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1.
Vasc Endovascular Surg ; 54(2): 102-110, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31746273

RESUMO

OBJECTIVE: Compare technical, clinical, and economic outcomes between endovascular and open approaches in patients with type D aortoiliac occlusive disease according to the TransAtlantic Inter-Society Consensus. METHODS: Patients undergoing revascularization for type D aortoiliac lesions, either endovascular or open surgery approach, from 2 Portuguese institutions between January 2011 and October 2017 were included. The surgical technique was left to the surgeon discretion. Patients with common femoral artery affection, both obstructive and aneurysmatic, were excluded. RESULTS: Twenty-seven patients underwent aortobifemoral bypass and 32 patients were submitted to endovascular repair. The patients undergoing endovascular procedure were more likely to present with chronic heart failure (P = .001) and chronic kidney disease (P = .022) and less likely to have a history of smoking (P = .05). The mean follow-up period was 67.84 (95% confidence interval = 61.85-73.83) months. The open surgery approach resulted in a higher technical success (P = .001); however, limb salvage and patency rates were not different between groups. Endovascular approach was associated with a shorter length-of-stay, both inpatient (6 vs 9 days; P = .041) and patients admitted in the intensive care unit (0 vs 3.81 days; P = .001) as well as lower hospital expenses (US$9281 vs US$23 038; P = .001) with a similar procedure cost (US$2316 vs US$1173; P = .6). No differences were found in the postsurgical quality of life. CONCLUSION: Endovascular approach is, at least, clinically equivalent to open surgery approach and is more cost-efficient. The "endovascular-first" approach should be considered for type D occlusive aortoiliac lesions.


Assuntos
Doenças da Aorta/cirurgia , Arteriopatias Oclusivas/cirurgia , Implante de Prótese Vascular , Procedimentos Endovasculares , Artéria Femoral/cirurgia , Artéria Ilíaca/cirurgia , Idoso , Doenças da Aorta/diagnóstico por imagem , Doenças da Aorta/economia , Doenças da Aorta/fisiopatologia , Arteriopatias Oclusivas/diagnóstico por imagem , Arteriopatias Oclusivas/economia , Arteriopatias Oclusivas/fisiopatologia , Prótese Vascular , Implante de Prótese Vascular/efeitos adversos , Implante de Prótese Vascular/economia , Implante de Prótese Vascular/instrumentação , Redução de Custos , Análise Custo-Benefício , Procedimentos Endovasculares/efeitos adversos , Procedimentos Endovasculares/economia , Procedimentos Endovasculares/instrumentação , Feminino , Artéria Femoral/diagnóstico por imagem , Artéria Femoral/fisiopatologia , Custos de Cuidados de Saúde , Humanos , Artéria Ilíaca/diagnóstico por imagem , Artéria Ilíaca/fisiopatologia , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Portugal , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Stents , Fatores de Tempo , Resultado do Tratamento
2.
Angiol Sosud Khir ; 25(4): 55-63, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31855201

RESUMO

The last decade has seen distinct dynamics of the worldwide growth of the number of endovascular interventions and a decrease in the number of 'open' surgical operations for pathology of the aorta and peripheral arteries. The world trends of treatment of patients presenting with pathology of the aorta and peripheral arteries are indicative of a steadily growing amount of operations, most of which are performed in an endovascular manner. In the Russian Federation, the past decade has also witnessed a noticeable jump of the amounts of endovascular interventions. Thus, the number of operations from 2008 to 2017 increased from 15 094 to 37 109 (2.5-fold). Nevertheless, in Russia there is a significant lag in both the total amount and the ratio of the performed surgical and endovascular operations in patients with pathology of the aorta and peripheral arteries. The article analyses the world and Russian trends in the development of surgical and endovascular treatment of patients with pathology of the aorta and peripheral arteries.


Assuntos
Doenças da Aorta/cirurgia , Doenças Vasculares Periféricas/cirurgia , Procedimentos Cirúrgicos Vasculares/tendências , Procedimentos Endovasculares/tendências , Humanos , Federação Russa
3.
Medicine (Baltimore) ; 98(51): e18303, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31860979

RESUMO

RATIONALE: Aortoesophageal fistula (AEF) is the direct communication between the aorta and esophagus, which can cause fatal hemorrhage, and its incidence increased with the use of an esophageal stent (ES). PATIENT CONCERNS: A 79-year-old man was admitted due to hemodynamic shock with massive hematemesis caused by AEF 1 month after the implantation of an ES. DIAGNOSES: Computed tomography angiography visualized an AEF with an ulcer-like projection on the aortic arch where the ES was placed. Angiography of the aorta revealed extravasation of contrast media from the aortic arch into the stented esophagus, which confirmed the diagnosis. INTERVENTIONS: Thoracic endovascular aortic repair (TEVAR) was performed for massive hematemesis caused by ES-related, AEF but did not solve the underlying problem, leading to the second fatal hemorrhage. LESSONS: TEVAR for the unique treatment of ES-related AEF is feasible in certain cases but may lead to collapse after a specific period.


Assuntos
Doenças da Aorta/complicações , Fístula Esofágica/complicações , Hemorragia Gastrointestinal/etiologia , Implantação de Prótese/efeitos adversos , Stents/efeitos adversos , Fístula Vascular/complicações , Idoso , Doenças da Aorta/etiologia , Doenças da Aorta/cirurgia , Angiografia por Tomografia Computadorizada , Fístula Esofágica/etiologia , Fístula Esofágica/cirurgia , Evolução Fatal , Hemorragia Gastrointestinal/cirurgia , Humanos , Masculino , Tomografia Computadorizada por Raios X , Fístula Vascular/etiologia , Fístula Vascular/cirurgia
4.
Rev Port Cir Cardiotorac Vasc ; 26(3): 195-197, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31734970

RESUMO

INTRODUCTION: The association between aortic valve disease and dilatation of the ascending aorta is well known and concomitant surgery is recommended when the aortic diameter is higher than 45mm. The use of the rapid deployment valves allows less cross-clamping and cardiopulmonary bypass times for both isolated and combined procedures in comparison to regular valves. We describe our initial experience of concomitant aortic valve and the ascending aortic replacement, using the rapid deployment valve Edward Intuity EliteTM. CASE PRESENTATION: All patients were male, with a mean age of 72-years-old. The mean cross-clamping time was 48 minutes, with a mean cardiopulmonary time of 61 minutes. The mean time of ICU stay was 4 days. All the patients had follow-up 1 and 3 months after discharge and were doing well. CONCLUSIONS: The rapid deployment aortic valves have recognized advantages in aortic valve replacement. Our small experience reinforces that replacement the ascending aortic and aortic valve with this prothesis is one procedure that can benefits from generalization without increased risks and with potentially better clinical outcomes. Larger cohort studies would allow clarification over this subject.


Assuntos
Aorta/cirurgia , Valva Aórtica/cirurgia , Implante de Prótese Vascular/métodos , Doenças Cardiovasculares/cirurgia , Implante de Prótese de Valva Cardíaca/métodos , Próteses Valvulares Cardíacas , Idoso , Doenças da Aorta/cirurgia , Bioprótese , Doenças das Valvas Cardíacas/cirurgia , Humanos , Masculino , Desenho de Prótese , Resultado do Tratamento
6.
J Cardiovasc Surg (Torino) ; 60(6): 733-741, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31599143

RESUMO

BACKGROUND: With the progressive aging of the population, aortic surgeons are caring for an increasing number of elderly patients. The objective of this study was to analyze early and late outcomes of aortic surgery with hypothermic circulatory arrest in patients aged 70 and above at our institution. METHODS: We performed a retrospective cohort study including every patient aged 70 years or older who underwent aortic surgery with hypothermic circulatory arrest between January 1995 and June 2016 at our institution. Operative results were compared with the contemporary younger counterparts aged <70 years. In-hospital mortality and postoperative stroke were primary outcomes of interest. The main secondary outcomes included acute renal failure, reoperation for bleeding, and spinal cord injury. RESULTS: In the study population, the in-hospital mortality was 16.8% (21/125). Ten (8.0%) patients presented postoperative stroke, and 6 had temporary neurologic disturbance (4.8%). Spinal cord injury occurred in 1 (0.8%) patient. For elective interventions and type A aortic dissections, the in-hospital mortality and stroke rates were 4.6% (3/65) and 7.7% (5/65), 26.8% (11/41) and 12.2% (5/41), respectively. The proportion of non-elective interventions, including type A aortic dissection, and the type of neuroprotective strategy were similar in septuagenarians and younger patients. Patients aged ≥70 had significant shorter cardiopulmonary bypass, myocardial ischemia, and circulatory arrest durations, compared to their younger counterparts. The in-hospital mortality of septuagenarians and younger patients were similar for elective surgery (4.6% vs. 4.7%, P=0.900) and aortic dissections (26.8% vs. 15.1%, P=0.107). There was no statistically significant difference between the two age groups regarding postoperative stroke, spinal cord injury, renal failure requiring dialysis or reintervention for bleeding. Estimated 1-, 3-, and 5-year survival was 78.0%, 70.6%, and 65.7%, respectively. The 5-year survival for elective surgery was 74.9% and 56.0% for non-elective procedures. CONCLUSIONS: Aortic surgery with circulatory arrest in the elderly demonstrated favorable early and late results when compared with younger individuals, with an acceptable operative risk even under emergency conditions, and should not be denied only because of the chronological age of the patients.


Assuntos
Aorta/cirurgia , Doenças da Aorta/cirurgia , Parada Cardíaca Induzida , Hipotermia Induzida , Procedimentos Cirúrgicos Vasculares , Fatores Etários , Idoso , Aorta/fisiopatologia , Doenças da Aorta/mortalidade , Doenças da Aorta/fisiopatologia , Feminino , Parada Cardíaca Induzida/efeitos adversos , Parada Cardíaca Induzida/mortalidade , Mortalidade Hospitalar , Humanos , Hipotermia Induzida/efeitos adversos , Hipotermia Induzida/mortalidade , Masculino , Complicações Pós-Operatórias/mortalidade , Complicações Pós-Operatórias/cirurgia , Reoperação , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Procedimentos Cirúrgicos Vasculares/efeitos adversos , Procedimentos Cirúrgicos Vasculares/mortalidade
8.
Medicine (Baltimore) ; 98(37): e17159, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31517864

RESUMO

RATIONALE: Penetrating aorta ulcer (PAU) with isolated left vertebral artery (ILVA) is a rare condition, accounting for no more than 1% of all kinds of aorta diseases. And traditional treatment was open surgery with total arch replacement by elephant trunk. Here, we report a case of PAU combined with ILVA managed by thoracic endovascular aortic repair (TEVAR) technique. PATIENT CONCERNS: A 65-year-old male with chronic hypertension and Nicotine abuse underwent intermittent back pain for 2 years and aggravated a bit for 1 week. DIAGNOSES: Preoperative computed tomography angiogram (CTA) indicated PAU combined with ILVA. INTERVENTIONS: TEVAR was performed for PAU following with retrograde in situ fenestration and chimney technique for revascularization of ILVA and left subclavian artery (LSA), respectively. OUTCOMES: The operation was successfully and the patient was discharged from hospital after 1 week of treatment. Postoperatively, the images of CTA illustrated the patency of aorta, ILVA, and LSA without obvious endoleak. Besides, no ischemia attack or other relative syndromes were detected at 6-months follow-up. LESSONS: This case demonstrates that TEVAR is an alternative to elephant trunk especially for PAU with ILVA. And it also showed the precise exposure of ILVA and necessity to reconstruct ILVA during TEVAR operation in order to reduce the occurrence of ischemia attack.


Assuntos
Aorta Torácica/cirurgia , Doenças da Aorta/cirurgia , Procedimentos Endovasculares , Úlcera/cirurgia , Artéria Vertebral/cirurgia , Idoso , Aorta Torácica/diagnóstico por imagem , Doenças da Aorta/diagnóstico , Diagnóstico Diferencial , Procedimentos Endovasculares/métodos , Humanos , Masculino , Úlcera/diagnóstico , Artéria Vertebral/diagnóstico por imagem
9.
J Cardiothorac Surg ; 14(1): 157, 2019 Sep 04.
Artigo em Inglês | MEDLINE | ID: mdl-31484541

RESUMO

BACKGROUND: A floating thrombus in the ascending aorta is occasionally found in clinical practice. The treatment for such lesions is poorly defined and mainly depends on the clinical experience of the surgeons. CASE PRESENTATION: We herein report a case involving a 22- × 22- × 45-mm space-occupying lesion in the ascending aorta. The patient was successfully treated with surgical intervention. Thrombectomy and ascending aorta replacement were performed to prevent systemic embolization. Histopathological examination revealed that the lesion was a thrombus. CONCLUSIONS: Aortic computed tomography angiography is a useful examination technique for patients with aortic thrombi. Resection of the thrombus can effectively reduce the risk of recurrent embolism.


Assuntos
Aorta , Doenças da Aorta/diagnóstico , Trombectomia/métodos , Trombose/diagnóstico , Doenças da Aorta/cirurgia , Angiografia por Tomografia Computadorizada , Ecocardiografia Transesofagiana , Humanos , Masculino , Pessoa de Meia-Idade , Trombose/cirurgia
10.
J Cardiothorac Surg ; 14(1): 159, 2019 Sep 06.
Artigo em Inglês | MEDLINE | ID: mdl-31492164

RESUMO

BACKGROUND: Aortic erosion is a serious complication that usually occurs shortly after Amplazter Septal Occluder (ASO) implantation for atrial septal defect (ASD). CASE PRESENTATION: A seven-year-old girl was diagnosed with secundum ASD without symptoms. Transesophageal echocardiography (TEE) showed a defect of 20 mm in diameter in the fossa ovalis without aortic rim. An ASO device of 24 mm in diameter was selected and electively implanted. The "A-shape" of the device was confirmed by intraoperative TEE, a landmark finding indicating the proper implantation of ASO in patients without aortic rim. After an uneventful postoperative course of 5 years and 10 months, she was transferred to our unit due to cardiogenic shock. Her echocardiogram in emergency room showed pericardial effusion with collapsed right ventricle. Given her history of ASO and the observation of the sequentially increasing pericardial effusion, we diagnosed her with acute cardiac tamponade due to aortic erosion. Emergency pericardiotomy was then performed to improve the hemodynamic condition. Fresh clots were found, so we immediately prepared the cardiopulmonary bypass circuit and explored the damage to the aorta, in which the clots had accumulated. Bleeding suddenly started when the clots were removed. We then inserted the cannulae for perfusion and venous drainage. The clots were removed, and tears were found in both the lateral side of the ascending aorta and the right atrial wall. Intraoperative TEE showed that an edge of the ASO device was directly touching the aortic wall and the Doppler color-flow imaging showed blood flow through this lesion. The erosive lacerations of both the ascending aorta and right atrium were detected from the inside after achieving cardioplegic cardiac arrest. The ascending aorta was obliquely incised, and the laceration was closed from inside the aortic root. The postoperative course was uneventful. She has been doing well for 5 years since the surgery. CONCLUSIONS: We experienced and successfully treated a rare case of acute cardiac tamponade caused by aortic erosion 5 years and 10 months after ASO implantation.


Assuntos
Aorta Torácica/diagnóstico por imagem , Doenças da Aorta/etiologia , Comunicação Interatrial/cirurgia , Complicações Pós-Operatórias/etiologia , Dispositivo para Oclusão Septal/efeitos adversos , Aorta Torácica/cirurgia , Doenças da Aorta/diagnóstico , Doenças da Aorta/cirurgia , Cateterismo Cardíaco/métodos , Criança , Remoção de Dispositivo , Ecocardiografia Transesofagiana , Feminino , Seguimentos , Comunicação Interatrial/diagnóstico , Humanos , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/cirurgia , Reoperação , Fatores de Tempo , Procedimentos Cirúrgicos Vasculares/métodos
11.
Medicine (Baltimore) ; 98(29): e16486, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31335713

RESUMO

RATIONALE: Esophageal foreign body is a commonly seen in China. However, pseudoaneurysm of the aortic arch caused by ingestion of fish bones is a rare, life-threatening condition. PATIENT CONCERNS: A 71-year-old male was admitted to the Ear, Nose, and Throat department with a 4-day history of chest pain after eating fish. DIAGNOSES: After taking out the fish bone by rigid endoscopy, magnetic resonance imaging and computerized tomography angiography (CTA) scans revealed the presence of an aortic arch pseudoaneurysm, which was likely caused by the fish bone. INTERVENTIONS: A successful endovascular graft exclusion surgery was performed to block the aorta ulcer. OUTCOMES: The patient recovered and was discharged 20 days after hospitalization. The patient was healthy and had no fever or chest pain 4 months after discharge from the hospital. LESSONS: Esophageal foreign bodies may lead to life-threatening impairment of the aorta or other big arteries. When esophageal foreign bodies puncture the esophageal wall, especially in the second stenosis of the esophagus, an enhanced-contrast computed tomography scan or a CTA scan may be necessary to exclude any potential impairment of the arteries.


Assuntos
Falso Aneurisma/etiologia , Aorta Torácica , Doenças da Aorta/etiologia , Esôfago/lesões , Corpos Estranhos/complicações , Alimentos Marinhos/efeitos adversos , Idoso , Falso Aneurisma/diagnóstico por imagem , Falso Aneurisma/cirurgia , Animais , Aorta Torácica/diagnóstico por imagem , Doenças da Aorta/diagnóstico por imagem , Doenças da Aorta/cirurgia , Osso e Ossos , Esofagoscopia , Esôfago/diagnóstico por imagem , Esôfago/cirurgia , Corpos Estranhos/diagnóstico por imagem , Corpos Estranhos/cirurgia , Humanos , Masculino , Tomografia Computadorizada por Raios X
12.
Khirurgiia (Mosk) ; (6): 101-106, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31317948

RESUMO

Aorto-esophageal and aorto-bronchial fistulas are rare and life-threatening diseases if emergency treatment is absent. The most of publications devoted to this problem are case reports describing successful treatment of patients with aorto-esophageal and aorto-bronchial fistulas by using of endovascular or open transthoracic surgery. However, we did not find reports of several aortic fistulas in a patient after previous aortic stenting. It is presented case report of patient with aorto-esophago-bronchial and aorto-pulmonary fistulas in postoperative period after thoracic endovascular aortic repair (TEVAR).


Assuntos
Aneurisma da Aorta Torácica/cirurgia , Fístula Brônquica/etiologia , Procedimentos Endovasculares/efeitos adversos , Fístula Esofágica/etiologia , Pneumopatias/etiologia , Fístula Vascular/etiologia , Aneurisma da Aorta Torácica/complicações , Doenças da Aorta/etiologia , Doenças da Aorta/cirurgia , Fístula Brônquica/cirurgia , Procedimentos Endovasculares/métodos , Fístula Esofágica/cirurgia , Humanos , Pneumopatias/cirurgia , Fístula do Sistema Respiratório/etiologia , Fístula do Sistema Respiratório/cirurgia , Fístula Vascular/cirurgia
13.
J Cardiothorac Surg ; 14(1): 135, 2019 Jul 18.
Artigo em Inglês | MEDLINE | ID: mdl-31319874

RESUMO

Concomitant replacement of the ascending aorta with the aortic valve in patients who have left ventricular dysfunction might carry high operative risks. Performing the conservative reduction aortoplasty was shown to have less complications in such patients. When combined with other concomitant cardiac procedures, the newly described "spiral" aortoplasty technique in this series allows for a mulitplanar wall tension reduction in moderately dilated ascending aorta.


Assuntos
Aorta/cirurgia , Doenças da Aorta/cirurgia , Valva Aórtica/cirurgia , Implante de Prótese de Valva Cardíaca/métodos , Procedimentos Cirúrgicos Vasculares/métodos , Disfunção Ventricular Esquerda/cirurgia , Idoso , Doenças da Aorta/complicações , Dilatação Patológica/cirurgia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Risco , Resultado do Tratamento , Disfunção Ventricular Esquerda/complicações
14.
Gen Thorac Cardiovasc Surg ; 67(9): 751-757, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31312983

RESUMO

BACKGROUND: Thoracic and thoracoabdominal aortic diseases are treated using operative procedures like open aortic repair (OAR), thoracic endovascular aortic repair (TEVAR), or hybrid aortic repair (HAR), or a combination of OAR and TEVAR. The surgical approach to aortic repair has evolved over the decades. The purpose of this study was to examine the current trends in treatment. METHODS: We extracted nationwide data of aortic repair procedures performed in 2015 and 2016 from the Japan Cardiovascular Surgery Database (JCVSD). In addition to estimating the number of cases, we also reviewed the respective operative mortalities and associated major morbidities (e.g., stroke, spinal cord insufficiency, and renal failure) according to disease pathology (e.g., acute dissection, chronic dissection, ruptured aneurysm, and unruptured aneurysm), site of operative repair (i.e., aortic root, ascending aorta, aortic root to arch, aortic arch, descending aorta, and thoracoabdominal aorta), and the preferred surgical approach (i.e., OAR, HAR, or TEVAR). RESULTS: The total number of cases studied was 35,427, with an overall operative mortality rate of 7.3%. Among the 3 procedures, 64% of patients were treated with OAR. Compared to the data from our previous report (also derived from the JCVSD in 2013 and 2014), the total number of cases and number of OAR, HAR, and TEVAR procedures have increased by 17.0%, 2.4%, 126.1%, and 34.9%, respectively. While the overall stroke rates following aortic arch surgical repair with HAR, OAR, and TEVAR were 10.1%, 8.4%, and 7.3%, respectively, OAR was found to have the lowest stroke rate when limited to cases presenting with a non-dissected/unruptured aorta. The incidence rates of paraplegia following descending/thoracoabdominal aortic surgical repair using HAR, OAR, and TEVAR were 6.3%/10.4%, 4.3%/8.9%, and 3.4%/4.6%, respectively. TEVAR was found to be associated with the lowest incidence of postoperative renal failure. CONCLUSIONS: The number of operations for thoracic and thoracoabdominal aortic diseases has increased, though the rate of operations using an OAR approach has decreased. While TEVAR showed the lowest mortality and morbidity rates, OAR demonstrated the lowest postoperative stroke rate for non-dissecting aortic arch aneurysms.


Assuntos
Aneurisma da Aorta Torácica/cirurgia , Implante de Prótese Vascular/métodos , Procedimentos Endovasculares/métodos , Idoso , Aneurisma Dissecante , Aorta Torácica/cirurgia , Doenças da Aorta/cirurgia , Implante de Prótese Vascular/tendências , Cardiologia/métodos , Cardiologia/tendências , Bases de Dados Factuais , Procedimentos Endovasculares/tendências , Feminino , Humanos , Incidência , Japão , Masculino , Pessoa de Meia-Idade , Morbidade , Paraplegia/etiologia , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
15.
Semin Thorac Cardiovasc Surg ; 31(4): 679-685, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31279912

RESUMO

Frozen Elephant Trunk (FET) combines the advantages of open and endovascular surgery for the treatment of complex aortic arch pathologies extending into the descending aorta. At University Hospital Essen, operative skills were developed to make FET surgery safer including guidance and control of FET deployment into the descending aorta by angioscopy and facilitation of arch repair by moving the distal anastomosis to Zone 2 and more proximally. Selective whole body perfusion during the arch repair was used to improve organ protection under moderate hypothermia. Our results demonstrate acceptable mortality in this high risk patient population and reduction of postoperative morbidity in the last years. With regard to the rate of exclusion of aneurysms in the distal arch and the false lumen in acute aortic dissection, FET should be the treatment of choice in both. In chronic aortic dissection and extensive descending aortic aneurysms, FET represents a safe first stage procedure and provides an ideal docking place in the mid-descending aorta for a second endovascular or open thoracoabdominal aortic repair, if required.


Assuntos
Aorta Torácica/cirurgia , Doenças da Aorta/cirurgia , Implante de Prótese Vascular/instrumentação , Prótese Vascular , Procedimentos Endovasculares/instrumentação , Stents , Idoso , Aorta Torácica/diagnóstico por imagem , Aorta Torácica/fisiopatologia , Doenças da Aorta/diagnóstico por imagem , Doenças da Aorta/mortalidade , Doenças da Aorta/fisiopatologia , Implante de Prótese Vascular/efeitos adversos , Implante de Prótese Vascular/mortalidade , Procedimentos Endovasculares/efeitos adversos , Procedimentos Endovasculares/mortalidade , Feminino , Alemanha , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/mortalidade , Desenho de Prótese , Fatores de Risco , Resultado do Tratamento
16.
Semin Thorac Cardiovasc Surg ; 31(4): 635-637, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31279913

RESUMO

The first concept of Artificial Intelligence (AI) came into attention during 1920s and currently it is rapidly being integrated in our daily clinical practice. The use of AI has evolved from basic image-based analysis into complex decisions related to different surgical procedure. AI has been very widely used in the cardiology field, however the use of such machine-led decisions has been limited and explored at slower pace in surgical practice. The use of AI in cardiac surgery is still at its infancy but growing dramatically to reflect the changes in the clinical decision making process for better patient outcomes. The machine-led but human controlled algorithms will soon be taking over most of the decision making processes in cardiac surgery. This review article focuses on the practice of AI in aortic surgery and the future of such technology-led decision making pathways on patient outcomes, surgeon's learning skills and adaptability.


Assuntos
Doenças da Aorta/cirurgia , Inteligência Artificial/tendências , Cirurgiões/tendências , Cirurgia Assistida por Computador/tendências , Procedimentos Cirúrgicos Vasculares/tendências , Doenças da Aorta/diagnóstico por imagem , Atitude do Pessoal de Saúde , Atitude Frente aos Computadores , Big Data , Competência Clínica , Difusão de Inovações , Previsões , Humanos , Curva de Aprendizado , Cirurgiões/educação , Cirurgiões/psicologia , Cirurgia Assistida por Computador/efeitos adversos , Cirurgia Assistida por Computador/educação , Procedimentos Cirúrgicos Vasculares/efeitos adversos , Procedimentos Cirúrgicos Vasculares/educação
18.
J Cardiovasc Surg (Torino) ; 60(5): 582-588, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31256581

RESUMO

BACKGROUND: A geometrical understanding of the individual patient's disease morphology is crucial in aortic surgery. The aim of our study was to validate a questionnaire addressing understanding of aortic disease and use this questionnaire to investigate the value of 3D printing as a teaching tool for surgical trainees. METHODS: Anonymized CT-angiography images of six different patients were selected as didactic cases of aortic disease and made into 3D models of transparent rigid resin with the Vat-photopolymerization technique. The 3D aortic models, which could be disassembled and reassembled, were displayed to 37 surgical trainees, immediately after a seminar on aortic disease. A questionnaire was developed to compare the trainees' understanding before (T0) and after (T1) demonstration of the 3D printed models. RESULTS: A panel of 15 experts participated in evaluating face and content validity of the questionnaire. The questionnaire validity was established and therefore the information investigated by the questionnaire could be synthetized using the mean of the items to indicate the understanding. The participants (mean age 28 years, range 26-34, male 59%) showed a significant improvement in understanding from T0 (median=7.25; IQR=1.50) to T1 (median=8.00; IQR=1.50; P=0.002). CONCLUSIONS: Preliminary data suggest that the use of 3D-printed aortic models as a teaching tool was feasible and improved the understanding of aortic disease among surgical trainees.


Assuntos
Aorta/diagnóstico por imagem , Doenças da Aorta/diagnóstico por imagem , Aortografia/métodos , Angiografia por Tomografia Computadorizada , Educação de Pós-Graduação em Medicina/métodos , Impressão Tridimensional , Cirurgiões/educação , Inquéritos e Questionários , Procedimentos Cirúrgicos Vasculares/educação , Adulto , Aorta/cirurgia , Doenças da Aorta/cirurgia , Compreensão , Escolaridade , Estudos de Viabilidade , Feminino , Humanos , Masculino , Modelos Anatômicos , Modelos Cardiovasculares , Modelagem Computacional Específica para o Paciente , Valor Preditivo dos Testes , Dados Preliminares , Interpretação de Imagem Radiográfica Assistida por Computador , Reprodutibilidade dos Testes
19.
Cardiol Young ; 29(6): 842-844, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31169093

RESUMO

We describe two cases of spontaneous embolisation and successful retrieval of ceramic-coated patent arterial duct devices. In both, the device embolised to the descending aorta in the absence of pulmonary hypertension and despite optimum placement. We have discussed possible mechanisms for embolisation in these patients and suggested alternative methods for device retrieval. Based on this limited experience, we conclude that for tubular ducts, ceramic-coated devices should be oversized to form a tighter waist or alternate devices may be considered.


Assuntos
Aorta Torácica/diagnóstico por imagem , Doenças da Aorta/cirurgia , Cateterismo Cardíaco/métodos , Cerâmica , Remoção de Dispositivo/métodos , Embolia/cirurgia , Dispositivo para Oclusão Septal/efeitos adversos , Doenças da Aorta/diagnóstico , Doenças da Aorta/etiologia , Aortografia , Materiais Revestidos Biocompatíveis , Permeabilidade do Canal Arterial/cirurgia , Embolia/diagnóstico , Feminino , Humanos , Lactente , Falha de Prótese
20.
Presse Med ; 48(6): 706-713, 2019 Jun.
Artigo em Francês | MEDLINE | ID: mdl-31151848

RESUMO

Aortic pathologies benefit from imaging innovation and interventional radiology developments in order to improve patient management. At the early phase, vital risk should be considered. Whole body CT scan evaluate the complete aorta and its branches to assess the pathology and to choose the best approach between surgery or interventional radiology (fenestration, stentgraft, peripheral stenting). Algorithms, based on the understanding of the complications mechanisms and evolutive risk, modified the management specifically for aortic dissection. At chronic phase, GPs and angiologists should follow their patients in order to detect aortic complications and to treat cardiovascular risk factors. MRA is well indicated if possible.


Assuntos
Aorta Torácica , Doenças da Aorta/diagnóstico , Doenças da Aorta/cirurgia , Doença Aguda , Algoritmos , Doença Crônica , Humanos
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