Optimizing Therapeutic Hypothermia Depths in Acute Type A Aortic Dissection Repair.

INTRODUCTION: Existing evidence regarding the impact of hypothermic circulatory arrest (HCA) depth in acute type A aortic dissection (ATAAD) repair lacks robustness concerning blood loss and mortality. We aimed to assess whether using mild and moderate HCA (MMHCA) versus deep and profound HCA (DPHCA) in ATAAD repair is associated with reduced bleeding risk, lower in-hospital mortality, and improved long-term survival. METHODS: This retrospective cohort study spanned from 2003 to 2023. ATAAD repair patients were identified from hospital records, with exclusion criteria applied to those who died before surgery, those with symptoms lasting longer than 14 d, and those who operated on without HCA. Patients in the DPHCA group underwent surgery with HCA (T ≤ 20°C), while those in the MMHCA group had temperatures ranging from 34°C to 20.1°C. RESULTS: Out of 549 eligible ATAAD patients, the MMHCA group exhibited a reduced rate of chest re-exploration for bleeding (39% versus 14%, P < 0.005), decreased blood loss after surgery (1637 mL versus 1045 mL, P < 0.005), and lower volumes for red blood cell transfusions (1375 mL versus 903 mL, P < 0.005) compared with the DPHCA group. Additionally, the MMHCA group had lower crude and age- and sex-adjusted in-hospital mortality rates, with a mortality rate ratio of 0.65 (P = 0.003). Cox regression analysis revealed a 25% reduction in long-term mortality for the MMHCA group compared with the DPHCA group (hazard ratio = 0.75; P = 0.045). CONCLUSIONS: ATAAD repair using MMHCA and antegrade cerebral perfusion is associated with lower blood loss and improved immediate and long-term survival.

Off-pump ascending aorta-abdominal aorta bypass in patient with endoleak.

Thoracic endovascular aortic repair is commonly used in the surgical treatment of patients with aortic coarctation, but complications such as endoleaks can occur. This video tutorial presents a case study involving the exclusion of a stent graft from the bloodstream through total transection of the aortic arch and abdominal aorta, with off-pump aortic grafting and debranching of the left carotid and subclavian arteries.

Aortic valve resuspension using the Florida sleeve technique with replacement of the aortic arch by stent grafting the thoracic aorta with the hybrid prosthesis E-Vita Open Plus in a patient with DeBakey type I acute aortic dissection.

Surgery for acute type A aortic dissection is highly challenging, even in expert hands. The goal in such emergency circumstances is primarily to save the patient's life. To minimize the perioperative risk, surgeons often choose surgery involving only supracoronary ascending aortic and hemiarch replacement. However, to achieve a successful repair, the extremely fragile dissected aortic layers must be reconstructed proximally and distally. Most of the surgical procedures for patients with acute type A aortic dissection are supracoronary ascending aortic replacements. Thereby, the Florida sleeve procedure is an attractive alternative for reimplanting the entire aortic root into a Dacron graft. This approach has overcome most of the technical problems associated with composite valve graft or valve-sparing procedures. The frozen elephant trunk procedure is particularly appealing for treating acute type A aortic dissection because of its ability to treat malperfusion by encouraging true lumen expansion and potentially reducing longer-term adverse remodelling within the descending aorta.

Aortic root replacement for aortic root aneurysm with severe aortic regurgitation and incidentally detected left ventricular hyper-trabeculation/noncompaction.

A 54-year-old male with severe aortic regurgitation (AR), aortic root aneurysm, left ventricular hyper-trabeculation/noncompaction (LVHT) and systolic dysfunction with a left ventricular ejection fraction (LVEF) of 52% underwent successful aortic root replacement. Intraoperative video-endoscopy confirmed LVHT. At 3-year follow-up, he remains in an excellent clinical condition and echocardiography shows an improvement of the systolic function, LVHT and LVEF of 66%. Timely surgical correction of severe AR may also lead to improvement of systolic function in a patient with LVHT.

Aortic root reinforcement using the Florida sleeve technique in a patient with acute aortic dissection type A.

Stanford type A acute aortic dissection is an inherently lethal condition that is regarded as a surgical emergency. The Bentall procedure is considered the gold standard for patients requiring aortic root replacement. However, this method can be technically difficult for less-experienced surgeons. Complications encountered after composite graft replacement include distortion of the proximal part of the coronary artery, bleeding from the conduit implant site, and reattached coronary artery origins caused in general by a consumption coagulopathy. In cases for which aortic valve preservation is not applicable and the root is not dissected or dilated, surgeons often opt for less complicated techniques like aortic valve and supracoronary ascending aortic replacement. Nevertheless, these patients carry a high risk of late aortic root dilatation and subsequent reoperation. The goal of aortic root reinforcement by the Florida sleeve technique is to encase the aortic root to prevent any further dilatation and perioperative bleeding.

Surgical Treatment of Acute Type A Aortic Dissection with 18-Litre Bleeding.

Surgical treatment of Type-A acute aortic dissection is associated with high mortality and morbidity. One of the reasons is perioperative bleeding, which may lead to worse outcomes. We present a case of successful treatment of a patient with 18-litre perioperative blood loss in DeBakey Type-I acute aortic dissection with drug-induced hypocoagulation and malperfusion of a lower extremity.

Simple Technique for Central Venous Cannulation with Cannula-Free Wound in Minimally Invasive Aortic Valve Surgery.

There are several approaches to venous cannulation in minimally invasive aortic valve surgery. Frequently used options include central dual-stage right atrial cannulation, or peripheral femoral venous cannulation. During minimally invasive aortic surgery via an upper hemisternotomy, central venous cannulas may obstruct the surgeon's visualization of the aortic valve and root, or require extension of the skin incision, while femoral venous cannulation requires an additional incision, time and resources. Here we describe a technique for central venous cannulation during minimally invasive aortic surgery, utilizing a novel device, to facilitate simple, convenient, and expedient central cannulation with a cannula-free surgical working space.

Upper ministernotomy for mitral valve replacement via superior approach.

This video tutorial demonstrates the surgical technique for mitral valve replacement through the roof of the left atrium via an upper inverted T-shaped ministernotomy, with central cannulation for cardiopulmonary bypass.

Anti-influenza activity of monoterpene-derived substituted hexahydro-2H-chromenes.

The antiviral activity of 4-hydroxy-hexahydro-2H-chromenes and 4-fluorine-hexahydro-2H-chromenes with an aromatic substituent, synthesized from monoterpene (-)-verbenone, was studied for the first time. Five of 11 (45 per cent) of 4-hydroxy-hexahydro-2H-chromene-type compounds have been found to exhibit antiviral activity against influenza A virus of subtype H1N1pdm09. Although a portion of active compounds among 4-fluorine-containing series was fewer, just compound 5i that contains a fluorine substituent exhibited more potent anti-influenza activity along with low cytotoxicity. Thus two new promising types of antiviral compounds were identified.

A patient with giant left atrium undergoes orthotopic heart transplantation.

We present a novel technique for resolving the problem of radical size mismatch at the time of orthotopic transplantation. A 48-year-old man presented with chronic rheumatic heart disease and a giant left atrium. Twenty-three years before, he had undergone mitral valve replacement with a mechanical prosthesis. At the time of the repeated intervention, the volume of his left atrium was 350 mL. Surgical features of the transplantation included approximation of the pulmonary vein ostia by gathering sutures intentionally, in order to decrease the area of the left atrial posterior wall and thereby enable appropriate coaptation with the donor left atrium. After the operation, left atrial volume had been reduced to 60 mL.

A Novel Tool to Facilitate Crimping Suture Placement for a Modified David V/Miller Aortic Root Replacement.

Surgical treatment of aortic root and ascending aorta aneurysms with aortic insufficiency is still controversial. A valve-sparing operation is the procedure of choice for such patients, and the reimplantation technique is preferable. We describe a simple technique for aortic root reconstruction that has been successfully performed for patients with aneurysms of aortic root and ascending aorta with aortic insufficiency.

A rare case of coronary artery bypass grafting in a patient with left ventricular noncompaction.

Ventricular myocardium noncompaction is a rare congenital cardiomyopathy resulting from an arrest in normal endomyocardial embryogenesis. Initially the noncompaction of the left ventricle was described in the pediatrics population with poor prognosis, but recent reports have noticed the presence of this pathology in the adult population. We describe a 54-year-old man with isolated noncompaction of the left ventricle who had ischemic heart disease and was successfully treated with bypass surgery.

First experience of cardiac autotransplantation for giant left atrium treatment.

Giant left atrium is a pathology that causes a lot of different complications, therefore it is very important to perform volume reduction. In some cases left atrium volume reaches a huge size. There are a lot of different methods for left atrium reduction: from wall plication, multicomponent resection followed by restoration integrity of wall to autotransplantation. In spite of the relative simplicity of plications and resection, these methods do not always allow to reduce left atrium to the desired volume. Cardiac autotransplantation is the most radical approach to the correction of giant left atrium which allows reducing left atrium including interatrial septum. The successful result of giant left atrium surgical treatment (volume of left atrium is 2200 ml according to the data of computerized tomography) by the method of autotransplantation is presented in the article.