement for acute type A aortic dissection.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.737098067.793569066 ◽

2019 ◽

Author(s):

John Augoustides

Keyword(s):

Aortic Dissection ◽

Aortic Regurgitation ◽

Aortic Root ◽

Type A ◽

Acute Type ◽

Type A Aortic Dissection ◽

Aortic Replacement ◽

Ascending Aortic Replacement

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Passing a Mechanical Aortic Valve With a Short Tip Dilator to Facilitate Aortic Arch Endovascular Branched Repair

Journal of Endovascular Therapy ◽

10.1177/15266028211002506 ◽

2021 ◽

pp. 152660282110025

Author(s):

Nikolaos Konstantinou ◽

Sven Peterss ◽

Jan Stana ◽

Barbara Rantner ◽

Ramin Banafsche ◽

...

Keyword(s):

Aortic Valve ◽

Aortic Arch ◽

Stent Graft ◽

Mechanical Valve ◽

Valve Prosthesis ◽

Proper Position ◽

Mechanical Aortic Valve ◽

Aortic Replacement ◽

Custom Made ◽

Aortic Valve Prosthesis

Purpose To present a novel technique to successfully cross a mechanical aortic valve prosthesis. Technique A 55-year-old female patient with genetically verified Marfan syndrome presented with a 5-cm anastomotic aneurysm of the proximal aortic arch after previous ascending aortic replacement due to a type A aortic dissection in 2007. The patient also underwent mechanical aortic valve replacement in 1991. A 3-stage hybrid repair was planned. The first 2 steps included debranching of the supra-aortic vessels. In the third procedure, a custom-made double branched endovascular stent-graft with a short 35-mm introducer tip was implanted. The mechanical valve was passed with the tip of the dilator on the lateral site of the leaflet, without destructing the valve and with only mild symptoms of aortic insufficiency, as one leaflet continued to work. This allowed the implantation of the stent-graft directly distally of the coronary arteries. Postoperative computed tomography angiography showed no endoleaks and patent coronary and supra-aortic vessels. Conclusion Passing a mechanical aortic valve prosthesis at the proper position is feasible and allows adequate endovascular treatment in complex arch anatomy. However, caution should be taken during positioning of the endovascular graft as the tip may potentially damage the valve prosthesis.

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A 60-year-old woman with asymptomatic total thoracic–abdominal aortic aneurysm

Journal of Cardiothoracic Surgery ◽

10.1186/s13019-021-01600-0 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Jianying Deng ◽

Wei Liu

Keyword(s):

Abdominal Aortic Aneurysm ◽

Aortic Aneurysm ◽

Effective Treatment ◽

Clinical Symptoms ◽

Aortic Aneurysms ◽

Case Presentation ◽

Second Stage ◽

Aortic Replacement ◽

Abdominal Aortic ◽

Thoracoabdominal Aortic Replacement

Abstract Introduction Total thoracic–abdominal aortic aneurysm is a rare disease in cardiovascular surgery, with high surgical risk and high mortality. Surgery is considered the most effective treatment for total aortic aneurysms. Case presentation Our group admitted a 60-year-old female patients with asymptomatic complex total thoracic–abdominal aortic aneurysm, and successfully performed two-staged surgery, namely Bentall + Sun’s operation in the first-stage and thoracoabdominal aortic replacement in the second-stage. The results of the surgery were satisfactory. Conclusions Patients with total thoracic–abdominal aortic aneurysm may not have typical clinical symptoms and require a careful and comprehensive physical examination and related auxiliary examinations by clinicians. Staged repair of total thoracic–abdominal aortic aneurysms is still a safe and effective treatment.

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