Staged hybrid approach to chronic type B aortic dissection involving the distal arch associated with aortic root aneurysm.

Open surgical repair of complex aortic pathologies using cardiopulmonary bypass and deep hypothermic circulatory arrest still carries a substantial rate of mortality and morbidity. Endovascular stent-graft placement has developed as a safe and effective treatment modality for various diseases of the aorta. We report on the case of a 65-year-old female presenting with symptomatic type B aortic dissection with aneurysm of the ascending aorta and the aortic root. The patient was treated with a flanged composite graft custom made from a branched 24-mm Dacron graft for entire prosthetic transposition of the supra-aortic branches. Metachronously, the patient underwent endovascular stent-grafting of the descending aorta. She was discharged free of complications on day 10.

Chronic constrictive tuberculous pericarditis: risk factors and outcome of pericardiectomy.

OBJECTIVE: Data on long-term outcome of pericardiectomy are limited. This retrospective study aimed to investigate risk factors and early and late outcomes of pericardiectomy for constrictive tuberculous pericarditis. DESIGN: Seventy patients with chronic constrictive pericarditis who underwent pericardiectomy between January 1990 and August 2005 were reviewed for perioperative and long-term survival. RESULTS: Patients (49 males; median age 40 years) had a median duration of symptoms of 24 months (range 8-72) before surgery. Perioperative mortality was 8.6%. During follow-up (mean 66.4 +/- 56.4), late mortality rates at 5 and 10 years were 1.6% and 9.7%, respectively. The mean censored survival in all patients was 155.2 months (SEM 8.3, 95%CI 138.8-171.6). Readmission-free survival was 68.6% over 10 years (mean 125.4 months, SEM 10.3, 95%CI 105.2-145.6). Ascites and duration of symptoms were found to be predictors of perioperative mortality (P = 0.047 and 0.036, respectively). CONCLUSIONS: The optimal time of pericardiectomy is most important in its management. Total or near-total pericardiectomy should always be performed as early as possible.