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.

Factors Associated With an Abnormal Blood Pressure Response During Exercise After Coarctation Repair

2021 ◽  
Vol 13 (1) ◽  
pp. 53-59
Author(s):  
Mia Pivirotto ◽  
Michael F. Swartz ◽  
Megan B. McGreevy ◽  
Nader Atallah-Yunes ◽  
Jill M. Cholette ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Aortic Arch ◽  
Blood Pressure Response ◽  
Pressure Response ◽  
Exercise Stress ◽  
Factors Associated ◽  
Coarctation Repair ◽  
Brachiocephalic Trunk ◽  
Aortic Arch Repair

Background Although resting blood pressures following aortic arch repair or the extended end-to-end anastomosis (EEA) repair for coarctation can be physiologic, factors associated with an abnormal blood pressure response after exercise are unknown. We measured blood pressure gradients following exercise in children who had undergone previous repair in accordance with a surgical selection algorithm and sought to identify factors associated with an abnormal blood pressure response. Methods In accordance with our practice's surgical algorithm for repair of coarctation, infants were stratified to aortic arch repair when the distal transverse arch-to-left carotid artery ratio (DTA:LCA) ≤ 1.0, or when a brachiocephalic trunk or intra-cardiac lesion requiring repair was present. A thoracotomy and EEA were otherwise used. A follow-up exercise stress test (EST) measured the arm:leg blood pressure gradient after exercise, and a gradient ≥ 20 mm Hg was defined as an abnormal blood pressure response. Results Thirty-seven infants who had previously undergone coarctation repair (aortic arch repair-19, EEA-18) completed an EST at 12.3 ± 2.2 years of age. Thirteen (35%) children (aortic arch repair-5, EEA-8; p = .3) exhibited an abnormal blood pressure response. Factors associated with an abnormal blood pressure response included: smaller DTA:LCA ratios prior to repair (1.0 ± .2 vs. 1.2 ± .3; p = .04) and greater body weight at the time of EST (57.5 ± 19.1 vs. 40.9 ± 15.6 kg; p = .03). Conclusion An abnormal blood pressure response following exercise is associated with smaller DTA:LCA ratios at the time of repair and increased weight during follow-up suggesting that patients with these factors warrant close observation.

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 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.

Ascending Aortic Replacement With Aortic Valve Reimplantation

Circulation ◽  
1999 ◽  
Vol 100 (suppl_2) ◽  
Author(s):  
Wolfgang Harringer ◽  
Klaus Pethig ◽  
Christian Hagl ◽  
Gerd P. Meyer ◽  
Axel Haverich
Keyword(s):  
Aortic Valve ◽  
Aortic Insufficiency ◽  
Additional Patient ◽  
Valve Repair ◽  
Sinotubular Junction ◽  
Aortic Replacement ◽  
Ascending Aortic Replacement ◽  
Ischemic Attack ◽  
Aortic Valve Reimplantation

Background —Reimplantation of the native, structurally intact aortic valve within a Dacron tube graft in patients with aortic root aneurysms corrects annular ectasia and dilatation of the sinotubular junction. The durability of this valve repair with respect to the increased mechanical stress on valve cusps has been discussed, is quite controversial, and is yet unknown. Methods and Results —From July 1993 to November 1998, a replacement of the ascending aorta with a repair of the aortic valve was performed in 75 patients (53 men and 22 women aged 50±19 years). Twenty-one patients (28%) had Marfan syndrome, and 11 patients (15%) had an aortic dissection, type Stanford A (6 acute, 5 chronic). In 17 patients (23%), concomitant replacement of the aortic arch was necessary. Clinical and echocardiographic follow-up was performed in 6- to 12-month intervals for a cumulative study period of 137 patient-years. No operative deaths occurred. Two patients (3%) died 5 and 20 months postoperatively. One additional patient experienced a transient ischemic attack within the first postoperative week. Three patients (4%) with progressive aortic insufficiency required aortic valve replacement after 9, 11, and 14 months. All other patients had no or mild aortic insufficiency. The repairs have now remained stable for ≤65 months (mean, 22±20 months). Other valve-related complications did not occur. Conclusions —Our results demonstrate that this type of aortic valve repair achieves excellent results in selected patients. Perfect coaptation of valve cusps during the repair with no or only trace aortic insufficiency at initial echocardiography seems to be essential for durability.

scholarly journals Mid-term durability of polytetrafluoroethylene patches in unicuspid aortic valve repair

2020 ◽  
Vol 31 (4) ◽  
pp. 555-558
Author(s):  
Irem Karliova ◽  
Tristan Ehrlich ◽  
Shunsuke Matsushima ◽  
Sebastian Ewen ◽  
Hans-Joachim Schäfers
Keyword(s):  
Aortic Valve ◽  
Aortic Regurgitation ◽  
Valve Replacement ◽  
Aortic Valve Repair ◽  
Valve Repair ◽  
Severe Aortic Regurgitation ◽  
Aortic Replacement ◽  
Primary Indication ◽  
Ascending Aortic Replacement

Abstract OBJECTIVES Unicuspid aortic valve (UAV) morphology is a cause for aortic valve dysfunction in childhood or adolescence. Repair requires the use of patch material, and polytetrafluoroethylene (PTFE) has been proposed for this purpose because of lack of calcification. We reviewed our mid-term experience with PTFE for the repair of UAV to analyse the durability of this technique. METHODS Out of 21 patients with an UAV undergoing aortic valve repair for severe aortic regurgitation between 2014 and 2016, 11 patients (52%) were treated using PTFE patch material. Aortic regurgitation was present in all patients, the primary indication for surgery was regurgitation in 8, stenosis in 2 and aneurysm in 1. Symmetric bicuspidization of the UAV was performed in all. One patient required additional root remodelling for root dilatation, and another 3 tubular ascending aortic replacement. RESULTS No patient died in hospital or during follow-up. Seven patients (63.6%) required reoperation for progressive AR. Freedom from reoperation was 58% at 1 and 35% at 5 years postoperatively. At reoperation the PTFE patches were found dehisced from aortic wall and/or native cusp tissue. In 3 patients re-repair was performed; a stable result was achieved in 1. Two patients underwent valve replacement 3 months and 1 year postoperatively. The other 4 patients underwent valve replacement. CONCLUSIONS The repair of UAVs using PTFE patch is associated with poor durability, a more durable patch with better healing characteristics material is needed.

scholarly journals Open descending aortic replacement in a patient with a fractured Djumbodis™ dissection system

2020 ◽  
Vol 58 (1) ◽  
pp. 199-201 ◽  
Author(s):  
Takuya Fujikawa ◽  
Simon C Y Chow ◽  
Aliss T C Chang ◽  
Randolph H L Wong
Keyword(s):  
Aortic Arch ◽  
Acute Type ◽  
Aortic Arch Replacement ◽  
Type A Aortic Dissection ◽  
Endovascular Interventions ◽  
Aortic Replacement ◽  
Stent System ◽  
High Incidence ◽  
Descending Aortic Aneurysm

Abstract The Djumbodis™ dissection system was introduced as an alternative to aortic arch replacement in acute type A aortic dissection involving the arch. In our own experience, some patients with Djumbodis implantation developed distal aortic arch and descending aortic aneurysm during subsequent follow-up and required additional interventions. However, as there is a high incidence of fracture associated with the Djumbodis system, further endovascular interventions are not feasible. We report a case of successful open descending aortic replacement in a patient with a fractured Djumbodis stent system.

scholarly journals Aortic Geometric Alteration Associated With Acute Type B Aortic Dissection: Angulation, Tortuosity, and Arch Type

2021 ◽  
Vol 12 ◽  
Author(s):  
Likun Sun ◽  
Jiehua Li ◽  
Lunchang Wang ◽  
Quanming Li ◽  
Hao He ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Aortic Arch ◽  
False Lumen ◽  
Ascending Aorta ◽  
Acute Type ◽  
Type B ◽  
Type B Aortic Dissection ◽  
True Lumen ◽  
Factors Associated ◽  
Geometric Factors

Background: Acute type B aortic dissection is a highly serious aortic pathology. Aortic geometric parameters may be useful variables related to the occurrence of acute type B aortic dissection (aTBAD). The aim of the study is to delineate the alteration in aortic geometric parameters and analyze the specific geometric factors associated with aTBAD.Methods: The propensity score matching method was applied to control confounding factors. The aortic diameter, length, angulation, tortuosity, and type of aortic arch of the aTBAD and control group were retrospectively analyzed via three-dimensional computed tomography imaging created by the 3mensio software (version 10.0, Maastricht, The Netherlands). The geometric variables of true lumen and false lumen in the descending aorta were measured to estimate the severity of aortic dissection. Multivariable logistic regression models were used to investigate the significant and specific factors associated with aTBAD occurrence. The area under the receiver operating characteristic curve (AUC) was used to estimate the performance of the model.Results: After propensity score matching, 168 matched pairs of patients were selected. The ascending aorta and aortic arch diameters were dilated, and the ascending aorta and total aorta lengths were elongated in aTBAD group significantly (P &lt; 0.001). The ascending aorta and aortic arch angulations in the aTBAD group were sharper than those of the controls (P = 0.01, P &lt; 0.001, respectively). The aortic arch and total aorta tortuosities were significantly higher in the aTBAD group (P = 0.001, P &lt; 0.001, respectively). There were more type III arch patients in the aTBAD group than the controls (67.9 vs. 22.6%). The true lumen angulation was sharper than that in the false lumen (P &lt; 0.01). The true lumen tortuosity was significantly lower than that in the false lumen (P &lt; 0.001). The multivariable models identified that aortic arch angulation, tortuosity, and type III arch were independent and specific geometric factors associated with aTBAD occurrence. The AUC of the multivariable models 1, 2, 3 were 0.945, 0.953, and 0.96, respectively.Conclusions: The sharper angulation and higher tortuosity of aortic arch and type III arch were the geometric factors associated with aTBAD in addition to the ascending aorta elongation and aortic arch dilation. The angulation and tortuosity of the true and false lumens may carry significant clinical implications for the treatment and prognosis of aTBAD.

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.

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