Moderate hypothermia circulatory arrest as a brain-protective strategy for type a aortic dissection.

OBJECTIVES: Brain protective strategies for acute type A aortic dissection (TAAD) remain controversial. Moderate hypothermia circulatory arrest (MHCA) without cerebral perfusion is not commonly used. However, we aimed to assess its safety and efficacy in 358 patients who underwent hemiarch replacement with MHCA for acute type A aortic dissection at our institution from August 2012 to August 2022. METHODS: Clinical outcomes were compared according to circulatory arrest time (≤15 min [S group, n = 52] vs ≥ 16 min [L group, n = 306]). The primary outcome was postoperative stroke. RESULTS: The S group had more older patients (72.5 vs 68.8 years; p = 0.04), a greater incidence of carotid artery malperfusion (21% vs 11%; p = 0.043), and a lower body mass index (21.7 vs 23.6 kg/m2; p < 0.01) and haemodynamic instability (3.8% vs 16%; p = 0.02) than the L group. The incidence of postoperative stroke (7.7% vs 12%; p = 0.33) and the rate of 30-day mortality (5.8% vs 6.5%; p = 0.83) did not significantly differ between groups. After adjusting for all potential confounding factors pre- and intraoperatively, there was no significant difference in postoperative outcomes between groups. CONCLUSIONS: MHCA alone for TAAD had comparable postoperative outcomes with circulatory arrest times under and over 15 min. However, longer arrest times were associated with a higher risk of stroke.

[Total Arch Replacement with Open Stent Grafting for Chronic Dissecting Aortic Aneurysm with Aberrant Right Subclavian Artery:Report of a Case].

A 59-year-old man was referred to our hospital for surgery for a dissecting aortic aneurysm with an aberrant right subclavian artery( ARSA). He had a history of surgery for atrial septal defect at the age of 3 and developed Stanford type B aortic dissection at the age of 53. The maximum diameter of the aortic aneurysm was 68 mm, and the entry was located close to the ARSA origin. We established cardiopulmonary bypass using the femoral artery and vein and performed a median re-sternotomy. We performed total arch replacement with the open stent-grafting technique. The ARSA was ligated from the right thoracic cavity. Three arch branches were reconstructed in situ, and the right axillary artery was bypassed with a 9 mm Dacron graft. Six months after that operation, reduction of the false lumen was observed. This strategy is considered to be effective for chronic aortic dissection with ARSA.

[A Novel Virtual-reality Imaging System in Cardiovascular Surgery:a Potentially Promising Technology for Surgeons].

Adequate preoperative planning may facilitate successful procedures in cardiovascular surgery. We have developed a system named the Vesalius 3D suite, combining three-dimensional (3D) image-processing software with an optic-tracking spatial navigation, allowing quick, accessible 3D image interpretation for virtual reality (VR) exploration and measurement from one or more of a range of imaging modalities. We present a novel method of virtual imaging analysis for preoperative planning and simulation in cardiovascular surgery using this 3D-VR system. Based on unimodal or multimodal medical imaging data, digital imaging and communication in medicine (DICOM) data sets can be reconstructed for 3D visualization. Virtually reconstructed images can be viewed on flat-screen or stereoscopic display, revealing each patient's specific anatomy and the internal structures in exquisite detail. Highly accessible 3D interpretation promptly permits precise measurements of repair-relevant anatomical parameters including geometrically complex shapes. This technology may promote understanding of form and function in the cardiovascular system, and facilitate operative procedures in more challenging cases, and it seems especially valuable for any surgeon to gain experience in practicing for rarely-performed procedures or uncommon patient-specific preoperative surgical rehearsal.

A Virtual-Reality Imaging Analysis of the Dynamic Aortic Root Anatomy.

PURPOSE: To measure and explore complex cardiac anatomy in research and preoperative simulation, a virtual imaging technology-the Vesalius 3D suite (PS Medtech, Amsterdam, Netherlands)-combines Vesalius three-dimensional (3D) image-processing software with an optic-tracking navigation system running PST-Client software. We present a novel method of evaluating dynamic aortic root geometry in vivo using this visualization system. DESCRIPTION: Based on electrocardiography-gated cardiac computed tomography data in systole and diastole, images of the aortic root in a healthy adult were reconstructed for 3D visualization. Virtual interaction tools were used to explore and measure the aortic root structures. EVALUATION: Virtually reconstructed images revealed the aortic root internal structures in exquisite detail. Highly accessible 3D interpretation promptly permitted precise measurements of repair-relevant anatomic parameters, including geometrically complex curves of the aortic root wall and dynamic changes in the aortic valves. Measurement accuracy examined against a known prosthesis showed within 1 mm of error (less than 0.5%). CONCLUSIONS: This technology may promote understanding of aortic root form and function, and facilitate valve-sparing surgery, and seems valuable for 3D exploration and measurement of cardiac anatomy in vivo.