Outcomes following endovascular or open repair for ruptured abdominal aortic aneurysm in a Chinese population.

To determine whether emergent endovascular repair (eEVAR) can be an alternative for anatomically suitable ruptured abdominal aortic aneurysms (RAAA) in a Chinese population compared to open aneurysm repair (OAR), 36 patients with RAAA undergoing either OAR or eEVAR in National Taiwan University Hospital from 2005 to 2012 were analyzed retrospectively. Thirty-five (97.2 %) patients were treated. Among them, 20 (57.1 %) were treated by OAR and 15 (42.9 %) by eEVAR. The overall 30-day survival rate was 77.1 %. There was no significant difference in 30-day mortality rate (OAR 15.0 % vs. eEVAR 33.3 %, p = 0.201) and midterm mortality rate (OAR 20.0 % vs. eEVAR 46.7 %, p = 0.093) between these two groups. On univariate analysis, free peritoneal rupture (p < 0.001), pre-operative shock (p = 0.001) and female gender (p = 0.016) are related to a higher 30-day mortality rate, while free peritoneal rupture (p = 0.012) and pre-operative shock (p = 0.030) are associated with a higher midterm mortality rate in both repair techniques. On multivariate analysis, free peritoneal rupture was associated with higher 30-day (OR 26.0, 95 % CI 2.2-295.6, p = 0.009) and midterm (OR 13.1, 95 % CI 1.2-37.6, p = 0.032) mortality rates. In patients with RAAA, there is no significant difference in 30-day mortality and midterm mortality between eEVAR and OAR groups in our study. eEVAR could be an alternative therapy for anatomically suitable RAAA in a Chinese population.

One-stage hybrid repair to thoracoabdominal aortic aneurysm.

BACKGROUND: Open repair of a thoracoabdominal aortic aneurysm (TAAA) is associated with high rates of morbidity and mortality. This study reviewed the midterm outcomes of hybrid TAAA repair in high-risk patients at our institution. METHODS: The clinical data of patients undergoing 1-stage hybrid repair of a TAAA between June 2007 and June 2011 were retrospectively analyzed. This study represents our experience with 10 patients at a single center who underwent 1-stage visceral hybrid procedures for complex thoracoabdominal aortic pathologies. There were 9 men and 1 woman with a median age of 65.7 years. The average preoperative European System for Cardiac Operative Risk Evaluation II score was 34.1%. RESULTS: The technical success rate with completion was 100%. No procedure was abandoned because of any aortic event. The 30-day mortality rate in this study was 10%. Overall major perioperative complication rates were 20%. Major complications included renal impairment requiring permanent support in 1 patient (10%) and paraplegia in 1 patient (10%). At a median follow-up of 20.1 months (range, 0.3-39 months), the overall survival rate was 70%. The primary graft patency rate was 96.8% (32/33). Only 1 renal artery graft was occluded. CONCLUSIONS: The midterm results in selected high-risk patients with TAAA undergoing 1-stage hybrid repair were encouraging. When open repair is hazardous and branched stent grafting is not an option, hybrid repair is a viable treatment alternative. However, larger study cohorts and longer durations of follow-up are necessary to provide data on the durability of aortic stent grafts and visceral artery reconstruction.

Why is the surgical ventricular restoration operation effective for ischemic cardiomyopathy? Geometric analysis with magnetic resonance imaging of changes in regional ventricular function after surgical ventricular restoration.

OBJECTIVE: Clinical improvement after a surgical ventricular restoration for ischemic cardiomyopathy is increasingly accepted by clinicians, but the mechanism is not completely understood. METHODS: Ten patients with ischemic cardiomyopathy underwent detailed magnetic resonance imaging for ventricular function before and 6 weeks after surgical ventricular restoration. Surgical procedures included combinations of coronary artery bypass grafting, restrictive mitral annuloplasty, and endoventricular patch plasty. Magnetic resonance imaging analysis included quantification of global and regional systolic function. Anterior and posterior left ventricular regions were divided by an imaginary plane (C-plane) determined from anterior mitral point and both papillary roots. RESULTS: Global stroke volume index increased from 28.8 +/- 4.9 mL/m(2) to 36.5 +/- 8.6 mL/m(2) after surgical ventricular restoration (P = .010) and seemed more related to increased posterior stroke volume index (15.9 +/- 4.3 mL/m(2) preoperatively, 21.8 +/- 3.9 mL/m(2) postoperatively, P = .001) than to changed anterior stroke volume index (15.9 +/- 4.4 mL/m(2) preoperatively, 18.2 +/- 6.9 mL/m(2) postoperatively, P = .369). C-plane area decreased only a little in diastole (37.7 +/- 8.3 cm(2) preoperatively, 32.9 +/- 5.9 cm(2) postoperatively, P = .119) but significantly in systole (31.5 +/- 9.4 cm(2) preoperatively, 23.7 +/- 7.6 cm(2) postoperatively, P = .023). This indicates functional recovery of border zone by restrictive endoventricular patch plasty. CONCLUSION: Rebuilding geometric normality by surgical ventricular restoration improves contractility of myocardium in border-zone and remote regions, resulting in increased stroke volume index from the posterior left ventricle.