scholarly journals Aneurysms of the ascending aorta and aortic arch – diagnostics, methods and results of surgical intervention

2019 ◽  
pp. 409-414
Author(s):  
Vasy Lazoryshynets ◽  
Anatolii Rudenko ◽  
Vitalii Kravchenko ◽  
Olena Larionova ◽  
Ivan Kravchenko ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Aortic Arch ◽  
Median Sternotomy ◽  
Ascending Aorta ◽  
Diagnostic Methods ◽  
Elephant Trunk ◽  
Aorta Aneurysm ◽  
Bentall Procedure ◽  
Heart Lung Machine ◽  
Lung Machine

Ascending aorta aneurysm and aortic arch aneurysm surgery remain some of the most complex problems that cardiovascular surgeons face. It stems from the need for the correction of the underlying pathology while simultaneously adequately protecting the brain and visceral arteries. Purpose. The aim of our study was to determine the incidence of post-surgical complications and the immediate post-surgical results of surgical treatment of ascending aorta aneurysms and/or aortic arch aneurysms. Materials and methods. During the twelve-year period of 1994– 2016, we have surgically operated on a total of 317 patients aneurysms of the ascending aorta and/or the aortic arch. The method we employed to diagnose the aneurysms consisted of evaluating the patients’ medical history, transthoracic and transesophageal echocardiographies, computer tomographies, X-ray examinations, and aortographies. All of the 317 surgeries were performed on the patients under general anaesthesia, and the incision via the the median sternotomy, employing the use of a heart-lung machine. Valve sparing technique with aortic valve resuspension / valvuloplasty and hemiarch/arch replacement – 221/6 patients (69.7 %). Bentall procedure with hemiarch/arch replacement – 67/4 (21.1 %). Other surgeries – 29 (9.2 % of patients). Results and discussion. The history of aortic aneurysm development is briefly mentioned in the paper. The diagnostic methods presented are currently the primary method of computer tomography. The initial condition of the patients was serious enough. All surgeries were performed through a median sternotomy and with the use of heart-lung machine. For surgical treatment of aneurysms the following techniques were used: напівдуги/дуги – у 221/6 (69,7 %) хворих. У цій групі 7 операцій Yacoub, 3 операції David. У 7 пацієнтів виконана плікація однієї зі стулок при пролапсі аортального клапана. Укріплення вільного краю стулки виконано в 3 хворих, пластика латкою фенестрацій стулки аортального клапана – у 4; 2) операція Bentall з протезуванням напівдуги/дуги – у 67/4 (21,1 %); 3) інші – ізольоване протезування дуги – у 14 (4,4 %); операція Wheat + протезування дуги – у 6 (1,9%); пластика дуги аорти – у 4 (1,3 %); гібридні операції Elephant trunk (conventional Elephant trunk) + TEVAR – у 5 (1,6 %). Захист головного мозку виконувався по-різному на кожному із трьох етапів хірургічного досвіду. Найкращий результат досягнутий на 3 етапі: з 229 прооперованих померли 9 хворих (3,9 %). Також у лікуванні використано сучасний ендоваскулярний метод – гібридні операції Elephant trunk + TEVAR – у 5 (1,6 %) з хорошим безпосереднім результатом. Висновки. 1. При розшаруванні аорти типу А (І тип за De Bakey) операцією вибору є супракоронарне протезування з півдугою (дугою) аорти. 2. Накопичення хірургічного досвіду, вишкіл команди, удосконалення методик захисту головного мозку й вісцеральних органів – дозволили знизити кількість післяопераційних ускладнень з 64 % до 8,7 % і госпітальну летальність з 28 % до 3,9 %. Ключові слова: аневризма дуги, розшарувальна аневризма, глибока гіпотермія, ретроградна церебральна перфузія. Для цитування: Кравченко ВІ, Кравченко ІМ, Третяк ОА, Ларіонова ОБ, Осадовська ІА, Жеков ІІ, Руденко АВ, Лазоришинець ВВ. Аневризми висхідного відділу та дуги аорти: діагностика, методи і результати хірургічного лікування. Журнал Національної академії медичних наук України. 2019;25(4):409–14.

scholarly journals Methods and Results of the Brain and Visceral Organs Protection During the Correction of the Ascending Aorta and Aortic Arch Aneurysm or Isolated Aortic Arch Aneurism

2021 ◽  
pp. 75-81
Author(s):  
V. I. Kravchenko ◽  
I. M. Kravchenko ◽  
I. I. Zhekov ◽  
V. D. Lybavka ◽  
V. V. Lazoryshynets
Keyword(s):  
Aortic Valve ◽  
Aortic Arch ◽  
Median Sternotomy ◽  
Ascending Aorta ◽  
Aortic Arch Aneurysm ◽  
Elephant Trunk ◽  
Bentall Operation ◽  
Visceral Organs ◽  
Arch Aneurysm ◽  
The Brain

The ascending aorta and aortic arch aneurysm surgical correction is the most difficult problem of cardiovascular surgery due to the necessity of management of the main disease and adequate protection of the brain and visceral organs. The aim. To present the methods and results of protection of the central nervous system and visceral organs during the correction of the ascending aorta and aortic arch aneurysm or isolated aortic arch aneurism. Materials and methods. During 1994–2018, we operated 419 patients with the ascending aorta and aortic arch aneurysm (or isolated aortic arch aneurism). Diagnosis of aneurysms was based on clinical data, transthoracic and transesophageal echocardiography, computed tomography, X-ray examination, aortography. All operations were performed under general anesthesia, through the median sternotomy using cardiopulmonary bypass. Valve-sparing technique with aortic valve resuspension/aortic valve plasty and semi-arch/arch replacement was used in 288/9 (68.7%) patients. Bentall operation with semi-arch/arch replacement was used in 86/9 (20.5%) patients. Other operations accounted for 45 (10.7%) patients. Results. The history of the development of aortic aneurysms treatment options is briefly overviewed in the paper. Diagnostic methods are mentioned, but the main method today is computed tomography. Initial status of the patients was severe. All operations were performed through median sternotomy using cardiopulmonary bypass. The following techniques were used for surgical treatment of aneurysms: 1) valve-sparing technique with aortic valve resuspension/ plasty and semi-arc/arch replacement was used in 288/9 (68.7%) patients. In this group there were 8 Yacoub operations, 6 David operations. In 7 patients, plication of one of the leaflets was performed in case of aortic valve prolapse. 3 patients underwent strengthening of the free edge of the leaflets and 4 patients underwent plasty by the patch in case of leaflet fenestrations; 2) Bentall operation with semi-arch/arch replacement was used in 86/9 (20.5%); 3) others: isolated arch in 15 (3.6%); Wheat operation + arch in 9 (1.0%); aortic arch plasty in 4 (1.0%); Elephant trunk (conventional Elephant trunk) + TEVAR was used in 17 (4.1%) patients. The brain protection was performed differently at each of the two stages in our surgical experience. The best result was achieved at the last stage. The number of postoperative complications decreased from 34.4% to 8.4% and hospital mortality from 17.2% to 5.3%, respectively. Also, a modern endovascular method – hybrid operations Elephant trunk + TEVAR – was used in 17 (4.1%) patients with good immediate result. Conclusions. 1. At type A aortic dissection (DeBakey type I) the operation of choice is supracoronary ascending aortic replacement with a semi-arch (arch) replacement of the aorta. 2. Accumulation of surgical experience, team training, improvement of methods of protection of the brain and visceral organs allowed to reduce the number of postoperative complications from 34.4% to 8.4% and hospital mortality from 17.2% to 5.3%.

Surgical treatment of the ascending aorta and aortic arch with antegrade cerebral perfusion and moderate hypothermia]]>

2006 ◽  
Vol 21 (4) ◽  
Author(s):  
Marcelo S. S. Martins ◽  
Mauro P. L. S� ◽  
Leonardo Abad ◽  
Eduardo S. Bastos ◽  
Ney Franklin Junior ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Aortic Arch ◽  
Cerebral Perfusion ◽  
Ascending Aorta ◽  
Moderate Hypothermia ◽  
Antegrade Cerebral Perfusion

scholarly journals 506 Uneventful pseudoaneurysm of the ascending aorta with sternal erosion in pregnancy

2020 ◽  
Vol 22 (Supplement_N) ◽  
pp. N142-N145
Author(s):  
Alice Benedetti ◽  
Alvise Del Monte ◽  
Maurizio Rubino ◽  
Daniela Mancuso
Keyword(s):  
Aortic Valve ◽  
Aortic Arch ◽  
Left Ventricular ◽  
Ascending Aorta ◽  
Aortic Arch Aneurysm ◽  
Elective Cesarean Section ◽  
Elephant Trunk ◽  
Severe Aortic Regurgitation ◽  
Intimal Flap ◽  
Arch Aneurysm

Abstract A 36-year-old woman at 31 weeks’ gestation presented with exertional dyspnoea and palpitations. She had a history of bicuspid aortic valve treated with surgical aortic valvotomy for severe stenosis, followed by ascending aorta replacement for type A acute aortic dissection and Bentall operation with a mechanical valve for severe aortic regurgitation. Eight years after the last surgery, magnetic resonance angiography showed aortic arch aneurysm (49 mm) with a small intimal flap. Thereafter, the patient was lost to follow-up until the current admission. She was hemodynamically stable on presentation and physical examination was unremarkable apart from a mechanical second heart sound. The electrocardiogram showed sinus rhythm with left bundle branch block (Panel A). Transthoracic echocardiography revealed severe left ventricular dilation (EDV 90 ml/m2) with mild dysfunction (EF 50%), normal prosthetic aortic valve function, and aortic arch dilation (50 mm) (Panel B and C). After a multidisciplinary evaluation, elective cesarean section was performed at 34 weeks’ gestation. A post-delivery aortic computed tomography angiography revealed aortic arch aneurysm (52 mm) with intimal flap and two pseudoaneurysms of the anterior aortic wall causing sternal erosion (Panel D, E, F and G). Subsequently, the patient underwent ascending aorta and aortic arch replacement by Frozen Elephant Trunk technique with a 24 x130 mm prosthesis between the aortic root and the descending aorta. The postoperative course was uneventful, and the patient was discharged to a cardiac rehabilitation centre.

scholarly journals Minimally Invasive Aortic Arch Repair: Technical Considerations and Mid-Term Outcomes

2020 ◽  
Vol 23 (6) ◽  
pp. E803-E808
Author(s):  
Petar Risteski ◽  
Medhat Radwan ◽  
Gjoko Boshkoski ◽  
Razan Salem ◽  
Annarita Iavazzo ◽  
...  
Keyword(s):  
Aortic Arch ◽  
Median Sternotomy ◽  
Minimal Invasive ◽  
Minimal Access ◽  
Organ Protection ◽  
Elephant Trunk ◽  
Aortic Arch Surgery ◽  
Cord Injury ◽  
Systemic Hypothermia ◽  
Aortic Arch Repair

Background: Reports of minimal invasive aortic arch surgery are scarce. We reviewed our experience with minimal access aortic arch surgery performed through an upper mini-sternotomy, with emphasis on details of operative technique and early and mid-term outcomes. Methods: The medical records of 123 adult patients (mean age 66 ± 12 years), who underwent primary elective minimal access aortic arch surgery in two aortic referral centers, were reviewed. The most common indication was degenerative aortic arch aneurysm in 92 (75%) patients. Standard operative and organ protection techniques used in all patients were upper mini-sternotomy, uninterrupted antegrade cerebral perfusion, and moderate systemic hypothermia (27.4 ± 1°C). Results: Sixty-eight (55%) patients received partial aortic arch replacement; the remaining 55 (45%) patients received total arch replacement, further extended with either a frozen elephant trunk in 43 (35%) patients or a conventional elephant trunk procedure in nine (7%) patients. No conversion to full sternotomy was required. New permanent renal failure occurred in one (0.8%) patient, stroke in two (1.6%), and spinal cord injury in four (3.3%) patients. Early mortality was observed in four (3.3%) patients. At five years, survival was 80 ± 6% and freedom from reoperation was 96 ± 3%. Conclusion: Minimal invasive aortic arch repair through an upper mini-sternotomy can be safely performed, with early and mid-term outcomes well comparable to series performed through a standard median sternotomy.

Diagnosis and surgical treatment of ascending aorta and aortic arch dissection

2020 ◽  
Vol 13 (1) ◽  
pp. 72
Author(s):  
R. N. Komarov ◽  
N. O. Kurasov ◽  
N. V. Chichkova ◽  
A. V. Buchneva
Keyword(s):  
Surgical Treatment ◽  
Aortic Arch ◽  
Ascending Aorta

scholarly journals Novel Straight Type Aortic Cannula with Spiral Flow Inducing Design

2015 ◽  
Vol 773-774 ◽  
pp. 69-74 ◽  
Author(s):  
Nofrizalidris Darlis ◽  
Nadia Shaira Shafii ◽  
Jeswant Dillon ◽  
Kahar Osman ◽  
Ahmad Zahran Md Khudzari
Keyword(s):  
Heart Surgery ◽  
Open Heart Surgery ◽  
Ascending Aorta ◽  
Spiral Flow ◽  
Heart Lung Machine ◽  
Atherosclerosis Development ◽  
Aortic Cannula ◽  
Major Factors ◽  
Novel Design ◽  
Lung Machine

Aortic cannula is one of major factors leading to adverse events such as thrombosis and atherosclerosis development during open heart surgery. This is due to oxygenated blood outflow with high velocity jet from heart lung machine when exiting the cannula tip into ascending aorta. It was discovered, and validated by several researchers that blood flow out of the left ventricle into the aorta is spiral in nature. In this study, a novel design in which internal profile of the cannula was made to induce spiral flow were tested by way of numerical simulation, and compared against existing commercial cannula. Three designs were tested, which differed in number of groove employed. Among the cannula model designs, cannula design with 4 grooves yielded the lowest value of maximum wall shear stress at testing tube with 3.778 Pa and highest value of area weighted helicity density at 40 mm from cannula tips with 11.829 m/s2. Overall, spiral cannula models were showed highly potential in inducing spiral flow, and also the effect on blood hemolysis is acceptable.

scholarly journals Simultaneous cardiac and lung perforation by bone cement after percutaneous kyphoplasty

2020 ◽  
Author(s):  
Soon jin kim ◽  
kyung hwa kim
Keyword(s):  
Bone Cement ◽  
Symptom Relief ◽  
Median Sternotomy ◽  
Lumbar Vertebra ◽  
Case Presentation ◽  
Specific Complication ◽  
Heart Lung Machine ◽  
Clinical Consequences ◽  
One Year ◽  
Lung Machine

Abstract Background: Intracardiac cement embolisms(ICE) have been poorly reported in the literature. When the presence of intracardiac cement embolismsis identified, the cardiorespiratory complications related to ICE may be delayed and opinions also differ regarding whether the clinical consequences of this specific complication of percutaneous vertebroplasty (PV) is benign or malignant. Case presentation: A 63-year-old female patient was referred to our institution with chest discomfort and dyspnea. She had underwent PV in the lumbar vertebra one year ago. Radiologic investigations revealed the foreign material in the RA, perforating the RA wall and penetrating right pleura. We performed the removal surgically of the cement fragments after a median sternotomy with under heart-lung machine.Conclusions: when the presence of ICE is identified, the cardiorespiratory complications related to ICE may be delayed and a symptomatic and migrating bone cement must be considered surgical retrieval for the prevention of the progression into a constrictive pericarditis as well as symptom relief. This is the first report describing simultaneous cardiac and lung perforation and the longest interval period case (one year after PV) treated surgically caused by bone cement.

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