The Journal of cardiovascular surgery最新文献

{"title":"Large bore access for transcatheter aortic valve replacement, endovascular aortic repair, and thoracic endovascular aortic repair. A review of anatomic challenges and operative considerations.","authors":"Cara G Pozolo, Angela S Giese, Trissa A Babrowski","doi":"10.23736/S0021-9509.24.13150-3","DOIUrl":"10.23736/S0021-9509.24.13150-3","url":null,"abstract":"<p><strong>Introduction: </strong>Transcatheter aortic valve replacement (TAVR), endovascular aortic repair (EVAR), and thoracic endovascular aortic repair (TEVAR) are standard and prolific procedures in the modern cardiovascular world, and appropriate delivery of these endoprostheses requires adequate understanding of the requisite large bore access. Percutaneous large bore access is the preferred route but may be accompanied by complications like thrombosis, hemorrhage, or inability to deliver the device. Anatomic limitations such as vessel tortuosity, small size, and heavy calcification may require alternative approaches for successful large bore access. This study aimed to better define large bore access, as well as to elucidate optimal adjuncts and alternatives to enable successful delivery of large bore endoprostheses.</p><p><strong>Evidence acquisition: </strong>A systematic review for \"large bore access\" in the cardiovascular literature was conducted on PubMed and the Cochrane Library Central according to PRISMA guidelines. Identified articles were filtered and sub-selected for TAVR, EVAR, and TEVAR; studies related to other large bore interventions were excluded.</p><p><strong>Evidence synthesis: </strong>A representative selection of 39 full-text studies included both cardiac and vascular studies and was critically interpreted to identify a consensus definition for large bore access, challenging anatomy, and adjuncts or alternative approaches to the standard transfemoral approach.</p><p><strong>Conclusions: </strong>Transfemoral access remains the first-line approach but in the setting of unfavorable anatomy, adjunct maneuvers (e.g. intravascular lithotripsy, endoconduits) or alternative approaches (supra-aortic, transcaval) help decrease morbidity, mortality, length of procedure, and overall health care cost in large bore access.</p>","PeriodicalId":101333,"journal":{"name":"The Journal of cardiovascular surgery","volume":" ","pages":"460-467"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142485166","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":"Tabular review of contemporary fenestrated-branched endovascular aortic repair experiences for treatment of thoracoabdominal aortic aneurysms.","authors":"Fernanda Jobim, Lucas Ruiter Kanamori, Martina Cambiaghi, Thomas Mesnard, Titia A Sulzer, Safa Savadi, Dora Babocs, Bruno Pagnin Schmid, Steven Maximus, Ying Huang, Fabio Verzini, Gustavo S Oderich","doi":"10.23736/S0021-9509.24.13168-0","DOIUrl":"10.23736/S0021-9509.24.13168-0","url":null,"abstract":"<p><strong>Introduction: </strong>Repair of thoracoabdominal aortic aneurysms (TAAAs) represents a technical challenge regardless of which technique is used. Open surgical repair (OSR) is the time-tested option against which novel techniques must be compared and it is still considered the gold standard option for younger, fit patients with heritable aortic diseases. Endovascular repair offers a less-invasive alternative in patients with suitable anatomy. This article aims to present a tabular review of the contemporary published data on endovascular repair of TAAAs using fenestrated-branched techniques.</p><p><strong>Evidence acquisition: </strong>The published literature for single-center and multicenter studies evaluating the outcomes of FB-EVAR for TAAAs was searched using MEDLINE and Embase databases. Studies published between January 1^st 2010 and July 11^th 2024, in the English language which provided data on FB-EVAR of TAAAs with more than fifty reported cases were included.</p><p><strong>Evidence synthesis: </strong>The average patient age at time of repair was 71 years old with majority of males (65.5%). Most patients presented with a Crawford Extent II TAAAs (21.6%), followed by Extent III (21.2%). Early mortality was 4.9% for the entire cohort. The most prevalent adverse event was acute kidney injury (9.4%), followed by spinal cord injury (8.0%).</p><p><strong>Conclusions: </strong>FB-EVAR of TAAAs continues to evolve. Pooled analysis of early mortality and morbidity is lower in this tabular review than historical outcomes of open TAAA repair.</p>","PeriodicalId":101333,"journal":{"name":"The Journal of cardiovascular surgery","volume":" ","pages":"499-505"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142368149","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":"Shockwave for peripheral artery disease: an update on trial data.","authors":"Pieter S de Klerk, Justin M Pacor, Peter Soukas","doi":"10.23736/S0021-9509.24.13191-6","DOIUrl":"https://doi.org/10.23736/S0021-9509.24.13191-6","url":null,"abstract":"<p><p>Intravascular lithotripsy (IVL) is fast becoming the vessel preparation tool of choice given its excellent safety profile and associated positive outcomes. In this review, we aim to summarize the most recent trial data as it applies to IVL's utility within the various peripheral arterial beds, including facilitation of large bore vascular access, and elaborate on future directions of this innovative therapy.</p>","PeriodicalId":101333,"journal":{"name":"The Journal of cardiovascular surgery","volume":"65 5","pages":"420-438"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142718087","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":"Intravascular lithotripsy in carotid disease.","authors":"Kathryn Dilosa, Steven Maximus, Misty D Humphries","doi":"10.23736/S0021-9509.24.13190-4","DOIUrl":"10.23736/S0021-9509.24.13190-4","url":null,"abstract":"<p><p>Transcarotid artery revascularization (TCAR) is a hybrid approach with neuroprotective flow reversal for treating carotid stenosis. Providers are increasingly choosing it for patients, especially those at high risk for carotid endarterectomy (CEA). However, TCAR's efficacy is limited by calcific atherosclerosis, which can hinder stent expansion and increase the risk of perioperative embolization. Intravascular lithotripsy (IVL) is introduced as a promising solution to this issue. Initially developed for coronary and peripheral vascular diseases, IVL uses acoustic pressure waves to fracture calcific plaque, enabling better stent deployment. This work details the procedural steps for IVL in conjunction with TCAR, emphasizing its potential benefits and the adjustments needed due to the off-label use of currently available lithotripsy balloons. While IVL shows promise in addressing calcific atherosclerosis in carotid interventions, further research and development of carotid-specific devices are necessary. There is also the need for additional data on the safety and efficacy of this approach before it can be widely adopted.</p>","PeriodicalId":101333,"journal":{"name":"The Journal of cardiovascular surgery","volume":" ","pages":"476-481"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142550013","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":"In-stent restenosis.","authors":"Rym El Khoury, Ahmad Asha, Philip V Bystrom, Robert Weiss, Chad E Jacobs, Lewis B Schwartz","doi":"10.23736/S0021-9509.24.13199-0","DOIUrl":"https://doi.org/10.23736/S0021-9509.24.13199-0","url":null,"abstract":"<p><p>Endovascular arterial recanalization has become the mainstay therapy for peripheral arterial occlusive disease. Although immediate technical success is achieved in greater than 90% of cases, longer-term results continue to vary based on the clinical presentation, and the treated target lesion. In the current era, sustained patency can be expected following intervention in the carotid, coronary, renal, and iliac arteries. However, maintaining patency in the femoropopliteal and tibial arteries continues to be present a significant challenge. Endovascular intervention in the peripheral arteries is met with heavy complex plaque burdens, multiple serial stenoses and occlusions, sluggish blood flow, low mean and oscillatory shear stress, and repetitive axial, radial and torsional deformation that hinder its outcomes. In order to maximize the longevity of endovascular intervention, its therapeutic armamentarium has developed to include vessel preparation, drug delivery, and arterial scaffolding. Nevertheless, in the aggregate of real-world clinical practice, recurrence of stenosis still complicates up to 50% of all infrainguinal endovascular procedures after only one year. Unfortunately, this timeline is often insufficient to reliably address lifestyle limiting symptoms, heal a wound, or save a threatened extremity. The purpose of this review is to discuss the pathophysiology, incidence, risk factors, morphology and treatment of restenosis following peripheral endovascular intervention.</p>","PeriodicalId":101333,"journal":{"name":"The Journal of cardiovascular surgery","volume":"65 5","pages":"439-453"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142718150","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":"Devices for aortoiliac occlusive disease.","authors":"Yasong Yu, Ross Milner","doi":"10.23736/S0021-9509.24.13211-9","DOIUrl":"https://doi.org/10.23736/S0021-9509.24.13211-9","url":null,"abstract":"<p><p>Aortoiliac occlusive disease (AIOD) has traditionally been repaired with open surgery. However, with advancements in endovascular devices and techniques, many have adopted endovascular first approach, even for complex lesions. Stenting is the fundamental technique for endovascular treatment of AIOD, has been proven to be effective and safe. However, different types of stents may have different outcomes based on patient anatomy, lesion characteristics, and location. Intravascular lithotripsy is another device which may provide value in the setting of AIOD. This paper summaries current evidence and literature on outcomes of aortoiliac stenting and use of IVL in the treatment of AIOD.</p>","PeriodicalId":101333,"journal":{"name":"The Journal of cardiovascular surgery","volume":"65 5","pages":"468-475"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142718146","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":"Intravascular lithotripsy in infra-popliteal peripheral artery disease.","authors":"Rhan Chong, Elizabeth Sebastian, Nedal Katib, Andrew Lennox, Ramon Varcoe, Shannon Thomas","doi":"10.23736/S0021-9509.24.13148-5","DOIUrl":"https://doi.org/10.23736/S0021-9509.24.13148-5","url":null,"abstract":"<p><p>Chronic limb-threatening ischemia (CLTI) carries a significant risk of limb loss and thus demands urgent attention. Calcified atherosclerotic disease affecting the infra-popliteal (IP) arteries poses a formidable challenge for effective revascularization due to the narrow vessel diameter and the common presence of extensively calcified, long occlusive lesions. Intravascular lithotripsy (IVL) is an endovascular treatment that induces microfractures in the medial calcifications of blood vessels, thereby facilitating the clearance of calcified obstructive arterial lesions. This review assesses the growing body of evidence from multiple prospective studies that have investigated the role of IVL in the treatment of peripheral arterial disease (PAD) involving the IP segment. The clinical efficacy of IVL has been extensively studied and validated in various trials and real-world experiences. These studies consistently demonstrate IVL's ability to achieve vessel preparation, with excellent procedural success rates and low rates of major adverse events. Moreover, IVL has shown remarkable versatility, proving effective across a wide spectrum of PAD, including iliac artery disease, femoropopliteal disease and IP calcified disease. The available results from existing literature are encouraging and demonstrates safety and efficacy of the technology in treating calcified PAD. Additional studies on a larger scale are needed to better understand its long-term effects.</p>","PeriodicalId":101333,"journal":{"name":"The Journal of cardiovascular surgery","volume":"65 5","pages":"454-459"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142718153","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":"Endovascular (stent-graft)-assisted open vascular anastomosis.","authors":"Fernando Motta, Vivian C Gomes, Jacob C Wood, F Ezequiel Parodi, Mark A Farber","doi":"10.23736/S0021-9509.24.12968-0","DOIUrl":"10.23736/S0021-9509.24.12968-0","url":null,"abstract":"<p><p>Endovascular and open surgical approaches are an integral part of treating patients with complex vascular disease and are often considered separately. In some situations, traditional open surgical techniques can be used to facilitate an endovascular approach, as example: iliac conduit use for EVAR/TEVAR, subclavian or axillary conduits for complex endovascular aortic repairs (chimney, B-FEVAR), and bypass to great vessels or visceral artery (celiac, superior mesenteric and renal arteries) debranching. As devices and techniques evolve, the open and endovascular approaches can be utilized in more complimentary fashion. This paper describes the use of endovascular procedures to assist difficult open surgical situations such as iliofemoral bypass, aortic arch debranching involving the left subclavian artery, and distal right iliac artery management during open thoracoabdominal aortic aneurysm (TAAA) repair.</p>","PeriodicalId":101333,"journal":{"name":"The Journal of cardiovascular surgery","volume":" ","pages":"376-382"},"PeriodicalIF":0.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141592555","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":"Mitral valve surgery in octogenarians: long-term and hemodynamic results.","authors":"Nicholas M Fialka, Ryaan El-Andari, Abeline Watkins, Jimmy J Kang, Yongzhe Hong, Sabin J Bozso, Michael C Moon, Jayan Nagendran, Jeevan Nagendran","doi":"10.23736/S0021-9509.24.13012-1","DOIUrl":"https://doi.org/10.23736/S0021-9509.24.13012-1","url":null,"abstract":"<p><strong>Background: </strong>Octogenarians are often denied mitral valve (MV) surgery secondary to concerns over increased perioperative morbidity and mortality. The objective of this study was to examine the outcomes of octogenarians undergoing mitral valve repair (MVr) and replacement (MVR).</p><p><strong>Methods: </strong>The outcomes of 139 patients between the ages of 80-90 who underwent MVR/MVr between 2004-2018 at the Mazankowski Alberta Heart Institute (Edmonton, AB, Canada) were retrospectively analyzed. Follow-up was extended to a maximum of 15.8 years.</p><p><strong>Results: </strong>Following MVR, all-cause mortality at 30 days, 1 year, 5 years, 10 years, and the longest follow-up was 7%, 14%, 36.3%, 61.8%, and 67.7%, respectively. Post-MVr, all-cause mortality at the same time points was 1.9%, 7.6%, 22.5%, 55.5%, and 100%, respectively. During the Hospitalization Index, rates of new-onset atrial fibrillation, sepsis, acute kidney injury, superficial sternal wound infection, deep sternal wound infection, mediastinal bleeding, and permanent pacemaker insertion ranged from 22.1-34.0%, 3.8-11.0%, 7.6-22.0%, 1.9-2.4%, 0-1.2%, 0%, and 0-6.1%, respectively. Rates of overall rehospitalization, as well as readmission for heart failure, stroke, myocardial infarction, and MV reoperation ranged from 71.0-85.5%, 52.2-63.3%, 10.9-22.8%, 1.9-6.0%, and 0% during the follow-up period. There were significant reductions in peak MV gradient (P=0.042) and left ventricular internal diameter in diastole (LVIDd; P=0.008) post-MVR, as well as LVIDd (P<0.001) and Left Atrial (LA) Volume Index (P=0.019) post-MVr.</p><p><strong>Conclusions: </strong>Octogenarians exhibit positive left atrial and left ventricular remodeling following MVR. Perioperative morbidity is low, late survival is reasonable, and long-term morbidity is considerable. Overall, these results add to the growing literature that MV surgery is relatively safe and effective in octogenarians.</p>","PeriodicalId":101333,"journal":{"name":"The Journal of cardiovascular surgery","volume":"65 4","pages":"406-413"},"PeriodicalIF":0.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142335963","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":"Directional atherectomy with anti-restenotic therapy versus open repair in patients with restenotic disease after surgical revascularization of the common femoral artery.","authors":"Dimitrios Kapetanios, Giovanni Torsello, Nikolaos Tsilimparis, Konstantinos Stavroulakis","doi":"10.23736/S0021-9509.24.13126-6","DOIUrl":"10.23736/S0021-9509.24.13126-6","url":null,"abstract":"<p><strong>Background: </strong>This study evaluated the performance of directional atherectomy with anti-restenotic therapy (DAART) compared to surgery in patients with restenosis of the groin arteries after endarterectomy or femoral bypass anastomosis.</p><p><strong>Methods: </strong>Consecutive patients with restenotic lesions from two vascular surgery units were retrospectively evaluated. Detailed medical history, type of previous reconstruction, anatomical and perioperative data, 30-day mortality and morbidity as well as data during follow-up were documented. The primary outcome measure was primary patency, whereas technical success, secondary patency, target lesion revascularization (TLR), freedom from major amputation, overall morbidity and mortality were additionally evaluated.</p><p><strong>Results: </strong>The endovascular (25 patients) and surgical (17 patients) groups were comparable regarding the initial surgical reconstruction, demographics, comorbidities and medication. In the DAART group technical success was 100% without any residual stenosis >30%, distal embolization, perforation or bailout stenting. Hospital stay was shorter after DAART (medial 2 vs. 7 days, P<0.001), while more wound complications were documented in the surgical group within the first 30-days (29.4% vs. 0%, P=0.004). Primary patency, secondary patency and TLR were comparable between the groups (66.7% vs. 64.7%, HR 0.95, 95% CI 0.3-2.9, P=0.93, 86.4% vs. 93.8%, HR 0.65, 95% CI 0.65-6.6, P=0.71, 68% vs. 70.6%, HR 0.95, 95% CI 0.3-2.9, P=0.93, respectively). During follow-up no major amputation was observed, the improvement of the Rutherford class was comparable between the two groups and there were two deaths in the surgical group.</p><p><strong>Conclusions: </strong>In this study, DAART for restenotic atherosclerotic disease of the common femoral artery and its branches is a safe alternative to redo surgery and is associated with shorter hospital stay, fewer wound complications, comparable patency and freedom from TLR rates.</p>","PeriodicalId":101333,"journal":{"name":"The Journal of cardiovascular surgery","volume":" ","pages":"339-345"},"PeriodicalIF":0.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141617977","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}