RESUMEN
BACKGROUND: This study aimed to compare the outcomes of minimally invasive aortic valve replacement (AVR) with or without concomitant ascending aortic and hemiarch replacement. The focus was on assessing the impact of additional ascending aortic procedures on postoperative morbidity and mortality in the context of minimally invasive sternal-sparing surgery. METHODS: In a retrospective analysis of 796 patients from 2019 to 2024, 2 groups were compared: 624 patients underwent isolated AVR, and 172 underwent combined AVR with proximal ascending aortic and/or hemiarch replacement (AVR+Asc). Among the latter group, 108 patients had a hemiarch replacement with circulatory arrest. The study examined postoperative outcomes, including mortality, stroke rates, and 30-day readmission rates. RESULTS: The median age of the patients was 64 (IQR, 58-72) years, and 25% of the patients were female. Operative times were longer in the AVR+Asc than AVR group, with increased cardiopulmonary bypass (152 vs 93 minutes; P < .001) and cross-clamp (124 vs 69 minutes; P < .001) times. However, no major significant differences were observed in conversion (0.6% vs 0.2%; P = .4), stroke (0.2% vs 0.0%; P = .2) rates between the groups. Intensive care unit stay durations were similar (26 vs 27 hours; P = .2), although hospital stays were longer for the AVR+Asc group (4 vs 3 days; P < .001). The in-hospital mortality rates were slightly higher in the AVR+Asc group (1.2% vs 0.0%; Fisher's P = .046) but did not differ significantly from the isolated AVR group at 5 years (log-rank P = .14). CONCLUSIONS: Minimally invasive, sternal-sparing AVR+Asc is associated with longer operative times but does not significantly increase short-term morbidity or mortality compared with isolated AVR. These findings suggest that additional ascending aortic procedures during minimally invasive AVR can be performed without substantially increasing postoperative risks.
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Aorta , Válvula Aórtica , Implantación de Prótesis Vascular , Implantación de Prótesis de Válvulas Cardíacas , Tratamientos Conservadores del Órgano , Esternón , Humanos , Femenino , Masculino , Estudios Retrospectivos , Persona de Mediana Edad , Anciano , Implantación de Prótesis de Válvulas Cardíacas/métodos , Procedimientos Quirúrgicos Mínimamente Invasivos/métodos , Válvula Aórtica/cirugía , Resultado del Tratamiento , Complicaciones Posoperatorias/epidemiología , Esternón/cirugía , Aorta/cirugía , Implantación de Prótesis Vascular/métodos , Tiempo Operativo , Tratamientos Conservadores del Órgano/métodosRESUMEN
OBJECTIVES: We sought to evaluate compliance and flow of the ascending aorta of patients with decellularized aortic homografts compared to donor age-matched healthy controls. METHODS: Male patients and donor age-matched male healthy controls were included. Cardiac function was evaluated by retrospectively electrocardiography-gated cine balanced steady-state free precession magnetic resonance imaging (MRI). Time-resolved 2- and 3-dimensional phase-contrast sequences were used to determine relative area change and pulse wave velocity as surrogate parameters for vessel compliance as well as maximum blood flow velocity. RESULTS: Thirteen patients were matched according to the age of their homograft donor (median 42 years, interquartile range [IQR] 32-50) to 7 healthy controls (median 40 years, IQR 36-48). Time to post-operative MRI was 3.33 (1.33-4.50) years. Relative area change in the proximal ascending aorta was significantly lower in the homograft group compared to healthy controls (26%, IQR 23-44 vs 38%, IQR 24-44, P < .001), with no significant difference observed in the distal ascending aorta (22%, IQR 22-33 vs 34%, IQR 22-41, P = .438). Maximum blood flow velocity in the proximal ascending aorta was significantly higher in the homograft group compared to healthy controls (168 cm s-1, IQR 148-188 vs 115 cm s-1, IQR 114-120, P = .009). CONCLUSIONS: Decellularized aortic homograft patients seem to have a reduced compliance of the proximal ascending aorta compared to donor age-matched healthy controls. This may be attributable to the in vitro decellularization process or post-operative graft degeneration. These findings highlight the ultimate need for follow-up data to understand the long-term in vivo effects of decellularized human tissue. This study is a follow-up study of the patients included in the ARISE Study registered on ClinicalTrials.gov (NCT02527629). For the purposes of this manuscript, healthy individuals were subsequently recruited to serve as the control group.
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Aorta , Implantación de Prótesis Vascular , Prótesis Vascular , Humanos , Masculino , Adulto , Aorta/fisiopatología , Aorta/diagnóstico por imagen , Aorta/cirugía , Aorta/trasplante , Persona de Mediana Edad , Velocidad del Flujo Sanguíneo , Estudios Retrospectivos , Aloinjertos , Implantación de Prótesis Vascular/efectos adversos , Implantación de Prótesis Vascular/instrumentación , Estudios de Casos y Controles , Imagen por Resonancia Cinemagnética , Adaptabilidad , Resultado del Tratamiento , Análisis de la Onda del PulsoRESUMEN
OBJECTIVES: Robotic cardiac surgery is well established in mitral valve repair and coronary artery bypass grafting. Outside of limited applications addressing the abdominal aorta, robotic technology is rarely utilized in vascular surgery. Robotic replacement of the ascending aorta has not yet been described. The aim of this experimental study was to establish the fundamental surgical techniques for robotically assisted replacement of the ascending aorta. METHODS: Robotic ascending aortic replacement was performed in 6 porcine thoracic organ packs and 2 human cadaver models by an experienced robotic surgeon and a surgical resident. All essential steps of the procedure were performed utilizing the DaVinci 5 robotic platform. Dacron grafts were implanted after ascending aorta resection in all models. Operative times and comfort level were recorded for each step of the procedure. RESULTS: Robotically assisted ascending aortic replacement was deemed feasible in all porcine and human cadaveric simulations. Distal and proximal anastomoses in the porcine organ block were completed in 10.7 (SD = 4.5) and 9.7 minutes (SD = 3.2), respectively. Anastomotic times were slightly longer in the cadaveric model at 13.3 (SD = 2.0) and 12.3 minutes (SD = 1.9). No gaps in suture alignment were noted in the porcine organ model, whereas 4 gaps out of 273 stitches in the human cadaveric model were observed. CONCLUSIONS: Robotic replacement of the ascending aorta is technically feasible in anatomical models with reasonable anastomotic times, which may be suitable for the clinical setting. Robotic suturing on the ascending aorta can be performed with accuracy and efficiency.
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Aorta , Implantación de Prótesis Vascular , Procedimientos Quirúrgicos Mínimamente Invasivos , Procedimientos Quirúrgicos Robotizados , Animales , Estudios de Factibilidad , Humanos , Procedimientos Quirúrgicos Robotizados/métodos , Aorta/cirugía , Porcinos , Procedimientos Quirúrgicos Mínimamente Invasivos/métodos , Implantación de Prótesis Vascular/métodos , Cadáver , Modelos Anatómicos , Tiempo OperativoRESUMEN
OBJECTIVE: Ascending aortic length (AAL) has recently garnered attention as an additional parameter of surgical indication. This study aimed to verify that AAL is extended in ascending aortic aneurysm patients when compared with the normal aorta. METHODS: The study included 132 patients who were diagnosed with true ascending aortic aneurysms from January 2002 to December 2021. The AAL was measured as the distance from the aortic annulus to the origin of the innominate artery. The data of 295 patients who underwent transcatheter aortic valve replacement during same period were compiled as the control group. In order to index AAL, it was divided by the patient's height (Length height index, LHI). RESULTS: The mean ascending aortic diameter (AAD) and AAL in the 132 patients were 5.3 ± 0.6 cm and 11.7 ± 1.6 cm, respectively. Propensity score matching revealed a significantly longer AAL in the aortic aneurysm group than in the control group (11.7 vs. 8.8 cm, P < 0.05). The LHI in the aortic aneurysm group was significantly greater than in the control group (7.4 vs. 5.7 cm/m, P < 0.05). The relationship between AAD and LHI was analyzed using linear regression analysis. The regression coefficient was 0.59, and the intercept was 4.22. As a tool to predict LHI, the formula: LHI = 0.59 × AAD + 4.22 was obtained. CONCLUSIONS: AAL and LHI were significantly increased in patients with ascending aortic aneurysms. Consequently, LHI may serve as an accurate indicator of surgical intervention.
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Aorta , Aneurisma de la Aorta , Implantación de Prótesis Vascular , Reemplazo de la Válvula Aórtica Transcatéter , Humanos , Masculino , Femenino , Anciano , Aorta/diagnóstico por imagen , Aorta/cirugía , Estudios Retrospectivos , Aneurisma de la Aorta/cirugía , Aneurisma de la Aorta/diagnóstico por imagen , Anciano de 80 o más Años , Valor Predictivo de las Pruebas , Resultado del Tratamiento , Persona de Mediana Edad , Implantación de Prótesis Vascular/efectos adversos , Angiografía por Tomografía Computarizada , Aneurisma de la Aorta AscendenteRESUMEN
BACKGROUND: Outcomes of aortic root replacement (ARR) versus conservative root approach (CRA) in patients undergoing acute type A aortic dissection (ATAAD) repair remained controversy. METHODS: The present study was a pooled meta-analysis of Kaplan-Meier-derived individual patient data (IPD) from comparative studies published by September 29, 2024. RESULTS: Forty studies met our eligibility criteria, comprising 11,734 patients (4212 in the ARR group and 7522 in the CRA group). In the overall population, the overall survival was similar between the ARR and CRA groups (hazard ratio [HR], 0.95; 95% CI, 0.87-1.02; p = 0.17, log-rank test p = 0.47), while ARR was associated with lower risk of reoperation compared with CRA (HR 0.72; 95% CI, 0.59-0.87; p < 0.001, log-rank test p < 0.001). Subgroup analysis revealed that valve-sparing root replacement (VSRR) was associated with better overall survival compared with CRA (HR 0.74; 95% CI, 0.60-0.91; p = 0.004, log-rank test p = 0.003), while Bentall procedure was not (HR 1.06; 95% CI, 0.93-1.20; p = 0.37, log-rank test p = 0.39). The restricted mean survival time (RMST) was overall 12.9 months longer with VSRR compared with CRA (p = 0.009). The meta-regression analyses did not find statistically significant coefficients for the covariates of age, male sex, hypertension, diabetes, Marfan syndrome, bicuspid aortic valve, aortic root diameter and ascending aorta diameter in the CRA arm. CONCLUSIONS: In patients underwent ATAAD repair, the overall survival was comparable between ARR and CRA, while ARR was associated with lower risk of reoperation compared with CRA. VSRR was associated with better long-term survival compared with CRA, while Bentall procedure was not.
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Aorta , Aneurisma de la Aorta Torácica , Disección Aórtica , Implantación de Prótesis Vascular , Humanos , Disección Aórtica/cirugía , Disección Aórtica/mortalidad , Enfermedad Aguda , Implantación de Prótesis Vascular/métodos , Aneurisma de la Aorta Torácica/cirugía , Aneurisma de la Aorta Torácica/mortalidad , Masculino , Aorta/cirugía , FemeninoRESUMEN
BACKGROUND: Traumatic aortic transection is a life-threatening injury with an acute mortality rate approaching 80%, typically resulting from high-energy blunt trauma, such as motor vehicle collisions. Without intervention, the overall mortality rate increases to 90-94%, primarily due to the rupture of pseudoaneurysms or expanding hematoma leading to exsanguination. Although delayed surgical repair may decrease immediate mortality, it is associated with significant perioperative risks. Endovascular techniques are becoming increasingly prevalent and have demonstrated lower morbidity and mortality rates in adult trauma patients compared with traditional open surgery. CASE PRESENTATION: A 32-year-old female Filipino healthcare worker presented to our institution in February 2021 following a high-speed head-on collision with seat-belt-related trauma. She exhibited respiratory distress, mild hypotension, and abdominal wall bruising. Initial hemoglobin was 12.6 g/dL and remained stable. Imaging (computed tomography angiography, magnetic resonance angiography) revealed a right pneumothorax, along with a partial pulmonary contusion, a suprarenal aortic transection with severe luminal narrowing, distortion of the celiac and superior mesenteric artery origins, and a small periaortic and suprarenal hematoma, without contrast extravasation. Following stabilization, including right-sided chest tube placement and comprehensive discussion of all therapeutic options, the patient declined open surgical repair. Due to the severe suprarenal aortic narrowing, fenestrated endograft deployment was not feasible. On 4 March 2021, she underwent percutaneous endovascular repair using a self-expanding nitinol stent (Sinus XL Flex, 14 × 80 mm; OptiMed, Germany) via right common femoral artery access. The procedure was successful without complications, and she was discharged on postoperative day 3 with aspirin therapy. Follow-up imaging at 3 and 12 months demonstrated near-complete aortic restoration and preserved renal and visceral perfusion. CONCLUSION: This case highlights the efficacy of a novel endovascular approach for nonhemorrhagic traumatic aortic transection. The open-cell nitinol stent provides immediate stabilization of the aortic wall while preserving perfusion to branch vessels, thereby preventing rupture and avoiding fatal outcomes. This unique, minimally invasive technique presents a viable alternative to conventional endografts, particularly in anatomically complex cases of nonhemorrhagic traumatic aortic transection.
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Aorta , Procedimientos Endovasculares , Stents Metálicos Autoexpandibles , Heridas no Penetrantes , Humanos , Femenino , Adulto , Aleaciones , Procedimientos Endovasculares/métodos , Procedimientos Endovasculares/instrumentación , Accidentes de Tránsito , Heridas no Penetrantes/cirugía , Stents , Angiografía por Tomografía Computarizada , Resultado del Tratamiento , Aorta/lesiones , Aorta/cirugía , Aorta/diagnóstico por imagenRESUMEN
Acute kidney injury requiring renal replacement therapy (RRT-AKI) is a serious complication after cardiac surgery, especially in aortic procedures. Validated risk models, such as the Cleveland Clinic Score, Mehta tool, and Simplified Renal Index (SRI) are widely applied, but their performance in predicting after aortic versus non-aortic cardiac surgery remains uncertain. We conducted a retrospective cohort study of 6,160 patients undergoing cardiac surgery (1,002 aortic and 5,158 non-aortic) (2006-2023) at a teaching hospital in Hong Kong. Predictive performance of the risk scores were assessed using the area under the receiver operating characteristic curve (AUC). Differences in AUC were assessed using DeLong's test. Hosmer-Lemeshow goodness-of-fit test was used to assess calibration. In this cohort, 3.2% developed RRT-AKI. RRT-AKI was more common after aortic surgery than non-aortic surgery (6.7 vs. 2.5%; p = <.001). Thirty-day mortality reached 40% in patients with acute kidney injury requiring renal replacement therapy after cardiac surgery. In the non-aortic surgery cohort, the three scores only showed moderate discriminatory power (worse than original cohorts) and good calibration: 0.77 (95% CI, 0.72-0.81) and p = .62 (Cleveland); 0.75 (95% CI, 0.70-0.80) and p = .10 (Mehta); and 0.75 (95% CI, 0.71-0.79) and p = .65 (SRI). In the aortic surgery cohort, there was only moderate discriminatory power and good calibration: AUC 0.70 (95% CI, 0.63-0.77) and p = .57 (Cleveland); 0.67 (95% CI, 0.59-0.74) and p = .67 (Mehta); 0.65 (95% CI, 0.58-0.72) and p = .79 (SRI). Currently established risk scores only have moderate discriminatory power (range of AUC 0.65-0.77) to predict RRT-AKI after both cardiac and aortic surgery.
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Lesión Renal Aguda , Procedimientos Quirúrgicos Cardíacos , Complicaciones Posoperatorias , Diálisis Renal , Humanos , Lesión Renal Aguda/terapia , Lesión Renal Aguda/etiología , Lesión Renal Aguda/mortalidad , Masculino , Femenino , Estudios Retrospectivos , Procedimientos Quirúrgicos Cardíacos/efectos adversos , Persona de Mediana Edad , Anciano , Medición de Riesgo/métodos , Complicaciones Posoperatorias/terapia , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/epidemiología , Hong Kong/epidemiología , Diálisis Renal/estadística & datos numéricos , Curva ROC , Factores de Riesgo , Aorta/cirugíaRESUMEN
PURPOSE: The use of Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) for temporary bleeding control in severely injured patients remains controversial. Epidemiological data from Germany, Austria and Switzerland are lacking. The objective of this study was therefore to collect data on the use of REBOA intervention and the characteristics of the affected patient population. METHODS: A retrospective analysis of the TraumaRegister DGU® between January 2020 and December 2022 was conducted to evaluate the frequency of REBOA interventions, injury patterns, injury severity, epidemiology and additional therapies received by patients treated with REBOA. RESULTS: Between 2020 and 2022, 95,510 patients were documented in Germany, Austria and Switzerland (DACH), of whom 62 received REBOA. 44 of 62 patients (71%) were under 60 years of age and 57 (92%) suffered a blunt trauma. Severe injury (AIS ≥ 3) was present in the following regions: head 36%, thorax 77%, abdomen 58%, extremities 65%. 23 of 59 patients (39%) did not have a systolic blood pressure ≤ 90 mmHg. Of the 62 patients, 42 (68%) received at least one unit of packed red blood cells (PRBC), and 24 (39%) received ≥ 10 PRBCs within the first 48 h. Thoracotomy was performed in nine patients (15%), laparotomy in 24 (39%), and 15 (23%) underwent surgical pelvic stabilisation. The expected mortality according to the RISC II score was 43%, while the observed mortality was 45%. Fourteen REBOAs (22%) were performed at one centre; two centres conducted six (10%) and seven (11%) procedures, and 27 centres performed a single REBOA within the three-year period. CONCLUSION: The use of REBOA is extremely rare in the DACH. Only a few centres perform REBOA more than once per year. A striking proportion of patients treated with REBOA had no hypotension, received no blood or massive transfusions, and underwent no emergency surgery, which may indicate that some patients were not in severe haemorrhage when REBOA was applied. On average, the REBOA-treated cohort was severely injured and critically ill. Whether REBOA use was beneficial and/or necessary in these patients cannot be determined from the present study.
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Aorta , Oclusión con Balón , Procedimientos Endovasculares , Hemorragia , Resucitación , Humanos , Oclusión con Balón/métodos , Oclusión con Balón/estadística & datos numéricos , Suiza/epidemiología , Austria/epidemiología , Masculino , Femenino , Estudios Retrospectivos , Alemania/epidemiología , Persona de Mediana Edad , Sistema de Registros , Resucitación/métodos , Adulto , Puntaje de Gravedad del Traumatismo , Aorta/cirugía , Anciano , Procedimientos Endovasculares/métodos , Hemorragia/terapia , Adulto Joven , AdolescenteRESUMEN
OBJECTIVES: To compare 3 surgical procedures (ascending aortic replacement [AAR], total arch replacement with conventional elephant trunk [cET], or frozen elephant trunk [FET]) for acute type A aortic dissection (ATAAD). Additionally, the AAR group was stratified by the presence or absence of arch vessel dissection (AVD), and outcomes were evaluated among the 4 groups. METHODS: Patients who underwent AAR or total arch replacement with cET or FET for DeBakey type I ATAAD between December 2006 to December 2024 at 5 institutions were included. The cumulative incidence of aortic events, defined as aortic enlargement, aortic reintervention, or aorta-related adverse events, was compared between procedures using pairwise comparisons adjusted by inverse probability of treatment weighting. RESULTS: Of the total 334 patients, 136 with AAR, 94 with cET, and 104 with FET were enrolled. The 5-year cumulative incidence of aortic events was lower for FET compared with that for cET and AAR (AAR: 57.7% vs cET: 49.1% vs FET: 25.2%). Further stratification of the AAR group revealed worse outcomes for AAR with AVD (hazard ratio, 2.25; 95% confidence interval, 1.28-3.95; P = .005). FET showed superior outcomes compared with all other groups, including AAR without AVD (hazard ratio, 0.25; 95% confidence interval, 0.09-0.67; P = .006). CONCLUSIONS: FET for ATAAD was associated with a lower incidence of aortic events compared with other procedures. FET may be a beneficial option for ATAAD with AVD, which is associated with a higher incidence of aortic events after AAR.
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Aorta Torácica , Aneurisma de la Aorta Torácica , Disección Aórtica , Implantación de Prótesis Vascular , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Enfermedad Aguda , Aorta/cirugía , Aorta Torácica/cirugía , Aneurisma de la Aorta Torácica/cirugía , Disección Aórtica/cirugía , Prótesis Vascular , Implantación de Prótesis Vascular/métodos , Implantación de Prótesis Vascular/efectos adversos , Complicaciones Posoperatorias/epidemiología , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
OBJECTIVES: This retrospective cohort study aims to evaluate the radiological changes of superior mesenteric artery (SMA), distal aorta, and visceral branches following reperfusion-first strategy with SMA stenting for acute type A aortic dissection (ATAAD) complicated with mesenteric malperfusion. METHODS: Computed tomographic angiograms (CTA) of 25 survivors who had undergone reperfusion-first strategy for ATAAD and mesenteric malperfusion were longitudinally evaluated at 2.5 ± 0.9 years (CTA was 100% available; averaging 2.1 scans/patient). CTA measurements include the areas of the false lumen (FL) of SMA proximal and distal to the stent, areas of the FL, true lumen (TL) of aorta, and the FL area to TL area ratios at zones 4-9. Mixed linear models were used to assess the temporal trends of CTA measurements across pre-stenting, (within) 30 days, 1 year, 2 years, and 3 years. RESULTS: The areas of FL proximal and distal to the SMA stent showed a significant trend of decrease overtime (P < .001 and P = .031). Areas of SMA proximal and distal to the stent dropped sharply immediately after stenting, then slowly increased or fluctuated, but remained significantly smaller than preoperative values (P < .001 and P = .010). Aorta at zones 4-7 showed a significant trend of TL expansion up to 3 years (all P < .050), which was not seen in zones 8-9. The coeliac artery showed a significant trend of FL shrinkage up to 3 years (P < .050). The FL area to TL area ratios in zones 4, 8, and 9 showed a significant trend of decrease through 3 years (all P < .050), which was seen in zones 5-7 only through 2 years (all P < .050), not at 3 years. CONCLUSIONS: In patients with ATAAD complicated by mesenteric malperfusion, a reperfusion-first strategy with SMA stenting may induce significant FL shrinkage in the SMA, which was most pronounced within 30 days and persisted through 3 years. The frozen elephant trunk (FET) could induce significant TL expansion in zones 4-7, which was most obvious within 30 postoperative days. The TL expansion effect of the FET was more pronounced at proximal levels (zones 4-7) than distal segments (zones 8-9).
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Aorta , Aneurisma de la Aorta , Disección Aórtica , Arteria Mesentérica Superior , Isquemia Mesentérica , Reperfusión , Humanos , Disección Aórtica/cirugía , Disección Aórtica/diagnóstico por imagen , Disección Aórtica/complicaciones , Masculino , Femenino , Estudios Retrospectivos , Persona de Mediana Edad , Arteria Mesentérica Superior/diagnóstico por imagen , Arteria Mesentérica Superior/cirugía , Stents , Angiografía por Tomografía Computarizada , Isquemia Mesentérica/cirugía , Isquemia Mesentérica/diagnóstico por imagen , Anciano , Aorta/diagnóstico por imagen , Aorta/cirugía , Reperfusión/métodos , Aneurisma de la Aorta/cirugía , Aneurisma de la Aorta/diagnóstico por imagen , Enfermedad Aguda , Procedimientos Endovasculares/métodosRESUMEN
OBJECTIVE: To evaluate the dynamics of intraventricular and intraaortic blood flows in ascending aorta dissection according to the data of transesophageal echocardiography (TEE) in the intraoperative period. MATERIAL AND METHODS: During the study, 36 patients with dissecting aneurysms of the ascending aorta with mean age 52.4±7.5 years were examined. All patients underwent TEE in 2, 3 and 4-chamber positions before and after the surgery. The data were stored and analyzed on the EchoPAC (GE) workstation. Left ventricular ejection fraction (LVEF), end-diastolic (EDV) and end-systolic (ESV) volumes of the LV, as well as blood flow velocities in the aorta and LV with turbulence assessment were calculated. Quantitative parameters and structure of the blood flows in the LV and aorta were evaluated in the Multivox software based on the data of LV and valve apparatus anatomy. Intraventricular blood flows (V) and pressure gradients for one cardiac cycle were plotted. RESULTS: The nature and subsequent calculations of the intraventricular and aortic blood flows are closely related to the valves and myocardial movement as well as the ascending aorta (AsAo) dimensions. High turbulence rates with uneven flow distribution in both the LV and aorta are noted in patients with dissecting aneurysms of AsAo in diastolic period before the surgery. Uneven intraventricular flow leads to additional increase in resistance and pressure gradient between the LV outflow tract and the aorta. Intra-aortic blood flow velocities are normalized and high turbulence almost disappears after the surgery. The gradient of blood flow velocity between the LV and aorta did not exceed 0.10±0.07 m/s on average during the ejection period. CONCLUSION: TEE is a reliable and objective method for assessing the results of correction of the AsAo dissecting aneurysms. Normalization of intraventricular and intra-aortic blood flow velocities with turbulence relief is one of the criteria for surgery radicality. Recovery of tension and dynamics of direction of blood flow velocity vectors in the LV and aorta are important for determining the effectiveness of pathology correction.
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Aorta , Aneurisma de la Aorta , Disección Aórtica , Ecocardiografía Transesofágica , Humanos , Ecocardiografía Transesofágica/métodos , Disección Aórtica/cirugía , Disección Aórtica/fisiopatología , Disección Aórtica/diagnóstico , Persona de Mediana Edad , Masculino , Femenino , Aorta/diagnóstico por imagen , Aorta/cirugía , Aorta/fisiopatología , Aorta/patología , Velocidad del Flujo Sanguíneo , Aneurisma de la Aorta/cirugía , Aneurisma de la Aorta/fisiopatología , Aneurisma de la Aorta/diagnóstico , Función Ventricular Izquierda , Volumen Sistólico , Disección de la Aorta AscendenteRESUMEN
During surgery for acute aortic dissection, reinforcing anastomoses in the aorta with felt strips is helpful for hemostasis. We had two cases of hemolytic anemia that developed due to inversion of an inner felt strip that was applied at the proximal anastomosis in the ascending aorta. A 78-year-old woman underwent ascending aorta replacement for type A aortic dissection, and over the next 2.5 years, she gradually developed hemolytic anemia and underwent reoperation. A 47-year-old woman also had to undergo reoperation due to hemolytic anemia 17 days after ascending aorta replacement for type A aortic dissection. Based on these experiences, we make suture line in the felt much more proximal, and no further cases of hemolytic anemia have occurred since then.
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Anemia Hemolítica , Aorta , Aneurisma de la Aorta , Disección Aórtica , Anciano , Femenino , Humanos , Persona de Mediana Edad , Enfermedad Aguda , Anastomosis Quirúrgica/efectos adversos , Anemia Hemolítica/diagnóstico , Anemia Hemolítica/etiología , Aorta/cirugía , Aneurisma de la Aorta/cirugía , Disección Aórtica/cirugíaRESUMEN
A 59-year-old woman with a history of aortic dissection that began during pregnancy at the age of 34, which affected the aorta and its branches, underwent multiple surgeries, including aortic root replacement with a mechanical valve, staged total aortic replacement extending to the bilateral iliac arteries, coil embolization of a left internal thoracic artery aneurysm, and bypass surgeries from the brachiocephalic artery to the right common carotid artery and right axillary artery, as well as from the left subclavian artery to the left axillary artery. Following these procedures, genetic testing was performed, leading to a diagnosis of Marfan syndrome. Genetic test identified the mutation c.2677+5 G>A in exon 21 of the FBN1 gene (variant:NM_000138.5). Even if the family history and phenotype do not meet the diagnostic criteria, genetic testing for aortic-related genes can play a supplementary role, leading to early and proactive antihypertensive treatment or surgical interventions to prevent events such as dissection or rupture.
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Aorta , Síndrome de Marfan , Humanos , Femenino , Persona de Mediana Edad , Síndrome de Marfan/genética , Síndrome de Marfan/cirugía , Síndrome de Marfan/diagnóstico , Pruebas Genéticas , Fibrilina-1/genética , Aorta/cirugía , AdipoquinasRESUMEN
OBJECTIVES: This study aimed to evaluate the diagnostic performance of 18-fluorodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT) for prosthetic aortic graft infection (PAGI) detection and describe its outcomes. METHODS: This retrospective study had 2 groups: the N-PAGI group (patients without PAGI who underwent 18F-FDG-PET/CT for detailed cancer screening) and the PAGI group (patients with PAGI). The PAGI group had 2 subgroups: the PET group (PAGI patients who underwent 18F-FDG-PET/CT), and the non-PET group (PAGI patients who did not undergo 18F-FDG-PET/CT). We compared the semi-quantitative analyses between the PET group and the N-PAGI group. The zones of aorta were labelled into 13 zones. Outcomes were compared between the PET group and the non-PET group. RESULTS: In total, 46, 19, and 24 patients were enrolled in the N-PAGI group, PET group, and non-PET group, respectively, between January 2008 and December2023. The PAGI group had significantly higher FDG uptake intensity score (4.7 ± 0.2 vs 3.2 ± 0.2), maximum standardized uptake value (SUVmax) value (9.6 ± 0.5 vs 4.5 ± 0.4), and target-to-background ratio (TBR) value (5.8 ± 0.3 vs 2.9 ± 0.2) than did the N-PAGI group. In the PAGI group, the in-hospital mortality, 5-year overall survival, and freedom from infection-related death were 15.9%, 69.3 ± 6.8%, and 81.8 ± 5.8%, respectively. The PET group (5.9 ± 0.4 zones) had previously undergone a significantly more extensive replacement or coverage than the non-PET group (3.5 ± 0.3 zones). However, late outcomes did not significantly differ between these 2 groups. CONCLUSIONS: Although 18F-FDG-PET/CT is useful for diagnosing PAGI, the in-hospital mortality remained high. Long-term outcomes of PAGI were acceptable.
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Aorta , Implantación de Prótesis Vascular , Prótesis Vascular , Fluorodesoxiglucosa F18 , Tomografía Computarizada por Tomografía de Emisión de Positrones , Infecciones Relacionadas con Prótesis , Humanos , Tomografía Computarizada por Tomografía de Emisión de Positrones/métodos , Infecciones Relacionadas con Prótesis/cirugía , Infecciones Relacionadas con Prótesis/diagnóstico por imagen , Infecciones Relacionadas con Prótesis/mortalidad , Masculino , Femenino , Estudios Retrospectivos , Anciano , Prótesis Vascular/efectos adversos , Persona de Mediana Edad , Radiofármacos , Aorta/cirugía , Aorta/diagnóstico por imagen , Implantación de Prótesis Vascular/efectos adversosRESUMEN
Introduction: Complex aortic surgery involving Jehovah's Witness patients presents a significant challenge due to their refusal of blood products.Case report: This case report details the management of a 50-year-old female Jehovah's Witness with anaemia and a low body surface area, undergoing an urgent ascending aorta and hemi-arch replacement for a type A dissection. A broad range of blood conservation strategies were utilised in order to preserve haematocrit and clotting factors.Conclusions: This report highlights the importance of careful planning, team collaboration, and the meticulous application of blood conservation techniques in achieving a favourable postoperative outcome.
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Aorta , Disección Aórtica , Procedimientos Médicos y Quirúrgicos sin Sangre , Testigos de Jehová , Humanos , Femenino , Persona de Mediana Edad , Procedimientos Médicos y Quirúrgicos sin Sangre/métodos , Aorta/cirugía , Disección Aórtica/cirugíaRESUMEN
Aortopexy is the most common surgical intervention for pediatric tracheomalacia (TM). The thoracoscopic approach, despite being reported by a few authors, remains controversial due to the different reported techniques and outcomes.We report a retrospective review of our preliminary experience with thoracoscopic aortopexy from 2023 to date. Patients' demographic data and symptoms were collected: age and weight at surgery, comorbidities, presence of brief resolved unexplained event (BRUE), dyspnea, chest infections, and barking cough. The study describes our surgical technique and its evolution. We analyzed the clinical outcome and endoscopic improvement, success and complication rate, operative time, and length of stay. We then compared our findings with the results of open and thoracoscopic aortopexy reported in the current literature.A total of 12 thoracoscopic aortopexies were performed on 10 patients (including two redo). The mean age and weight at operation were 3.2 years (range: 4 months-6 years) and 13.6 kg (range: 3.5-23), respectively. Two patients presented with BRUE, one with dyspnea, in the other cases the indications were recurrent pneumonia (more than six per year or three in 6 months). All patients underwent preoperative flexible bronchoscopy for the diagnosis of TM. The average estimated tracheal collapse was 86% (range: 70-95%). One intraoperative bleeding caused a conversion to open surgery, but no other complications occurred. All patients were extubated on the same day. Two cases required a redo due to suture tearing, and one of them required an additional posterior tracheopexy for persistent symptoms. The remaining patients had significant improvement on follow-up: success rate is 75%. Both patients requiring redo underwent aortopexy without pledgeted sutures or innominate artery (IA) suspension: these steps are associated with a success rate of 88.9% (p = 0.0182). Our refined technique now includes total thymectomy, pericardiotomy, pledgeted horizontal mattress sutures on the aorta, and the IA after full mobilization of the innominate vein.Thoracoscopic aortopexy appears to be a feasible and effective option for pediatric TM, particularly when replicating open surgical principles. Further research is needed to optimize the technique and improve the clinical results.
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Aorta , Toracoscopía , Traqueomalacia , Humanos , Estudios Retrospectivos , Preescolar , Niño , Lactante , Toracoscopía/métodos , Masculino , Femenino , Traqueomalacia/cirugía , Resultado del Tratamiento , Complicaciones Posoperatorias , Aorta/cirugía , Tiempo Operativo , Tiempo de InternaciónRESUMEN
Root enlargement via traditional transverse or oblique aortotomy disrupts the anatomical features of smooth continuity and symmetry from the aortic root to the proximal ascending aorta. A straight longitudinal aortotomy, extended vertically into nadir of noncoronary aortic annulus, achieves smooth continuity and symmetrical enlargement from the aortic root to the proximal ascending aorta with a tear-drop-shaped bovine pericardial patch. Herein, we report successful symmetrical root enlargement following straight longitudinal aortotomy via right anterior minithoracotomy.
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Aorta , Válvula Aórtica , Implantación de Prótesis de Válvulas Cardíacas , Toracotomía , Toracotomía/métodos , Humanos , Aorta/cirugía , Aorta/diagnóstico por imagen , Masculino , Válvula Aórtica/cirugía , Válvula Aórtica/diagnóstico por imagen , Resultado del Tratamiento , Femenino , Pericardio/trasplanteRESUMEN
Typically, the presence of ascending aortic IMH is treated with open surgical repair due to the unpredictability of subsequent rupture. We demonstrate successful endovascular management of retrograde ascending IMH with TEVAR in a 58-year-old, high-risk patient. Assisted by high-quality pre- and intra-operative imaging, TEVAR for type B dissection with retrograde IMH extension into the ascending aorta may offer a less invasive treatment and possibly a better outcome for patients.
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Aorta Torácica , Aorta , Aneurisma de la Aorta Torácica , Disección Aórtica , Implantación de Prótesis Vascular , Procedimientos Endovasculares , Hematoma , Humanos , Persona de Mediana Edad , Procedimientos Endovasculares/métodos , Hematoma/cirugía , Hematoma/diagnóstico por imagen , Aorta Torácica/cirugía , Aorta Torácica/diagnóstico por imagen , Masculino , Disección Aórtica/cirugía , Disección Aórtica/diagnóstico por imagen , Aneurisma de la Aorta Torácica/cirugía , Aneurisma de la Aorta Torácica/diagnóstico por imagen , Aorta/cirugía , Aorta/diagnóstico por imagen , Implantación de Prótesis Vascular/métodos , Tomografía Computarizada por Rayos X , Reparación Endovascular de AneurismasRESUMEN
BACKGROUND: Aortic stenosis is a debilitating disease characterized by pressure overload and development of myocardial fibrosis. Animal models that mimic this disease are crucial for translational research. Aortic constriction in rats is commonly used to induce pressure overload, but the precise disease progression in the O-ring induced model of ascending aortic constriction has not been thoroughly evaluated. Additionally, identifying early imaging biomarkers that can predict fibrosis could enhance the model's translational relevance. This study aims to evaluate a rat model of progressive pressure overload using cardiovascular magnetic resonance imaging (CMR) by investigating the degree of constriction at different time points and identifying early imaging biomarkers predicting myocardial fibrosis at later stages. METHODS: Sprague Dawley rats (n=14) underwent aortic banding with O-rings (inner diameter of 1.5 mm or 1.3 mm). Sham-operated rats (n=8) served as controls. CMR was performed every fourth week until 20 weeks post-surgery, followed by tissue harvesting and measurements of fibrosis with histology. RESULTS: All banding groups gradually developed left ventricular (LV) hypertrophy, impaired LV diastolic function (increased E/SRe), increased left atrial (LA) size, and impaired LA function (reduced LA ejection fraction and peak LA strain), but preserved LV ejection fraction during the course of study. The tightest constriction exhibited increased LV fibrosis at 20 weeks. LA diameter at 4 weeks independently predicted LV myocardial fibrosis. CONCLUSION: This animal model mimics the gradual progression of stenosis seen in humans, highlighting its translational potential. Early LA diameter predicted myocardial fibrosis. These findings underscore the model's relevance for studying disease progression in LV pressure overload.
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Aorta , Estenosis de la Válvula Aórtica , Presión Arterial , Hipertrofia Ventricular Izquierda , Imagen por Resonancia Cinemagnética , Miocardio , Disfunción Ventricular Izquierda , Función Ventricular Izquierda , Remodelación Ventricular , Animales , Ratas Sprague-Dawley , Modelos Animales de Enfermedad , Fibrosis , Progresión de la Enfermedad , Miocardio/patología , Masculino , Factores de Tiempo , Valor Predictivo de las Pruebas , Estenosis de la Válvula Aórtica/fisiopatología , Estenosis de la Válvula Aórtica/diagnóstico por imagen , Estenosis de la Válvula Aórtica/patología , Estenosis de la Válvula Aórtica/etiología , Hipertrofia Ventricular Izquierda/fisiopatología , Hipertrofia Ventricular Izquierda/etiología , Hipertrofia Ventricular Izquierda/patología , Hipertrofia Ventricular Izquierda/diagnóstico por imagen , Aorta/fisiopatología , Aorta/cirugía , Aorta/diagnóstico por imagen , Aorta/patología , Disfunción Ventricular Izquierda/fisiopatología , Disfunción Ventricular Izquierda/etiología , Disfunción Ventricular Izquierda/diagnóstico por imagen , Disfunción Ventricular Izquierda/patologíaRESUMEN
Aortic malignancies are rare diseases, of which only about 200 cases have been described in the literature. Most common forms are high-grade sarcomas, in over 80% of patients, which predominantly grow intimately and which can occur at any location in the aorta. In addition to non-specific symptoms, such as fever, hypertension and general weakness, aortic sarcomas in one third of patients manifest as peripheral embolism or, in the case of mural sarcoma, as an aneurysm or aortic rupture. In diagnostic testing, MRI is considered the gold standard, as CT angiography or PET CT can only show non-specific signs. Since aortic malignancies often manifest themselves as other diseases, diagnosis and therapy are often delayed. In therapy, the focus is on radial tumour resection with aortic replacement, possibly followed by adjuvant medical therapy. The 1-, 3- and 5-year survival rates are 26%, 7.6% and 3.5%, respectively.