The Journal of cardiovascular surgery最新文献

{"title":"Endovascular reintervention after frozen elephant trunk: where is the evidence?","authors":"A. Geragotellis, Abedalaziz O Surkhi, Matti Jubouri, Ayah S Alsmadi, Yazan El-Dayeh, Fatima Kayali, Idhrees Mohammed, M. Bashir","doi":"10.23736/S0021-9509.22.12393-1","DOIUrl":"https://doi.org/10.23736/S0021-9509.22.12393-1","url":null,"abstract":"INTRODUCTION\u0000The introduction of the single-step hybrid frozen elephant trunk (FET) procedure for total arch replacement has revolutionised the field of aortovascular surgery. FET has proven to achieve excellent results in the repair of complex thoracic aorta pathologies. However, there remains a risk of reintervention post-FET for a variety of causes. This secondary intervention can either be performed endovascular, with thoracic endovascular aortic repair (TEVAR), or via open surgery. Multiple FET hybrid prosthesis are commercially available, each requiring different rates of endovascular reintervention. The current review will focus on providing an overview of the reintervention rates for main causes in relation to the FET grafts on the market. In addition, strategies to prevent reintervention will be highlighted.\u0000\u0000\u0000EVIDENCE ACQUISITION\u0000A comprehensive literature search was conducted on multiple electronic databases including PubMed, Ovid, Scopus and Embase to highlight the evidence in the literature on endovascular reintervention after FET.\u0000\u0000\u0000EVIDENCE SYNTHESIS\u0000The main causes for secondary intervention are distal stent graft-induced new entry (dSINE), endoleak and negative aortic remodelling, and to a much lesser extent, graft kinking and aorto-oesophageal fistulae. In addition, it is clear that the Thoraflex Hybrid is the superior FET device, showing excellent reintervention rates for all the above causes. Interestingly, the choice of FET device as well as its size and length can help prevent the need for reintervention.\u0000\u0000\u0000CONCLUSIONS\u0000The FET procedure is indeed associated with excellent clinical outcomes, however, the need for reintervention may still arise. Importantly, the Thoraflex Hybrid prosthesis has shown excellent results when it comes to endovascular reintervention. Finally, several strategies exist that can prevent reintervention.","PeriodicalId":101333,"journal":{"name":"The Journal of cardiovascular surgery","volume":"66 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116166549","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":"Aortic remodelling in aortic dissection after frozen elephant trunk: overcoming the challenges.","authors":"Fatima Kayali, Matti Jubouri, S. Z. Tan, Idhrees Mohammed, M. Bashir","doi":"10.23736/S0021-9509.22.12385-2","DOIUrl":"https://doi.org/10.23736/S0021-9509.22.12385-2","url":null,"abstract":"INTRODUCTION\u0000The introduction of the single-step hybrid frozen elephant trunk (FET) procedure expanded the surgeon's armamentarium in managing aortic dissection (AD). This is evident by the reduction in mortality and complication rates associated with conventional techniques used to repair ADs. Although FET still carries a risk of certain complications, it has been associated with excellent aortic remodelling following the procedure. The main scope of this review is to evaluate aortic remodelling in aortic dissection after FET as well as to highlight the challenges that may arise and ways to overcome them.\u0000\u0000\u0000EVIDENCE ACQUISITION\u0000A comprehensive literature search was conducted on multiple electronic databases including PubMed, Ovid, Scopus and Embase to highlight the evidence in the literature on aortic remodelling in aortic dissection after FET.\u0000\u0000\u0000EVIDENCE SYNTHESIS\u0000The FET procedure promotes excellent long-term remodelling, this is seen in the substantial increase in the size of the true lumen along with the decrease in that of the false lumen (FL), in addition to significant FL thrombosis. However, this occurs to a lesser extent more distally at the level of the abdominal aorta. Negative remodelling may present a major challenge to the process of aortic remodelling, nevertheless, this can be overcome with endovascular reintervention which has demonstrated highly favourable results. Additionally, the choice of FET graft, in terms of type and length, seems to influence outcomes. Namely, the Thoraflex™ Hybrid graft can be considered the superior graft on the global market. On the other hand, there seems to be a debate in the literature on the optimal FET graft length.\u0000\u0000\u0000CONCLUSIONS\u0000The FET procedure has revolutionised the field of aortovascular surgery and promotes excellent long-term aortic remodelling. Negative remodelling can occur but can also be favourably overcome with endovascular reintervention. Finally, the choice of FET graft may also influence results, thus, should be taken with great care.","PeriodicalId":101333,"journal":{"name":"The Journal of cardiovascular surgery","volume":"43 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127383284","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":"Barlow disease: effect of mitral valve repair on ventricular arrhythmias in 82 patients in a retrospective long-term study.","authors":"Mira Brunec-Keller, C. Scharf, J. Radulovic, P. Berdat, C. A. Attenhofer Jost, P. Vogt, F. Duru, S. Caselli","doi":"10.23736/S0021-9509.22.12239-1","DOIUrl":"https://doi.org/10.23736/S0021-9509.22.12239-1","url":null,"abstract":"BACKGROUND\u0000Patients (pt) with mitral valve prolapse (MVP) due to Barlow disase (BD) have an increased incidence of ventricular arrhythmias (VA; including ventricular tachycardias VT) and sudden cardiac death (SCD). Data on the effect of MV repair on VA are scarce.\u0000\u0000\u0000METHODS\u0000Pre- and postoperative VA in severe mitral regurgitation (MR) with MVP due to BD undergoing surgical mitral valve repair were analyzed. Patients with degenerative mitral valve disease not fulfilling BD criteria were excluded. Information was from charts, ECG/Holter ECG and/or pacemaker/ implantable cardioverter defibrillator (ICD) data. SCD, sustained VT >30 sec and/or ventricular fibrillation necessitating an ICD-shock were considered major events. Event probability was calculated using the Kaplan-Meier estimator throughout the follow-up period of 20.7 years.\u0000\u0000\u0000RESULTS\u0000There were 82 pts (61% males), mean age at surgery 62±14 years. Bileaflet MVP was present in 54%, mitral annular dysjunction (MAD) in 37% and left ventricular ejection fraction (LVEF) < 50% in 12%. MV repair included ring annuloplasty in all and artificial chords in 48%. Mean follow-up was 3.1 years (0.2 to 14.2 years). Postoperative rhythm surveillance by Holter ECG and/or pacemaker was available in 67%. A VA load of ≥ 10% and/or any VT was noted in 26% before and 32% after surgery (p=0.44). Postoperative VA load was not predicted by MAD, artificial chords, LVEF of <50%, age at surgery >50 years and/or residual ≥ moderate MR (all p<0.05), it correlated only with bileaflet MVP (p=0.009). Major events occurred in 3 pts: SCD in 2 pts and ICD for sustained polymorphic VT in 1 pt (incidence 1.2%/year). The event probability of receiving a SCD or an ICD-shock was 4.9%.\u0000\u0000\u0000CONCLUSIONS\u0000VA burden does not seem to change after MV repair in MVP due to BD. The occurrence of major arrhythmic events can not be predicted reliably, thus, patients with MVP due to BD may need lifelong postoperative follow-up, especially in bileaflet MVP which was an independent risk factor for increased VA burden in this retrospective long-term study in a small but well selected patient group.","PeriodicalId":101333,"journal":{"name":"The Journal of cardiovascular surgery","volume":"32 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134434755","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":"Aortic arch repair: lessons learned over three decades at Baylor College of Medicine.","authors":"Arsalan Amin, Ginger M Etheridge, Hiruni S. Amarasekara, S. Green, J. Coselli","doi":"10.23736/S0021-9509.22.12376-1","DOIUrl":"https://doi.org/10.23736/S0021-9509.22.12376-1","url":null,"abstract":"The treatment of complex aortic arch disease continues to be among the most demanding cardiovascular operations, with a considerable risk of death and stroke. Since January 1990, our single-practice service has performed over 3,000 repairs of the aortic arch. Our aim is to describe the progression of our technical approach to open aortic arch repair. Our center's surgical technique has evolved considerably over the last three decades. When it comes to initial arterial cannulation, we have shifted away from femoral artery cannulation to innominate and axillary artery cannulation. During difficult repairs, this transition has made it easier to use antegrade cerebral perfusion rather than retrograde cerebral perfusion, which was commonly used in the early days. Brain protection tactics during open aortic arch procedures have evolved from profound (≤14 °C) hypothermia during circulatory arrest to moderate (22-24 °C) hypothermia. Aortic arch repair is performed through a median sternotomy and may treat acute aortic dissection, chronic aortic dissection, or degenerative aneurysm. Reoperative repair-that necessitating redo sternotomy-is common in patients undergoing aortic arch repair. The majority of repairs will include varying portions of the ascending aortic and may involve the aortic valve or the aortic root. In some patients, repair may extend into the proximal descending thoracic aorta; this includes elephant trunk, frozen elephant trunk, and antegrade hybrid approaches.","PeriodicalId":101333,"journal":{"name":"The Journal of cardiovascular surgery","volume":"51 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133288337","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":"Technical feasibility of three-dimensional rotational angiography during experimental minimally invasive segmental artery occlusion.","authors":"K. von Aspern, J. Haunschild, J. Garbade, M. Borger, C. Etz","doi":"10.23736/S0021-9509.22.12312-8","DOIUrl":"https://doi.org/10.23736/S0021-9509.22.12312-8","url":null,"abstract":"","PeriodicalId":101333,"journal":{"name":"The Journal of cardiovascular surgery","volume":"20 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129178642","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":"Impact of true or false lumen renal perfusion after type B aortic dissection on renal volume.","authors":"N. Tsilimparis, C. Prendes, F. Heidemann, R. Jacobi, F. Rohlffs, S. Debus, K. Spanos, T. Kölbel","doi":"10.23736/S0021-9509.21.12203-7","DOIUrl":"https://doi.org/10.23736/S0021-9509.21.12203-7","url":null,"abstract":"BACKGROUND\u0000The aim of this study was to analyse the influence of true, false, and combined lumen perfusion of renal arteries on mid- and long-term kidney volume in patients with type B aortic dissection (TBAD).\u0000\u0000\u0000METHODS\u0000Retrospective analysis of patients diagnosed with a TBAD between 2008 and 2015 in a single high-volume European center. The origin of the renal arteries was evaluated on a dedicated 3D workstation (TeraRecon Inc., San Mateo, CA, USA) and coded as either arising from the true lumen (TL), false lumen (FL) or from a combination of both (CL). Additional evaluated anatomical parameters were renal volume, length, width, and depth of the kidneys. Measurements were recorded at the time of diagnosis (T0) and at 1-month (T1), 6-months (T2), 18-months (T3) and 36-month of follow-up time (T4).\u0000\u0000\u0000RESULTS\u0000A total of 131 renal arteries and kidneys were evaluated in 69 patients. Mean age was 64±13 years and 77% were male. The absolute number and percentage of assessed renal arteries/kidneys was 131 (100%) at T0, 89 (68%) at T1, 73 (56%) at T2, 57 (44%) at T3 and 43 (44%) at T4. At the time of diagnosis, 71.6% renal arteries originated from the TL, 19.1% from the FL and 9.2% from a CL. TEVAR was performed in 92.7% patients and nine patients had additional renal artery stenting. At T0 the mean renal volume was 212.1±70.9cm3, 178±61.2 in women versus 222.2±70.6 in men (P=0.002). Forty-three percent of the patients had a renal volume reduction ≥15% from T0 to their last available CTA. Mixed model analysis showed a significant overall renal volume reduction of 13.7cm3 from T0 to T4 (P<0.05). No significant differences in renal-volume reduction were observed depending on origin of the renal artery, though an estimated reduction of renal volume from T0 to T4 of 40.8 cm3 was seen when the kidneys were perfused by a CL, while TL perfusion only caused a reduction of 15.6 cm3 and no relevant volume change over time was observed when the renal artery originated from FL. Alongside a renal volume reduction, mixed model analysis also showed a significant serum-creatinine increase, from 0.8618mg/at T0 to 1.38±0.56 mg/dL at T4 (P<0.001), as well as a significant glomerular filtration rate reduction over time, from > 60mL/min at T0 to 49±13 mL/min at T4 (P<0.001). A negative correlation was observed between creatinine values and renal volume change, while a positive correlation was observed between GFR and renal volume change (P<0.001).\u0000\u0000\u0000CONCLUSIONS\u0000There is a significant mid-term renal-volume reduction in patients with TBAD, independent of the origin of the renal arteries. Albeit not statistically significant, combined renal artery perfusion may lead to a greater volume reduction, potentially secondary to a relevant dynamic compression by the dissection membrane. Further multicentre studies are warranted to determine the effect on long-term renal function and on possible preventive strategies.","PeriodicalId":101333,"journal":{"name":"The Journal of cardiovascular surgery","volume":"22 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"117231520","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":"Initial experience with repositionable J-Valve for severe aortic regurgitation: a single-center experience.","authors":"Lulu Liu, Ying Peng, Jun Shi, Hong Qian, Ying-qiang Guo","doi":"10.23736/S0021-9509.22.11260-7","DOIUrl":"https://doi.org/10.23736/S0021-9509.22.11260-7","url":null,"abstract":"BACKGROUND\u0000This study aimed to evaluate the clinical outcomes of treating high-risk patients presenting with severe aortic regurgitation (AR) or aortic stenosis (AS) using transcatheter aortic valve replacement (TAVR).\u0000\u0000\u0000METHODS\u0000This retrospective study included 290 consecutive patients with symptomatic severe aortic regurgitation or aortic stenosis. All patients who underwent TAVR with J-Valve at our institution between March 2014 and July 2019. Preoperative demographic data, clinical and echocardiographic parameters, procedural parameters, postoperative clinical outcomes, and echocardiographic parameters were recorded retrospectively.\u0000\u0000\u0000RESULTS\u0000The study included a total of 290 participants 161 patients were had severe aortic regurgitation and 129 patients had severe aortic stenosis. The baseline characteristics of the two groups were similar. The device success rate was high for both aortic regurgitation and aortic stenosis groups (95.0% vs 93.0%, p = 0.47). All-cause mortality of both groups conditions were similar at 30 days (1.9% vs 3.9%, p = 0.48). Patients treated for aortic regurgitation had a higher incidence of pacemaker implantation compared to the aortic stenosis group (8.3% vs. 0.8%, p<0.01) at 30 days postoperation. There was no significant difference between the groups in moderate or severe paravalvular leakage (1.9% vs. 0, p=0.13). The use of larger prostheses was more common in the aortic regurgitation group compared to the aortic stenosis group (66.5% vs. 13.2%, p＜0.01). Mean pressure gradient was lower in the aortic stenosis group (8.5±2.9 vs. 12.9±6.6, p < 0.01), but structural valve deterioration was more common in the aortic stenosis group (9.7% vs. 0, p<0.01) at 30 days post-op.\u0000\u0000\u0000CONCLUSIONS\u0000In this study, we found that the prognosis of patients with aortic regurgitation is comparable to that of patients with aortic stenosis after TAVR with J-valve. For patients with severe aortic regurgitation or aortic stenosis, TAVR is an effective therapeutic option. Pacemaker rate in the aortic regurgitation group was higher, but structural valve deterioration is was more common in aortic stenosis patients.","PeriodicalId":101333,"journal":{"name":"The Journal of cardiovascular surgery","volume":"12 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127339213","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":"Malperfusion in aortic dissections: a game of pressures we need to understand better.","authors":"N. Tsilimparis, P. Spath","doi":"10.23736/S0021-9509.22.12282-2","DOIUrl":"https://doi.org/10.23736/S0021-9509.22.12282-2","url":null,"abstract":"","PeriodicalId":101333,"journal":{"name":"The Journal of cardiovascular surgery","volume":"95 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130268324","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":"Severe infrarenal aortic neck angulation alone may not be a predictor of adverse outcomes in the medium term following endovascular aortic aneurysm repair.","authors":"Haisum Qayyum, R. Narlawar, G. Biondi‐Zoccai, E. Cavarretta, F. Versaci, G. Antoniou","doi":"10.23736/S0021-9509.21.11997-4","DOIUrl":"https://doi.org/10.23736/S0021-9509.21.11997-4","url":null,"abstract":"","PeriodicalId":101333,"journal":{"name":"The Journal of cardiovascular surgery","volume":"9 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131615565","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":"Visceral and renal malperfusion syndromes in acute aortic dissection type A: the fate of the branch vessel.","authors":"Joscha Buech, Caroline Radner, Thomas G Fabry, K. Horke, Ahmad Ali, S. Saha, C. Hagl, M. Pichlmaier, S. Peterss","doi":"10.23736/S0021-9509.22.12276-7","DOIUrl":"https://doi.org/10.23736/S0021-9509.22.12276-7","url":null,"abstract":"BACKGROUND\u0000Malperfusion in acute aortic dissection is not uncommonly observed and associated with a highly significant increase in mortality and morbidity. Of the various malperfusion syndromes, visceral and renal involvement is the most challenging in terms of correct and timely diagnosis as well as the choice of management strategy. The purpose of this study was to identify the pathology and associated fate of each visceral and renal vessel in acute type A dissections.\u0000\u0000\u0000METHODS\u0000Over a 12-year period, 167 consecutive patients with acute dissection type A extending into the thoracoabdominal aorta were included and radiographic images analysed with a focus on individual branch vessel pathology and dependent organ perfusion.\u0000\u0000\u0000RESULTS\u000065 patients (39%) were diagnosed with radiological signs of malperfusion on the CT Images. Of those, 20% expired during the hospital stay, compared to 8% without malperfusion. The left renal artery was the most frequently affected by dissection (31%) or false lumen supply (28%). False lumen perfusion was more often associated with manifest malperfusion than an extension of the dissection flap into the branch vessel. During the study period, there was no preference of surgical procedure treating the malperfusion.\u0000\u0000\u0000CONCLUSIONS\u0000Malperfusion of the visceral/renal branches of a dissected aorta represents a manifest indicator for postoperative mortality and morbidity. Neither clinical outcome, nor the fate of individual vessels can reliably be predicted prior to proximal reconstruction and thus, surgical strategy cannot generally be defined alone by radiological findings.","PeriodicalId":101333,"journal":{"name":"The Journal of cardiovascular surgery","volume":"28 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115169607","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}