The Journal of cardiovascular surgery最新文献

{"title":"Exploring clinical results of innovative procedures.","authors":"Fabio Verzini","doi":"10.23736/S0021-9509.24.13221-1","DOIUrl":"https://doi.org/10.23736/S0021-9509.24.13221-1","url":null,"abstract":"","PeriodicalId":101333,"journal":{"name":"The Journal of cardiovascular surgery","volume":"65 5","pages":"417-418"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142718148","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":"Performance of a new generation balloon expandable stent-graft (Gore VBX) as bridging stent for B-EVAR.","authors":"Ciro Ferrer, Ottavia Borghese, Bernardo Orellana, Carlotta Mancusi, Federico F Pennetta, Carlo Coscarella, Marco Giudice, Rocco Giudice","doi":"10.23736/S0021-9509.24.13071-6","DOIUrl":"10.23736/S0021-9509.24.13071-6","url":null,"abstract":"<p><strong>Background: </strong>The aim of this study was to report the results of a single-centre experience with a new generation balloon expandable stent-graft (Viabahn VBX; W. L. Gore & Associates, Flagstaff, AZ, USA) as bridging stent in branched endovascular aortic repair (B-EVAR).</p><p><strong>Methods: </strong>This is a retrospective single institution analysis of a prospectively maintained database. All patients undergone implantation of at least one VBX as bridging stent in B-EVAR over the last 5 years (from July 1, 2018, to November 31, 2023) were included. Primary outcomes were technical success, primary and secondary stent patency rate, branch-related reinterventions, and branch instability. Secondary outcomes were clinical success, mortality, and rate of aortic-related reinterventions.</p><p><strong>Results: </strong>This study involved 40 patients for a total of 147 VBX stent-grafts implanted in 141 target vessels as bridging stents in B-EVAR (62.5% off-the-shelf and 37.5% custom made devices; 65% with outer branches and 35% with inner branches) for the treatment of 38 (95%) degenerative and 2 (5%) postdissection aneurysms. In 28 cases (70%) a total transfemoral approach was used to deliver the bridging stents. Technical success was 100%. No target vessel was lost intraoperatively. Over a median follow-up of 26.5 months (range 0-74), primary and secondary patency, branch-related reintervention, and branch instability were 98.5% (139/141), 99.3% (140/141), 15% (6/40), and 4.9% (7/141), respectively. Four of the 7 cases of branch instability, all requiring an endovascular correction, were secondary to type Ic endoleak. Clinical success was 97.5% as effect of 1 perioperative death. During the follow-up other 6 patients died, contributing to an overall survival rate of 82.5%. The overall rate of aortic-related reinterventions was 20%.</p><p><strong>Conclusions: </strong>Despite further evaluation is mandatory to determine durability of the VBX in the long-term after B-EVAR, in our experience VBX demonstrated a high flexibility and trackability, excellent stent retention, and outstanding patency over time. A generous distal landing of the bridging stent into the target vessel should be always achieved, whereas possible, to reduce the risk of type Ic endoleak, which seems to be the main cause of branch instability.</p>","PeriodicalId":101333,"journal":{"name":"The Journal of cardiovascular surgery","volume":" ","pages":"482-489"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142305520","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":"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}