Corrigendum to: 2014 ESC Guidelines on the diagnosis and treatment of aortic diseases.

Corrigendum to: 2014 ESC Guidelines on the diagnosis and treatment of aortic diseases [Eur Heart Journal (2014) 35, 2873­2926,doi:10.1093/eurheartj/ehu281]. In Table 3, the radiation for MRI is "0" and not "-". The corrected table is shown below.

Long-term outcome after acute type A aortic dissection: does an age limit still exist?

AIM: Aim of the study was to analyze outcome in patients who underwent surgery following type A aortic dissections and to evaluate the long-term survival rates in patients 70 years of age and older and those under 70 years of age, and in males as compared to females. METHODS: Between September 1997 and October 2008, 154 patients were retrospectively enrolled. There were 102 males (66.2%) and 52 females (33.8%) with a mean age of 63.5±12; seven patients (4.5%) were over 80 years of age, 46 (29.8%) were between 70 and 80 years of age and 101 were under 70 years of age at the time of surgery. We compared patients 70 years of age and older with those under 70 years of age, analyzing the early and long-term survival results and postoperative complications. RESULTS: Overall in-hospital mortality was 17.5% and permanent neurological dysfunction occurred in 10 patients (6.5%). Twenty patients (12.9%) died during follow-up. Among the males, the long-term survival rate was 80%, 68% and 51% at 1, 5 and 10 years, respectively. Among the females, survival rate was 84.6%, 72.3% and 47.5% at 1, 5 and 10 years, respectively. Five- and 10-year survival rates were 78.1% and 59.4%, respectively, for patients under 70 years of age, and 50.8% at 5 years and 26.1% at 10 years for those over 70. CONCLUSION: Patients might not be excluded from surgical intervention for acute type A aortic dissection (ATAAD) only due to age. It is important to consider biological age and the clinical features of the patients at the time of surgery. Age is a relative but not absolute contraindication for surgery in ATAAD. Long-term survival was not statistically different between males and females.

Axillary and innominate artery cannulation during surgery of the thoracic aorta: a comparative study.

AIM: The aim of this paper was to compare hospital outcomes in patients undergoing elective surgery of the thoracic aorta using the right axillary artery (RAA) and the innominate artery (IA) as a cannulation site for cardiopulmonary bypass (CPB) arterial inflow. METHODS: Between September 2009 and October 2011, 71 patients underwent elective aortic procedures with RAA (N.=27) and IA (N.=44) cannulation. Selection of RAA vs. IA was not randomized, but rather based on surgical judgment of best indication in each patient. Pre-, intra-, and postoperative variables were compared according to cannulation site. RESULTS: Preoperative comorbidities, underlying aortic pathology, and surgical procedures were similar in RAA and IA patients. Hospital mortality was 11.1% and 6.8% in RAA and IA patients, respectively (P=0.243). Overall, 4 brain infarctions occurred, all left sided (RAA: 3.7% vs. IA: 6.8%; P=0.508). One brachial plexus injury, and 1 arterial dissection occurred in RAA group. No cannulation-related morbidity was observed in IA patients. Theoretical CPB flow could be reached in all patients, but resistances through the cannulation sites were more favourable in IA patients. CONCLUSION: RAA and IA were associated with similarly valid results. The choice between the two, based on the specific patient's characteristics, can improve outcomes after aortic surgery.

The International E-vita Open Registry: data sets of 274 patients.

AIM: After the introduction of the hybrid stent-graft "E-vita-open" by the Essen group in 1/2005 for one stage repair of complex thoracic aortic disease, the International E-vita open Registry was founded in 2008 to study the principles of this treatment algorithm and to control reported favorable single center results on a large patient data set basis up to six years after the first clinical implant. METHODS: Retrospective data work-up after prospective data acquisition was achieved by institution of the International E-vita open Registry with anonymous registration and calculation at Essen University Hospital. From January 2005 to December 2010, 274 patients (mean age 60; 74% males) with complex aortic disease, 190 with aortic dissection (88 acute (AAD), 102 chronic aortic dissection (CAD), and 84 with complex thoracic aortic aneurysm (TAA) were included in the studied. RESULTS: Eighty-one out of 274 (30%) patients underwent emergency surgery. Stent-graft deployment and arch replacement (238 total, 36 subtotal) was performed under selective antegrade cerebral perfusion (75 min mean). Cardiopulmonary bypass (CPB) and cardiac arrest times were mean 235 and 134 minutes, respectively. In-hospital mortality was 15% (40/274), 18% for AAD, 13% for CAD, and 14% for TAA. New strokes were observed in 6% (16/274), spinal cord injury in 8% (22/274). The false lumen (FL) was evaluated throughout the first hospital stay and at a median follow up time of 59 months after surgery. From the first follow up CT-examination to the last, thoracic complete FL thrombosis increased from 83% to 93% in AAD, from 72% to 92% in CAD. Full exclusion of the aneurysmal disease was achieved in 77% (61/79) during the primary hospital stay. CONCLUSION: Favorable single center results could be confirmed by an International community of cardiac surgical centers in regard to hospital mortality and morbidity, as well as a low postoperative complication rate and exclusion of false lumen in aortic dissection.

Endovascular approach for acute aortic syndrome.

Acute aortic syndrome (AAS) refers to the spectrum of aortic emergencies that include aortic dissection, intramural hematoma and penetrating atherosclerotic ulcer. These aortic pathologies may lead to aortic rupture and a timely treatment is crucial to obtain clinical success and benefit on survival. Endovascular strategies have gained wide acceptance in the management of AAS and currently represent the new minimally invasive alternative to traditional surgery. In particular in acute complicated aortic dissection endovascular therapy demonstrated a better survival and limited complications with respect to open surgery. Aim of the present study was to provide an overview of AAS and to assess the current role of endovascular aortic repair in its treatment.

Subclavian embolization associated to carotid-subclavian bypass and stent-graft repair of acute type-B dissection.

Intentional closure of the left subclavian artery (LSA) during an endovascular procedure can be complicated by retrograde filling of the excluded aorta, increasing the risk of aneurysm expansion and sudden rupture. Retrograde coil embolization of the LSA, as alternative to open subclavian ligature, is a safe and effective method of rapid false lumen sealing in patients requiring coverage of the LSA and carotid-subclavian bypass, even in the setting of acute aortic syndromes.

Optimal management of traumatic aortic injury.

BACKGROUND: The best time to intervene in traumatic aortic injuries has long been a matter of debate. While emergency surgery is characterized by high morbidity and mortality, initial medical management of uncomplicated aortic injury and subsequent delayed surgery resulted in better outcome. METHODS AND RESULTS: From analysis of medical literature of the last 10 years, major paradigm shift in management of traumatic injuries includes the use of different imaging methods for diagnosis, with a almost complete elimination of aortography and transesophageal echocardiography in favour of CT scan, and a significant change in method of definitive repair, shifting from exclusively open techniques in 1997 to predominantly endovascular repairs in 2007. At present several reports in literature provide data on comparative results of endovascular therapy with respect open surgery, supporting the use of stent-graft in traumatic injuries, both in acute and chronic cases. The authors' personal experience comprises 58 patients treated with endovascular stent-graft repair, with no mortality or treatment failure even during 11 years follow-up. CONCLUSIONS: For many years traumatic aortic injury has been considered a highly lethal lesion and a potential cause of death in blunt chest trauma. Because of the lower invasivity endovascular repair can be applied in traumatic aortic injury with very low risk and limited impact on trauma destabilization. Long term follow-up seems indicate a substantial durability of the procedure.

Complex repair of the thoracic aorta with the E-vita open prosthesis.

AIM: The treatment of complex aortic pathologies of the thoracic aorta remains a challenging issue in aortic surgery. The'' Frozen elephant trunk'' technique represents a recent development of the classic elephant trunk technique combining endovascular with conventional surgery. METHODS: Between January 2007 and January 2008, 24 patients were operated on for complex pathologies of the thoracic aorta using the frozen elephant trunk technique with the E-vita open prosthesis. There were 21 male (87.5%) and the mean age was 62.4+/-9.9 years. The majority of patients (N=11) presented type A chronic dissection, 6 (25%) patients had chronic aneurysm of distal aortic arch and 5 (20.8%) type B aortic dissection associated with ascending aorta/aortic arch aneurysm. There were 2 cases of acute aortic dissection (1 type A and 1 type B). Nine patients (37.5%) underwent previous cardiovascular operations. RESULTS: The overall in-hospital mortality was 4.2% (1 patient). None patient developed postoperative stroke and 1 patient suffered from spinal cord ischemia (1 paraparesis, 1 paraplegia). There were 2 cases (8.3%) of renal failure (dialysis), 2 patients (8.3%) had pulmonary complications and 2 patients (8.3%) needed rethoracotomy for bleeding. Five patients (21.7%) required extension of the descending thoracic aorta repair with endovascular treatment for persistent perfusion of dilated false lumen. CONCLUSION: The Frozen Elephant trunk technique with the new E-vita open prosthesis combines surgical and interventional technologies and it represents a feasible and efficient option in the treatment of complex aortic pathologies. However long term follow up is required.

Evolving concepts in the treatment of traumatic aortic injury. A review article.

Traumatic aortic injury (TAI) has long been considered a surgical emergency, despite the high mortality and morbidity rates in traumatized patients submitted to open surgery. Initial medical management until stabilization of associated traumatic lesions has long been a matter of debate because of the inherent risk of rupture in some of these cases. Endovascular techniques in the management of polytraumatized patients provides an additional low-invasive treatment option. Because of its lower invasiveness, without thoracotomy or the use of heparin, endovascular repair can be performed in acute patients, without the risk of destabilizing pulmonary, head or abdominal traumatic lesions. Following the publication of early small series and case reports, endovascular repair has become a widely accepted method for treating both acute and chronic traumatic lesions. Our series comprised 51 TAI patients submitted to endovascular aneurysm repair from July 1997 to December 2006, of which 24 had chronic post-traumatic aneurysms and 27 were treated in the acute or subacute phase after the traumatic event. No mortality occurred; aneurysm sealing was consistently good. Major complications included a cerebellar stroke in 1 patient due to occlusion of the left subclavian artery. No failure of aortic procedure, mortality or complications were observed during the follow-up period. Should long-term follow-up in larger series show substantial durability of the graft material, endovascular treatment will become the management of choice for TAIs.