The Journal of cardiovascular surgery最新文献

{"title":"The role of post-dilatation in carotid MicroNet-covered stent implantation, evaluated using 3D cone-beam CT angiography.","authors":"Luca Ginanni Corradini, Luciano Maresca, Pierleone Lucatelli, Simone Balocco, Adolfo D'Onofrio, Matteo Stefanini","doi":"10.23736/S0021-9509.23.12756-X","DOIUrl":"10.23736/S0021-9509.23.12756-X","url":null,"abstract":"<p><strong>Background: </strong>This study aims to assess the role and safety of post-dilatation in protected carotid artery stenting (PCAS) using the new MicroNet-covered 2nd-generation stent assessed by cone beam CT scans.</p><p><strong>Methods: </strong>From March 2020 to March 2022, patients were enrolled in the study according to CT angiography results based on the following criteria: Evidence of 70% to 99% carotid stenosis in asymptomatic patients and 50% to 99% in symptomatic patients, per the NASCET index. Using a FilterWire EZ™ (Boston Scientific, Natick, MA, USA) embolic protection system (EPS), MicroNet-covered stent PCAS was performed by two interventional radiologists with at least 8 years of experience in endovascular intervention. Each patient underwent post-dilatation following stent placement. Finally, a third radiologist (not participating in the interventional procedures) evaluated the cone beam CT scans and calculated residual stenosis. Major and minor complications were recorded in the 30 days following the procedure.</p><p><strong>Results: </strong>A total of 192 patients (121 male, mean age 73±10 years) were included in the study, and all patients received post-dilatation following stent implantation. Technical successes were achieved in all procedures. Adverse events noted in this study were limited to periprocedural transient ischemic attacks that occurred in three out of 192 patients (1.6%) and showed a swift complete recovery. The post-dilatation balloon diameters used in the study were: 5.0 mm (30.3%), 5.5 mm (39.3%) and 6 mm (30.3%). Optimized postdilatation resulted in a significant increase in the final luminal area. Similar improvements were observed in all subtypes of plaque.</p><p><strong>Conclusions: </strong>Post-dilatation in protected CAS is safe and induces a significant improvement in the cross-sectional area regardless of the stenotic plaque.</p>","PeriodicalId":101333,"journal":{"name":"The Journal of cardiovascular surgery","volume":" ","pages":"608-614"},"PeriodicalIF":0.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138447749","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":"Vascular surgery study of the CGuard MicroNet-covered stent in patients with indication to carotid revascularization: POLGUARD.","authors":"Lukasz Szkolka, Dorota Lyko-Morawska, Simone Balocco, Lukasz Bedkowski, Michal Buczek, Ewa Medon, Maciej Wolkowski, Maciej Dryjski, Waclaw Kuczmik","doi":"10.23736/S0021-9509.23.12891-6","DOIUrl":"10.23736/S0021-9509.23.12891-6","url":null,"abstract":"<p><strong>Background: </strong>In a recent randomized study, MicroNet-covered stent (CGuard) significantly reduced procedural and post-procedural cerebral embolism in relation to a single-layer CREST study carotid stent, but real-life clinical practice data are limited. The aim is to prospectively assess clinical outcomes of CGuard as a routine revascularization tool for patients with indication to carotid revascularization.</p><p><strong>Methods: </strong>From April 2019 to November 2021, 204 elective patients (age 71.0±7.1years, 69.6% males, 21.7% symptomatic) were enrolled.</p><p><strong>Results: </strong>Mean basal peak-systolic velocity was 251.41±91.85 cm/s with angiographic diameter stenosis 89.7±8.46%. About 34.4% lesions were severely calcified, 6.8% were angulated, and 4.4% showed significant access tortuosity. Access was femoral, with 100% protection device (filter) use. Two hundred and three lesions in 203 patients were treated (1 cross-over to surgery for lack of effective access, no cross-over to other devices); in most cases (66.9%) the stent was placed directly. For pre-dilated lesions, mean balloon diameter was 3.36±0.34mm. Mean nominal stent diameter was 7.64±0.5 mm; length was 37.19±4.5 mm. All stents were post-dilated (balloon diameter 5.2±0.25 mm). Residual stenosis was <30% in all (3.77±6.91%). By discharge, there were 2 minor strokes (0.9%) and one transient ischemic attack. By 30-days, one other minor stroke occurred in relation to de-novo atrial fibrillation. With no deaths or myocardial infarctions, 30-day total death/stroke/myocardial infarction rate was 1.48%. No in-stent thrombosis or patency loss occurred by 30-days. In-stent peak-systolic velocity was 55.49±22.73 cm/s.</p><p><strong>Conclusions: </strong>Thirty-day results from POLGUARD study indicate safety and a low complication rate of the MicroNet-covered carotid stent use in every-day vascular surgery practice of carotid revascularization. Long-term observation is underway.</p>","PeriodicalId":101333,"journal":{"name":"The Journal of cardiovascular surgery","volume":" ","pages":"615-623"},"PeriodicalIF":0.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72016647","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":"Is open surgery still the first line of treatment for long femoropopliteal lesions?","authors":"P. Nierlich, Thomas Hoelzenbein, F. Enzmann","doi":"10.23736/S0021-9509.22.12347-5","DOIUrl":"https://doi.org/10.23736/S0021-9509.22.12347-5","url":null,"abstract":"INTRODUCTION\u0000Treatment of long femoropopliteal lesions remains a challenge for vascular physicians as patients often present with multilevel complex pathologies and consequently face a high amputation risk and associated mortality. This review aimed to assess the current state of optimal revascularizations for the treatment of long femoropopliteal lesions.\u0000\u0000\u0000EVIDENCE ACQUISITION\u0000An online literature research of medical databases for original articles and review articles on open and endovascular revascularization of femoropopliteal lesions was conducted using mesh terms.\u0000\u0000\u0000EVIDENCE SYNTHESIS\u0000There has been an accumulation of evidence over the last years that endovascular treatment is a feasible and enduring alternative to open surgery for treatment of long femoropopliteal lesions if the lesions are restricted to the superficial femoral artery. But when disease extends to the infragenual level venous bypass remains superior with regards to long-term patency, clinical improvement and limb-salvage.\u0000\u0000\u0000CONCLUSIONS\u0000While the role of venous bypass as a first-line treatment might be declining, especially in frail patients or claudicants, the superior clinical improvement and amputation-free survival highlighted in several trials, demonstrate the relevance of bypass surgery. More randomized clinical trials are needed to verify the non-inferiority of endovascular treatment options to open surgery, especially when arterial disease extends below the knee.","PeriodicalId":101333,"journal":{"name":"The Journal of cardiovascular surgery","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"117022822","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":"Postoperative management in patients with complex aortic aneurysms.","authors":"M. Dias-Neto, Emanuel R. Tenorio, Guilherme Baumgardt Barbosa Lima, Aidin Baghbani-Oskouei, G. Oderich","doi":"10.23736/S0021-9509.22.12359-1","DOIUrl":"https://doi.org/10.23736/S0021-9509.22.12359-1","url":null,"abstract":"Patients with complex aortic aneurysms (CAA) are often high risk due to advanced age and widespread atherosclerosis affecting numerous vascular territories. Therefore, a thorough perioperative evaluation is needed prior to performing in any type of aortic repair, regardless of whether an endovascular or open surgical approach is selected. Because these operations are technically demanding and often result in end organ ischemia, it is not surprising that complex aortic repair carries significant risk of morbidity and mortality. Disabling complications such as dialysis, major stroke and paraplegia remain constitute the main limitation of complex aortic repair. The aim of this article was to review postoperative management to mitigate complications after CAA repair.","PeriodicalId":101333,"journal":{"name":"The Journal of cardiovascular surgery","volume":"14 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127988684","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":"Guidelines on the management of abdominal aortic aneurysms: updates from the Italian Society of Vascular and Endovascular Surgery (SICVE).","authors":"C. Pratesi, D. Esposito, D. Apostolou, L. Attisani, R. Bellosta, F. Benedetto, I. Blangetti, S. Bonardelli, A. Casini, A. Fargion, E. Favaretto, A. Freyrie, Edoardo Frola, V. Miele, R. Niola, C. Novali, Chiara Panzera, M. Pegorer, P. Perini, G. Piffaretti, R. Pini, A. Robaldo, M. Sartori, Alfonso Stigliano, M. Taurino, P. Veroux, F. Verzini, Erica Zaninelli, M. Orso","doi":"10.23736/S0021-9509.22.12330-X","DOIUrl":"https://doi.org/10.23736/S0021-9509.22.12330-X","url":null,"abstract":"The objective of these Guidelines was to revise and update the previous 2016 Italian Guidelines on Abdominal Aortic Aneurysm Disease, in accordance with the National Guidelines System (SNLG), to guide every practitioner toward the most correct management pathway for this pathology. The methodology applied in this update was the GRADE-SIGN version methodology, following the instructions of the AGREE quality of reporting checklist as well. The first methodological step was the formulation of clinical questions structured according to the PICO (Population, Intervention, Comparison, Outcome) model according to which the Recommendations were issued. Then, systematic reviews of the Literature were carried out for each PICO question or for homogeneous groups of questions, followed by the selection of the articles and the assessment of the methodological quality for each of them using qualitative checklists. Finally, a Considered Judgment form was filled in for each clinical question, in which the features of the evidence as a whole are assessed to establish the transition from the level of evidence to the direction and strength of the recommendations. These guidelines outline the correct management of patients with abdominal aortic aneurysm in terms of screening and surveillance. Medical management and indication for surgery are discussed, as well as preoperative assessment regarding patients' background and surgical risk evaluation. Once the indication for surgery has been established, the options for traditional open and endovascular surgery are described and compared, focusing specifically on patients with ruptured abdominal aortic aneurysms as well. Finally, indications for early and late postoperative follow-up are explained. The most recent evidence in the Literature has been able to confirm and possibly modify the previous recommendations updating them, likewise to propose new recommendations on prospectively relevant topics.","PeriodicalId":101333,"journal":{"name":"The Journal of cardiovascular surgery","volume":"35 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122404199","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":"Sex differences in acute type A aortic dissection: a systematic review and meta-analysis.","authors":"N. Fialka, S. Bozso, R. El-Andari, Jimmy J. H. Kang, Andrew O’Connell, M. Moon, R. Macarthur, J. Nagendran","doi":"10.23736/S0021-9509.22.12273-1","DOIUrl":"https://doi.org/10.23736/S0021-9509.22.12273-1","url":null,"abstract":"INTRODUCTION\u0000The objective of this study is to provide a comprehensive comparison of outcomes following acute type A aortic dissection (ATAAD) repair in males and females.\u0000\u0000\u0000EVIDENCE ACQUISITION\u0000PubMed, Medline, and Web of Science were systematically searched by 2 authors for studies published from January 1st, 2000, to May 10th, 2021. 2,405 articles were screened, and 16 were included in this review. Meta-analysis of the compiled data was performed.\u0000\u0000\u0000EVIDENCE SYNTHESIS\u0000Pooled estimates indicated no difference in operative (odds ratio (OR) 1.00, 95% confidence interval (CI) 0.59-1.67, p=0.99, I2=52%), in-hospital (OR 0.78, 95% CI 0.56-1.08; p=0.13, I2=57%), and 30-day mortality (OR 1.09, 95% CI 0.83-1.43, p=0.52, I2=45%) between the sexes. However, males had significantly reduced 5-year mortality rates (OR 0.71, 95% CI 0.51-1.00, p=0.05, I2=45%). There was no difference between sexes in rates of postoperative stroke (OR 1.07, 95% CI 0.86-1.33, p=0.54, I2=0%), atrial fibrillation (OR 0.99, 95% CI 0.82-1.19, p=0.92, I2=0%), as well as mesenteric or limb ischemia (OR 0.73, 95% CI 0.22-2.43, p=0.61, I2=77%; OR 0.83, 95% CI 0.30-2.30, p=0.72, I2=76%, respectively). Males did experience significantly increased rates of acute renal failure and reoperation (OR 1.35, 95% CI 1.16-1.56, p=0.0001, I2=29%; OR 1.40, 95% CI 1.09-1.81, p=0.010, I2=42%).\u0000\u0000\u0000CONCLUSIONS\u0000Composite analysis indicates that early mortality does not differ between the sexes; however, late outcomes favour males. Differences in preoperative presentation and subsequent procedure selection between the sexes likely contribute to the disparity in late outcomes. Decision-making for surgical treatment of ATAAD should account for sex-specific risk factors.","PeriodicalId":101333,"journal":{"name":"The Journal of cardiovascular surgery","volume":"48 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133038430","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 bypass as a strategy for long femoropopliteal lesions.","authors":"D. van den Hondel, L. A. van Walraven, S. Holewijn, M. Reijnen","doi":"10.23736/S0021-9509.22.12318-9","DOIUrl":"https://doi.org/10.23736/S0021-9509.22.12318-9","url":null,"abstract":"INTRODUCTION\u0000Endovascular treatment has become the predominant treatment modality for femoropopliteal lesions. In longer and more complex lesions advanced technology is often required to improve results, with the endovascular bypass being one of them.\u0000\u0000\u0000EVIDENCE ACQUISITION\u0000A systematic review of the literature was performed to determine the clinical and technical outcomes of the latest generation endoprosthesis, with heparin bioactive surface and contoured proximal edge.\u0000\u0000\u0000EVIDENCE SYNTHESIS\u000013 articles were enrolled: 3 randomized controlled trials, 4 prospective multicenter trials and 6 retrospective studies. The VIASTAR trial showed that the endoprosthesis has a better two-year primary patency compared to bare metal stenting, especially in long lesions (62% vs. 27%, p=0.004). The SUPERB trial showed that the endoprosthesis had similar results compared to bypass surgery, albeit with less complications (31% vs. 55%, p=0.048). The RELINE study showed that treatment with an endoprosthesis had a better one-year primary patency compared to balloon angioplasty for in-stent restenosis (75% vs. 28%, p<0.001). In the cohort studies one-year patency rates ranged from 61% to 86% for primary patency, from 65% to 92% for primary assisted patency, and from 83% to 95% for secondary patency.\u0000\u0000\u0000CONCLUSIONS\u0000For long femoropopliteal lesions, the heparin-bonded endoprosthesis is related to better outcomes compared to bare nitinol stents, and comparable outcomes as with the femoropopliteal bypass, but with less complications. There is a wide range in primary patency rates, with consistent high secondary patency rates. The endovascular bypass can be considered an appropriate strategy in these patients.","PeriodicalId":101333,"journal":{"name":"The Journal of cardiovascular surgery","volume":"46 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115503136","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":"Bare metal stent in the area of drug eluting devices for long femoropopliteal lesions.","authors":"B. Nasr, Maxime Dubosq, Y. Gouëffic","doi":"10.23736/S0021-9509.22.12374-8","DOIUrl":"https://doi.org/10.23736/S0021-9509.22.12374-8","url":null,"abstract":"The Advancement in the endovascular treatment and the introduction of novel techniques allowed treatment of more complex and longer femoropopliteal lesions. However, the optimal treatment modality is still a source of controversy. The use of bare metal stents (BMS) showed good results for long femoropopliteal lesions. In this review we summarized all available data on the different treatment strategies of long femoro-popliteal lesions using BMS. Nevertheless, RCTs with head to head comparison between BMS strategies are still needed to have more clarification on the best strategy for the endovascular treatment of long femoropopliteal occlusive lesions.","PeriodicalId":101333,"journal":{"name":"The Journal of cardiovascular surgery","volume":"40 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115213784","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":"Ruptured abdominal aortic aneurysm in a 93-year-old patient: is palliative care always the correct approach?","authors":"L. F. Rinaldi, G. Marazzi, C. Brioschi, Maura Pallini, E. Visetti, E. Marone","doi":"10.23736/S0021-9509.22.12230-5","DOIUrl":"https://doi.org/10.23736/S0021-9509.22.12230-5","url":null,"abstract":"","PeriodicalId":101333,"journal":{"name":"The Journal of cardiovascular surgery","volume":"13 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116563327","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 arch surgery in the redo setting. Contemporary outcomes.","authors":"A. Vekstein, G. Hughes, E. Chen","doi":"10.23736/S0021-9509.22.12388-8","DOIUrl":"https://doi.org/10.23736/S0021-9509.22.12388-8","url":null,"abstract":"BACKGROUND\u0000Aortic arch reconstruction after prior cardiac surgery is technically complex, especially after proximal aortic surgery. While multiple surgical adaptations in the redo setting have been described, traditional open reconstruction remains the most common approach with significant variability in outcomes in prior reports. This study describes institutional adaptations to surgical technique and perioperative care and assesses operative and long-term outcomes after redo-aortic arch repair in the modern era.\u0000\u0000\u0000METHODS\u0000Patients undergoing hemi- or total arch reconstruction after prior cardiac surgery (2005-2022) were identified from a prospectively maintained institutional database. Strategic adaptations in approach over the study interval included a shift towards Type II hybrid arch repair for patients with \"mega-aorta,\" redo-cannulation of the axillary artery when necessary, and adoption of transfusion and early extubation protocols. Outcomes of interest included 30-day/in-hospital adverse events and actuarial long-term overall and aorta-specific survival.\u0000\u0000\u0000RESULTS\u0000The study cohort included 214 patients undergoing hemi-arch (n=154, 72%) or total arch (n=60, 28%) after prior cardiac surgery (50% prior proximal aortic surgery). Surgical indications included degenerative aneurysm (47%, n=101), residual arch dissection after prior type A repair (29%, n=61), acute or chronic type A dissection (18%, n=39) or other (6%, n=13). 30-day/in-hospital mortality was 6% (5% hemi-arch; 10% total arch) and stroke was 3% (3% hemi-arch; 2% total arch). At median follow-up of 56 months, overall 5- and 10-year survival was 76% and 58% (hemi-arch: 81%, 62%; total arch: 63%, 43%); aorta-specific survival was 91% and 90% (hemi-arch: 96%, 94%; total arch: 79%, 79%).\u0000\u0000\u0000CONCLUSIONS\u0000In this modern single-institution series, a systematic approach to redo-arch repair yields excellent operative outcomes and late aorta-specific survival. Reduced late overall survival reflects the comorbidity burden of this population. Open reconstruction continues to play an important role in reoperative arch repair in the modern era.","PeriodicalId":101333,"journal":{"name":"The Journal of cardiovascular surgery","volume":"9 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":"124936464","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}