aortic interventions
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Author(s):  
Paolo Berretta ◽  
Michele Galeazzi ◽  
Mariano Cefarelli ◽  
Jacopo Alfonsi ◽  
Veronica De Angelis ◽  
...  

AbstractMedian sternotomy incision has shown to be a safe and efficacious approach in patients who require thoracic aortic interventions and still represents the gold-standard access. Nevertheless, over the last decade, less invasive techniques have gained wider clinical application in cardiac surgery becoming the first-choice approach to treat heart valve diseases, in experienced centers. The popularization of less invasive techniques coupled with an increased patient demand for less invasive therapies has motivated aortic surgeons to apply minimally invasive approaches to more challenging procedures, such as aortic root replacement and arch repair. However, technical demands and the paucity of available clinical data have still limited the widespread adoption of minimally invasive thoracic aortic interventions. This review aimed to assess and comment on the surgical techniques and the current evidence on mini thoracic aortic surgery.


2021 ◽  
Vol 25 (3) ◽  
pp. 61
Author(s):  
A. A. Shadanov ◽  
D. A. Sirota ◽  
M. M. Lyashenko ◽  
A. M. Chernyavskiy

<p><strong>Background.</strong> The frozen elephant trunk (FET) technique for the treatment of both thoracic aortic aneurysms and dissections has become universally popular over the past two decades because extensive open surgical reconstruction of the thoracic aorta has been found to be associated with high complication and mortality rates or unfavourable long-term outcomes as it requires repeated interventions. The FET technique has also been shown to produce excellent, immediate and long-term results. Hence, it is important to evaluate the outcomes of thoracic aortic reconstruction using this technique.<br /><strong>Aim.</strong> This study aimed to investigate immediate and long-term outcomes of the FET technique in patients with thoracic aortic diseases.<br /><strong>Methods.</strong> We retrospectively analysed the pre-, intra- and post-operative data of 40 patients with distal aortic arch aneurysm who had undergone aortic arch reconstruction using the FET technique at Meshalkin National Research Medical Center from February 2012 to October 2020. To assess the early and long-term post-operative survival of these patients, we categorised them into group I (including 14 patients without aortic dissection) and group II (including 26 patients with type I and type III aortic dissections).<br /><strong>Results.</strong> The in-hospital survival rates for groups I and II were found to be 68.5% and 95.9%, respectively (log rank, p = 0.048). Groups I and II did not differ significantly in the incidence of stroke (7.1% vs 7.7%, respectively; p = 0.724) and spinal cord ischaemia (14.3% vs 0%, respectively; p = 0.117). Long-term (1-, 3- and 5-year) survival rates in group II remained unchanged at 95.9%, whereas survival rates at 30 days, 6 months and 1 year in group I were 91.3%, 68.5% and 57%, respectively. The risk of mortality was 90% lower in group II than in group I, with a hazard ratio of 0.096 and a 95% confidence interval of 0.01–0.81 (p = 0.038). The rates of freedom from thoracoabdominal aortic interventions in group II were 91.8%, 83%, 64.7%, 59.3% and 59.3% at 30 days, 6 months, 1 year, 3 years and 5 years, respectively; these rates in group I were 90.9%, 75.7% and 75.7% at 30 days, 6 months and 1 year, respectively. There was no significant difference between the groups concerning thoracoabdominal aortic interventions (log rank, p = 0.587).<br /><strong>Conclusion.</strong> The use of the FET technique in patients with thoracic aortic diseases is associated with acceptable rates of mortality and thoracoabdominal aortic interventions in immediate and long-term post-operative periods.</p><p>Received 28 January 2021. Revised 28 April 2021. Accepted 29 April 2021.</p><p><strong>Funding:</strong> This work was carried out within the framework of the state task of the Ministry of Health of the Russian Federation (No. 121032300337-5).</p><p><strong>Conflict of interest:</strong> The authors declare no conflicts of interests.</p><p><strong>Contribution of the authors:</strong> The authors contributed equally to this article.</p>


Author(s):  
Amit S. Kainth ◽  
Tej A. Sura ◽  
Michael S. Williams ◽  
Catherine Wittgen ◽  
Emad Zakhary ◽  
...  
Keyword(s):  

2021 ◽  
Vol 74 (3) ◽  
pp. e123
Author(s):  
Priya Patel ◽  
Christina Marcaccio ◽  
Livia de Guerre ◽  
Nicholas J. Swerdlow ◽  
Thomas F. O'Donnell ◽  
...  

BJS Open ◽  
2021 ◽  
Vol 5 (Supplement_1) ◽  
Author(s):  
◽  
Ryan Preece

Abstract Introduction The COVID-19 pandemic forced rapid adaptations to healthcare provision. The COvid-19 Vascular sERvice (COVER) Study aimed to contemporaneously report outcomes for patients undergoing vascular interventions worldwide during the pandemic. Methods COVER is an international multi-centre observational cohort study of outcomes following vascular interventions during the pandemic. The primary outcome was to capture procedural information on all open and endovascular interventions undertaken. Secondary outcomes included in-hospital mortality and changes in management resulting from the pandemic. Results 1103 patients from 57 institutions in 19 countries were enrolled. Mean age was 66.9±13.9 (75·6% male). The rate of suspected/confirmed COVID-19 infection was 4·0%. Overall, in-hospital mortality was 11.0%. Aortic interventions had a mortality of 15·2% (23/151), amputations 12·1% (28/232), carotid interventions 10·7% (11/103) and lower limb revascularisation 9·8% (51/521). Increased risk of in-hospital mortality was noted for patients with chronic obstructive pulmonary disease, lower respiratory tract infection, Caucasian ethnicity and those undergoing urgent/immediate surgery. Choice of procedure deviated from standard management in 7·1% cases. Adjusting for confounders, antiplatelet (OR 0·503 (0·273-0·928) and oral anticoagulant (OR 0·411 (0·205-0·824) reduced risk of in-hospital mortality. Conclusions Patients undergoing vascular intervention during the pandemic had substantially higher overall and condition-specific mortality compared to pre-pandemic cohort reports, despite low COVID-19 infection rates.


Author(s):  
Mireya Castro Verdes ◽  
Xun Yuan ◽  
Wei Li ◽  
Roxy Senior ◽  
Christoph A Nienaber

Abstract Background  Aortic complications can happen during left ventricular assist devices (LVADs) insertion and its treatment remains challenging. Percutaneous aortic interventions can be an alternative to surgery in such high-risk cases. Case summary  We present a patient with idiopatic dilated cardiomyopathy and advanced heart failure requiring LVAD insertion as a bridge to transplant, who developed an aortic pseudoaneurysm below the anastomosis of the LVAD tube. He was successfully treated with percutaneous coiling under contrast-enhanced transoesophageal echocardiography (TOE) guidance, reaching destination therapy (heart transplantation) a year later. Discussion  Left ventricular assist devices provide haemodynamic support for patients with advanced heart failure waiting for heart transplantation. Although uncommon, aortic complications can happen as a result of LVAD insertion and be life-threatening. Percutaneous aortic interventions can be performed in such cases to promote thrombosis and remodelling of false lumen or aneurysmatic spaces, hence potentially reducing the risk of sudden death. Contrast-enhanced TOE can be easily and safely used to monitor the intervention in order to improve anatomic definition, guide positioning of wires and catheters and assess early results.


2020 ◽  
Vol 72 (5) ◽  
pp. 1593-1601 ◽  
Author(s):  
Nicholas J. Swerdlow ◽  
Patric Liang ◽  
Chun Li ◽  
Kirsten Dansey ◽  
Thomas F.X. O'Donnell ◽  
...  

2020 ◽  
Vol 59 (1) ◽  
pp. 130-136
Author(s):  
Tim Berger ◽  
Maximilian Kreibich ◽  
Felix Mueller ◽  
Bartosz Rylski ◽  
Stoyan Kondov ◽  
...  

Abstract OBJECTIVES The goal of this study was to evaluate outcomes of aortic arch replacement using the frozen elephant trunk (FET) technique after previous proximal and/or distal open or endovascular thoracic aortic repair. METHODS Sixty-three patients [median age: 63 (55–74) years; 65% men] were operated on for acute or chronic aortic dissection after previous proximal and/or distal open or endovascular thoracic aortic repair. Intraoperative details, clinical outcome and follow-up results were evaluated. RESULTS The median time between the index and the FET procedure was 81 (40–113) months. Fifty-eight (92%) patients had already undergone proximal aortic surgery; supracoronary ascending aortic replacement was the most frequent index procedure [n = 25 (40%)]. Distal aortic interventions had been done in 8 (13%) patients including endovascular thoracic aortic repair in 6 patients (10%). In-hospital mortality was 3% (n = 2). Postoperative strokes occurred in 5 patients (8%); of those, 1 stroke was dissection-related (2%). Subsequent aortic reinterventions after the FET procedure had to be done in 33% (n = 21). CONCLUSIONS Outcomes of aortic arch replacement using the FET technique after previous proximal and/or distal open or endovascular thoracic aortic repair are associated with low mortality and morbidity. Still, postoperative stroke remains an issue. After the successful accomplishments, the approach serves as an ideal platform for the secondary surgical or endovascular downstream aortic procedures, which are frequently needed.


2020 ◽  
Vol 58 (6) ◽  
pp. 1289-1295
Author(s):  
Selim Mosbahi ◽  
Murat Yildiz ◽  
Paul-Philipp Heinisch ◽  
Bettina Langhammer ◽  
Silvan Jungi ◽  
...  

Abstract OBJECTIVES The goal of this study was to report the long-term outcomes of patients with Marfan syndrome who had aortic surgery on any aortic segment except for the replacement of the aortic root itself. METHODS An observational retrospective single-centre study was conducted with 115 Marfan syndrome patients who underwent 189 major aortic interventions from 1995 until 2018. Patients without aortic root replacement were identified and aortic root growth was analysed over time. RESULTS Eleven of 115 patients (9.5%) did not have aortic root replacement during a follow-up of 10.5 [standard deviation (SD) 5.7] years and a mean age at last follow-up of 53.9 (SD 13.4) years. Patients without root replacement did not suffer less frequently from any type of acute aortic dissection (type A 27% vs 25%, P = 0.999; type B 36% vs 25%, P = 0.474). Patients with native aortic roots did not undergo fewer aortic interventions than those with aortic root replacement [12/11, mean 1.09 (SD 0.54) operations/patient vs 177/104, mean 1.7 (SD 1.3); P = 0.128]. Progression of the aortic root dimension was 0.5 (SD 0.3) mm/year in the group of patients with native aortic roots. CONCLUSIONS Current data suggest that 10% of patients with Marfan syndrome with previous aortic surgery will be free from aortic root replacement until the sixth decade of life.


Vascular ◽  
2020 ◽  
pp. 170853812095366
Author(s):  
Jason R Cook ◽  
Thomas J Desmarais ◽  
Jeffrey Jim

Aortic interventions in patients with underlying connective tissues disorders present a unique challenge. The inevitable degeneration of the native aorta can lead to the need for multiple staged interventions with significant risk of complications associated with reoperative aortic procedures. We present a challenging case of progressive aortic degeneration in a patient with Marfan syndrome treated with multi-staged open surgical and endovascular procedures.


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