The Journal of cardiovascular surgery最新文献

{"title":"Management options for large fenestrations between true and false lumens in aortic dissection.","authors":"Kathleen Marulanda, Raquel Vicario-Feliciano, Faizaan Aziz, Ali Hakimi, Kristine Gilligan, Faisal Aziz","doi":"10.23736/S0021-9509.25.13388-0","DOIUrl":"https://doi.org/10.23736/S0021-9509.25.13388-0","url":null,"abstract":"<p><p>Thoracic endovascular aortic repair (TEVAR) has become the cornerstone surgical operation of choice for treatment of type B aortic dissection (TBAD), especially in acute and subacute phases. The primary goal of TEVAR in these situations to seal proximal entry tear in the aortic dissection to promote false lumen thrombosis, prevent aneurysmal degeneration and rupture. In patients with large fenestrations between the true and false lumen in the perivisceral aorta, false lumen may still be perfused via retrograde flow from the fenestrations. As a result, complete FL thrombosis is achieved in only 40% of patients who undergo TEVAR for TBAD. Management of large fenestrations in chronic TBAD is not standardized and there is no single technique which can be used in all cases. This review summarizes different techniques that can be used to obliterate large fenestrations between true and false aortic lumens. For thoracic FL involvement without abdominal aortic segment, Knickerbocker, Candy-Plug and Cork-in-the-Bottle techniques have demonstrated good outcomes. In cases where the dissection flap extends into the perivisceral segment, PETTICOAT and STABILISE techniques can be useful. More complex dissections involving visceral branches coming off the false lumen may require F/BEVAR. Additional techniques include septotomy, transcatheter fenestration, re-entry specific therapy using plug embolization and the streamliner multilayer flow modulator. While current data support these strategies, further prospective studies are needed to establish clear guidelines for optimizing long-term management of TBAD.</p>","PeriodicalId":101333,"journal":{"name":"The Journal of cardiovascular surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145215138","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early reintervention improves outcomes in patients with stroke after carotid endarterectomy: observational study.","authors":"Igor Koncar, Aleksandar Mitrović, David Matejevic, Aleksa Jovanovic, Nikola Ilic, Marko Dragas, Lazar Davidovic","doi":"10.23736/S0021-9509.25.13243-6","DOIUrl":"https://doi.org/10.23736/S0021-9509.25.13243-6","url":null,"abstract":"<p><strong>Background: </strong>Thrombosis of the reconstructed artery after carotid endarterectomy (CEA) may be cause of the postoperative stroke or transitory ischemic attack (TIA). Secondary procedure with the aim to restore carotid flow is required in order to potentially improve patients' condition. Results of such intervention are scarce in the literature. The aim of this study was to assess the outcomes of early reintervention in patients who developed early neurological complications after CEA.</p><p><strong>Methods: </strong>A retrospective cohort study was conducted on 36 patients who underwent urgent reoperation with synthetic graft interposition after CEA due to early postoperative neurological deficits. Patient data, including demographics, comorbidities, neurological scores, and surgical details, were collected. Post-revision outcomes were evaluated using the Rankin and NIHSS scores. Patients with intraoperative stroke or those with postoperative stroke who were not operated were excluded from the study. Statistical analyses were performed using McNemar's chi-square and Wilcoxon's signed-rank tests, with multivariate analysis to assess predictive factors for recovery.</p><p><strong>Results: </strong>Out of 36 patients, 94.44% experienced neurological improvement after reoperation. The median Rankin score decreased from 2 to 1 (P<0.001), and the median NIHSS score decreased from 10 to 4 (P<0.001). Significant improvement was observed in arm, leg, and speech deficits, though in patients with consciousness impairments limited recovery was noted. Higher pre-revision Rankin scores and the presence of exulcerated plaques on primary procedure were predictive of poorer outcomes.</p><p><strong>Conclusions: </strong>Detect of early postoperative neurological deficit after CEA is very important. This study showed significant clinical improvement in most patients reoperated immediately with synthetic graft interposition. Further comparison of other potential strategies, including conservative therapy, might bring more data on how to deal with such a difficult complication.</p>","PeriodicalId":101333,"journal":{"name":"The Journal of cardiovascular surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145215114","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Contemporary randomized controlled trials in uncomplicated type B aortic dissection: a comparative methodological analysis.","authors":"Tasnia Rahman, Colin D Bicknell, Firas F Mussa, Patrick Björkman","doi":"10.23736/S0021-9509.25.13339-9","DOIUrl":"https://doi.org/10.23736/S0021-9509.25.13339-9","url":null,"abstract":"<p><p>The management of uncomplicated type B aortic dissection (uTBAD) remains a subject of ongoing debate. While best medical therapy (BMT) has been the conventional approach, thoracic endovascular aortic repair (TEVAR) has been proposed as an alternative due to its potential to promote aortic remodeling and reduce long-term complications. However, conflicting evidence regarding its survival benefits, procedural risks, and long-term durability has limited its widespread adoption. Three contemporary randomized controlled trials, IMPROVE-AD, EARNEST, and SUNDAY, are currently evaluating the role of TEVAR in uTBAD management. IMPROVE-AD, conducted across North America, aims to determine whether TEVAR reduces all-cause mortality and major aortic complications over six years in a cohort of 1,100 patients. The Scandinavian SUNDAY trial focuses on the subacute phase of uTBAD, investigating aortic remodeling, procedural safety, and long-term survival. EARNEST, based in the UK, integrates clinical, anatomical, and economic endpoints, assessing cost-effectiveness alongside patient-reported quality-of-life outcomes. This article provides a comparative analysis of these trials, examining their study designs, inclusion criteria, intervention protocols, and outcome measures. By synthesizing their methodologies and expected findings, this review contextualizes the evolving role of TEVAR in uTBAD and highlights key considerations for future clinical practice. The results of these trials are expected to shape guideline recommendations, refine patient selection criteria, and clarify TEVAR's long-term benefits in uTBAD management.</p>","PeriodicalId":101333,"journal":{"name":"The Journal of cardiovascular surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145088705","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"SUNDAY trial insights: questionnaire of clinical perspectives on medical therapy in uncomplicated type B aortic dissections.","authors":"Erin C Saricilar, Jacob Budtz-Lilly, Bianca Biersteker, Joost VAN DER Vorst, Kevin Mani","doi":"10.23736/S0021-9509.25.13363-6","DOIUrl":"https://doi.org/10.23736/S0021-9509.25.13363-6","url":null,"abstract":"<p><strong>Background: </strong>Medical therapy is the cornerstone of managing uncomplicated type B aortic dissections (uTBAD), however there are limited guidelines on its implementation. This study aimed to investigate variations in the interpretation and implementation of medical therapy among principal investigators of an ongoing international randomized clinical trial on uTBAD management.</p><p><strong>Methods: </strong>A cross-sectional questionnaire-based study was conducted among all principal investigators participating in the Scandinavian trial of Uncomplicated Aortic Dissection Therapy (SUNDAY) trial across seven countries. A secure online survey was distributed and entered into Research Electronic Data Capture (REDCap), collecting categorical data on different aspects of medical therapy, including therapy targets, reporting standards, medical management and investigations.</p><p><strong>Results: </strong>A total of 34 of 46 investigators responded (74%). While 31 (91%) agreed upon blood pressure targets of less than 120 mmHg, refractory hypertension was defined as blood pressure exceeding 140 mmHg by 12 (35%), with 17 (50%) considering the number of antihypertensives used to determine refractory hypertension of which eight (24%) set this at >3, and nine (27%) at >5. The upper limit for heart rate was agreed as 60 bpm by 20 (59%). There was no agreement on the definition of refractory pain, with seven (21%) not even considering it in decision-making. There was notable variation in reporting standards regarding chronicity, with 11 (32%) deeming hyperacute to be <24 hours, 13 (38%) deeming it <48 hours and five (15%) not considering it at all. 29 (85%) stated that they have a standardized hospital protocol for medical therapy for acute uTBAD. There was general agreement on escalation of anti-hypertensives in acute uTBAD with 30 (88%) starting with IV labetalol as first line, followed by calcium channel antagonists by 13 (38%) as second- and third-line treatments. Adjunctive medications were used consistently with 20 (59%) commenced statins as part of medical therapy and 22 (65%) commenced life-long single antiplatelets.</p><p><strong>Conclusions: </strong>These findings highlight variation and possibly reflect a lack of high-level evidence for medical therapy for uTBAD. Variations in therapeutic targets, reporting standards, medical management and adjunctive therapies between clinicians are evident.</p>","PeriodicalId":101333,"journal":{"name":"The Journal of cardiovascular surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145071584","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes of graft oversizing in small aortic lumens for the treatment of blunt thoracic aortic injuries.","authors":"Narongchai Wongkonkitsin, Parichat Tanmit, Phaniphak Chatchairat, Phati Angkasith, Supatcha Prasertcharoensuk, Chawalit Wongbuddha, Panu Teeratakulpisarn, Chaiyut Thanapaisal","doi":"10.23736/S0021-9509.25.13304-1","DOIUrl":"https://doi.org/10.23736/S0021-9509.25.13304-1","url":null,"abstract":"<p><strong>Background: </strong>Blunt traumatic thoracic aortic injury (BTAI) is considered a life-threatening surgical emergency. Thoracic endovascular aortic repair (TEVAR) has significantly improved survival rates and reduced complications. The patients are typically young and present with normal aortic diameter. Often, there is a discrepancy in diameter between commercially available \"off-the-shelf\" thoracic aortic endografts and the diameter of the aorta.</p><p><strong>Methods: </strong>We performed a retrospective study examining short-term outcomes of TEVAR oversizing for BTAI patients at our institution from 2004 to 2024. The primary outcome was procedural success, while secondary outcomes included endoleak, graft occlusion, and reintervention.</p><p><strong>Results: </strong>A total of thirty-three cases involving BTAI were managed by TEVAR, with a mean age of 48.9±19.4 years. The injury severity score averaged 29.1±9.6 points. Most cases were grade 3 BTAI, accounting for 87.9%. The mean aortic diameter at the proximal landing zone was 24.4±3.6 mm, and the distal zone was 22.5±4.0 mm. Proximal stent oversizing was 31.9±4.1%, and the distal was 28.5±4.1%. All cases achieved procedural success. One case involved an early retrograde aortic dissection that required subsequent proximal extension, while another case presented an endoleak originating from the left subclavian branch, necessitating subclavian embolization and a bypass from the left carotid to the subclavian artery. No graft occlusions were reported.</p><p><strong>Conclusions: </strong>The oversized TEVAR procedure may be performed under emergency conditions of BTAI, providing life-saving benefits with acceptable early outcomes.</p>","PeriodicalId":101333,"journal":{"name":"The Journal of cardiovascular surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144786348","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Robotic assisted left atrial appendage exclusion in patients with atrial fibrillation and intolerance to oral anticoagulation.","authors":"Benjamin D Seadler, Ali Syed, Brody Bien, Mami Sow, Marcie Berger, James Oujiri, G Hossein Almassi, David L Joyce, Stefano Schena, Mario G Gasparri","doi":"10.23736/S0021-9509.25.13101-7","DOIUrl":"10.23736/S0021-9509.25.13101-7","url":null,"abstract":"<p><strong>Background: </strong>Oral anticoagulation (OAC) and exclusion of the left atrial appendage (LAA) greatly reduce the risk of thromboembolic events in patients with atrial fibrillation (AF). Patients with known intolerance to OAC, however, have limited options for transcatheter management of both AF and the LAA. Previous investigation has suggested that minimally invasive LAA exclusion via epicardial clip placement is feasible without OAC but is associated with variable increase in morbidity and mortality. This study aims to assess the safety and long-term efficacy of robotic-assisted LAA exclusion (RA-LAAE) in patients intolerant to OAC.</p><p><strong>Methods: </strong>Retrospective, single-center, analysis of patients with AF and OAC intolerance that underwent RA-LAAE between 2019 and 2023. The primary objective assessed was freedom from cerebral and systemic thromboembolic events at 90 days and 1 year. Secondary outcomes included radiographic assessment of successful LAAE, rates of readmission, and overall mortality.</p><p><strong>Results: </strong>Twenty-nine patients (mean age 74.6 years, 28% female), with a diagnosis of paroxysmal (48%), persistent (10%), or long-standing (41%) AF, CHA<inf>2</inf>DS<inf>2</inf>VASc 4.4±1.4, HAS-BLED 3.8±0.9, and left atrial volume index 49.1±15.2 underwent RA-LAAE. All procedures were completed successfully with an operative duration of 100±40 minutes. Postoperative length of stay was 1.7±1.3 days. Follow-up imaging at 90 days confirmed successful LAAE for all cases. MACCE within 90 days occurred in 1 (3%) patient and in no additional patients at 1 year.</p><p><strong>Conclusions: </strong>RA-LAAE in patients intolerant to OAC appears to be safe and effective with low MACCE and mortality rates.</p>","PeriodicalId":101333,"journal":{"name":"The Journal of cardiovascular surgery","volume":" ","pages":"299-307"},"PeriodicalIF":0.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144164190","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"One-year outcomes of polymer-free Sirolimus-eluting stents in complex femoropopliteal stenosis: a single center real-world registry.","authors":"Michele Franzese, Armando Pucciarelli, Luigi Salemme, Grigore Popusoi, Giuseppe Ciliberti, Luca Pittorino, Raffaele Moscato, Francesco Spione, Giuseppe DI Gioia, Marco Ferrone, Sebastiano Verdoliva, Carlo Cioppa, Eugenio Stabile, Tullio Tesorio, Angelo Cioppa","doi":"10.23736/S0021-9509.25.13349-1","DOIUrl":"10.23736/S0021-9509.25.13349-1","url":null,"abstract":"<p><strong>Background: </strong>Lower extremity arterial disease is a prevalent vascular condition leading to ischemic symptoms and increased risk of cardiovascular events. Drug-eluting stents have improved outcomes by reducing restenosis, with sirolimus emerging as a promising alternative to paclitaxel due to its safer profile. This study evaluates the efficacy and safety of novel polymer-free Amphilimus^™ formulation (Sirolimus + fatty acid) eluting self-expanding stent in the treatment of femoropopliteal disease in a real-world population.</p><p><strong>Methods: </strong>A prospective, single-center study was conducted from November 2022 to January 2024, including 78 patients with femoropopliteal artery disease. Patients underwent percutaneous transluminal angioplasty with stent implantation and follow-up at discharge, 30 days, 6 and 12 months. The primary endpoints were overall and device related major adverse events and primary patency at 12 months. Secondary endpoints included freedom from clinically driven target lesion revascularization and the presence of the HALO effect on ultrasound.</p><p><strong>Results: </strong>The mean age of patients was 68.5±9.4 years and mean target lesion length was 151±75 mm. The occlusions were 39% while 48.1% of patients had chronic limb threatening ischemia. Device and clinical success were obtained in all cases. At 12 months, primary patency was 87%, freedom from clinically driven target lesion revascularization was 92.2% and overall freedom from major adverse events was 89%. No HALO effect was observed.</p><p><strong>Conclusions: </strong>These findings suggest that using a novel polymer-free sirolimus self-expanding stent is a safe and effective treatment option for femoropopliteal lesions, supporting its use in routine clinical practice.</p>","PeriodicalId":101333,"journal":{"name":"The Journal of cardiovascular surgery","volume":" ","pages":"316-322"},"PeriodicalIF":0.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145025025","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early and late effects of suprarenal aortic cross-clamping on kidney function in patients undergoing open surgery for complex abdominal aortic aneurysms.","authors":"Nicola Troisi, Giulia Bertagna, Valerio Artini, Sofia Pierozzi, Lorenzo Torri, Domitilla Stortoni, Daniele Adami, Raffaella Berchiolli","doi":"10.23736/S0021-9509.25.13217-5","DOIUrl":"10.23736/S0021-9509.25.13217-5","url":null,"abstract":"<p><strong>Background: </strong>Aim of this study was to analyze perioperative factors affecting long-term decline of renal function in patients undergoing Open Surgical Repair (OSR) with suprarenal aortic cross-clamping for pararenal/juxtarenal/\"short-neck\" abdominal aortic aneurysms (AAAs).</p><p><strong>Methods: </strong>Between November 2012 and February 2022, a retrospectively maintained dataset of all consecutive AAAs who underwent OSR was investigated. Elective surgery, suprarenal aortic cross-clamping, and pararenal/juxtarenal/\"short-neck\" AAA have been considered eligibility criteria. One-hundred-eighteen patients were included. Early (30-day) outcomes were evaluation of acute kidney injury (AKI), defined either as a decrease in eGFR >50% or as a doubling of serum creatinine at the nadir of patient's kidney function (RIFLE criteria). At follow-up, main primary outcome was freedom from major adverse kidney event (MAKE). Secondary outcomes were survival, and freedom from reintervention(s). Estimated 5-year outcomes were assessed. Multivariate Cox regression analysis was used to evaluate factors affecting MAKE during the follow-up.</p><p><strong>Results: </strong>Complex AAAs were: pararenal in FOUR cases (3.4%), juxtarenal in 58 cases (49.1%), and 'short neck' in 56 cases (47.5%). Bilateral suprarenal was the most common modality of aortic cross-clamping (100, 84.7%). Mean renal ischemia time was 31.5±12.7 min. At 30 days, mortality rate was 2.5%. During the postoperative period, 19 patients (16.1%) developed AKI. Pre-existing CKD (OR 3.7; 95% CI: 2.9 to 4.6), operation time exceeding 240 minutes (OR 2.8; 95% CI: 2.1 to 3.9), and reinterventions (OR 4.6; 95% CI: 3.5 to 6.1) significantly affected the onset of postoperative AKI. Median duration of follow-up was 48 months IQR 24-84. Estimated 5-year survival, and freedom from reintervention(s) rates were 86.9% (95% CI: 79.3% to 91.2%), and 91.1% (95% CI: 88.5% to 95.4%), respectively. Multivariate Cox regression analysis showed that postoperative AKI was the only predictive factor (OR 7.7; 95% CI: 5.9 to 8.8) to develop MAKEs in no pre-existing CKD patients during follow-up.</p><p><strong>Conclusions: </strong>Pre-existing CKD, operation time >240 minutes, and reinterventions seemed to be risk factors for postoperative AKI in patients undergoing OSR with suprarenal aortic cross-clamping for complex AAAs. Postoperative AKI significantly affected MAKE in no pre-existing CKD patients during follow-up. MAKE seemed to occur starting from the third year of follow-up.</p>","PeriodicalId":101333,"journal":{"name":"The Journal of cardiovascular surgery","volume":" ","pages":"266-273"},"PeriodicalIF":0.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144065551","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Management of the left subclavian artery during zone II thoracic endovascular aneurysm repair: a systematic review and network meta-analysis.","authors":"Vasiliki Manaki, Alkis Bontinis, Vangelis Bontinis, Argirios Giannopoulos, Ioannis Kontes, Andreas Kitromilis, Kiriakos Ktenidis","doi":"10.23736/S0021-9509.25.13285-0","DOIUrl":"10.23736/S0021-9509.25.13285-0","url":null,"abstract":"<p><strong>Introduction: </strong>The aim of this study was to compare interventions for left subclavian artery (LSA) revascularization during zone II thoracic endovascular aortic repair (TEVAR).</p><p><strong>Evidence acquisition: </strong>A systematic review was conducted per PRISMA 2020 and PRISMA-NMA2015 guidelines, focusing on interventions for LSA management during TEVAR. Primary endpoints included perioperative ipsilateral stroke, LSA patency, and overall LSA patency.</p><p><strong>Evidence synthesis: </strong>Twenty-four studies (N.=2893) compared carotid-subclavian bypass (CSB), subclavian-to-carotid transposition (SCT), branched endografts, fenestration, chimney technique, and LSA coverage. Branched endografts significantly reduced the risk of perioperative ipsilateral stroke compared to SCT (RR 0.02) and CSB (RR 0.01). CSB and SCT showed better overall LSA patency, but branched endografts demonstrated superior perioperative LSA patency. The chimney technique had the highest likelihood of perioperative spinal cord ischemia, while fenestration was least likely to result in postoperative complications.</p><p><strong>Conclusions: </strong>Both endovascular and open procedures are viable, but branched and fenestrated endografts should be prioritized due to superior safety and efficacy.</p>","PeriodicalId":101333,"journal":{"name":"The Journal of cardiovascular surgery","volume":" ","pages":"323-336"},"PeriodicalIF":0.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145035008","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Open repair of native and prosthetic aortic infection with pre-sutured or stapled xenopericardial grafts.","authors":"Andrea Melloni, Apollonia Verrengia, Luca Bertoglio, Silvia Amadasi, Franco Nodari, Alessandro Grandi, Deborah Ongaro, Stefano Bonardelli","doi":"10.23736/S0021-9509.25.13336-3","DOIUrl":"https://doi.org/10.23736/S0021-9509.25.13336-3","url":null,"abstract":"<p><strong>Background: </strong>Aortic Graft Infection (AGI) and Infective Native Aortic Aneurysm (INAA) require open repair with infection-resistant prostheses. Physician's made xeno-pericardial grafts combine availability with freedom from reinfection, but mainly short-term results are reported. The aim is to examine the mid-term outcomes in aortic infections using stapled physician-made or pre-sutured bovine pericardium tube grafts.</p><p><strong>Methods: </strong>We report all patients who underwent in situ aortic reconstruction using pericardial tube grafts (prepared from pericardial patches using a surgical stapler or pre-sutured) for AGI or INAA between January 2019 and October 2024 at a single center. Perioperative outcomes and follow-up data were retrospectively collected.</p><p><strong>Results: </strong>Twenty-one patients (18 male, median age 72 years) underwent aortic surgery and implantation of a preformed (N.=5) or stapled physician-made (N.=16) pericardial tubes graft for an INAA (N.=7) or AGI (N.=14). All AGI patients had late infections (median time from primary surgery of 81 months), in nine cases associated with aorto-digestive fistula. One perioperative death was recorded. Patients treated for an AGI demonstrated a longer median length of stay (22 vs. 12 days; P=0.020) and higher intraoperative blood loss (1400 vs. 400 mL; P=0.025). Of the 20 patients surviving the index event, at a mean follow-up of 23±8 months, no aortic-related death, nor mechanical failure were recorded. One case of reinfection and reintervention has been observed (4.8%). All but one patient discontinued the antibiotic therapy after a median duration of 146 days.</p><p><strong>Conclusions: </strong>Aortic repair with preformed and home-made stapled xeno-pericardial grafts is safe and provides durable infection-free survival at a mid-term follow-up.</p>","PeriodicalId":101333,"journal":{"name":"The Journal of cardiovascular surgery","volume":"66 4","pages":"291-298"},"PeriodicalIF":0.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145126413","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}