AORTA最新文献

{"title":"Valve-Sparing Aortic Root Reimplantation: Early- and Mid-Term Outcomes.","authors":"Joshua R Chen, Vishal N Shah, Scott H Koeneman, Colin King, Jacqueline McGee, Konstadinos Plestis","doi":"10.1055/a-2642-8919","DOIUrl":"https://doi.org/10.1055/a-2642-8919","url":null,"abstract":"<p><p>Valve-sparing root replacement (VSRR) is an alternative to traditional valve-replacing root replacement. We examined early- and mid-term outcomes after VSRR.We performed a retrospective review of a prospectively maintained aortic registry. All patients undergoing VSRR from 2005 to 2023 were included. Statistical analysis was performed in R version 4.3.1. Kaplan-Meier curves were used to describe mortality and freedom from mortality, aortic insufficiency (AI) > 1 + , and aortic valve-related reoperation.Eighty-one patients underwent VSRR, 59 (72.8%) through full sternotomy (FS) and 22 (27.2%) through upper hemisternotomy. There were no cases of AI > 1+ in the perioperative period, 1 (1.2%) stroke, and no in-hospital mortality. Mean intensive care unit and hospital stay were 3 and 7 days, respectively. Mean follow-up time was 8 years. Freedom from all-cause mortality at 1, 5, and 10 years was 100, 96.6, and 94.4%, respectively. Composite freedom from reoperation, recurrence, or mortality at 1, 5, and 10 years was 98.8, 92.1, and 87.3%, respectively.With careful preoperative selection, VSRR is a durable procedure for patients with aortic root aneurysm.</p>","PeriodicalId":52392,"journal":{"name":"AORTA","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144668999","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":"The Western Aortic Collaborative: Multi-institutional Aortic Surgery, Education, and Research.","authors":"Fenton H McCarthy, Christopher R Burke, Jason P Glotzbach, Michael P Fischbein, Anthony Caffarelli, Fernando Fleischman, T Brett Reece","doi":"10.1055/s-0045-1809344","DOIUrl":"10.1055/s-0045-1809344","url":null,"abstract":"<p><p>The Western Aortic Collaborative (WAC) is a new, hybrid, multi-institutional academic model that seeks to perform aortic surgery research and education.The WAC has three fundamental thoracic aortic surgery goals: (1) advancing surgical techniques, (2) furthering education and development of aortic surgeons, and (3) performing multi-institutional clinical research. The WAC utilizes a hybrid model of annual in-person meetings at the Western Thoracic Surgical Association (WTSA) combined with videoconferencing platforms that regularly connect surgeons dispersed throughout the Western region. The structure of WAC is intentionally horizontal. The goal is to promote cross-pollination of ideas, techniques, and experiences between surgeons at different institutions.For its research goals, the WAC first identified the principal areas of aortic surgery with the greatest knowledge gaps and which of those knowledge gaps could best be addressed by institutional practice differences within WAC. Using this natural experiment design, five high-priority research topics from the aortic root to the left subclavian artery were created. In order to perform this subspecialized, multi-institutional research, the WAC created a novel, cloud-based database that piggybacks on the Society for Thoracic Surgeon database. The combined database also preserves the ability to generate subspecialized variables and to link with each institution's medical record system for semi-automated functionality.In its inaugural year, the WAC succeeded in its primary goals of utilizing remote technology platforms and the annual WTSA meeting to create a regional community of aortic surgeons with shared research and educational goals.</p>","PeriodicalId":52392,"journal":{"name":"AORTA","volume":" ","pages":"9-13"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12202023/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144183613","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating Patient Outcomes and Access to Care in Aortic Surgery Based on Ethnicity and Social Vulnerability.","authors":"Ananya Shah, Adam M Carroll, Nicolas Chanes, Kyndall Hadley, Cenea Kemp, Bo Chang Brian Wu, Alejandro Suarez-Pierre, Jessica Rove, Catherine Velopulos, Muhammad Aftab, T Brett Reece","doi":"10.1055/a-2608-1346","DOIUrl":"10.1055/a-2608-1346","url":null,"abstract":"<p><p>We previously demonstrated the impact of ethnicity on aortic surgery, with underrepresentation and greater acuity in minority patients, raising concerns regarding access to care. The Centers for Disease Control and Prevention's social vulnerability index (SVI) measure is increasingly used to quantify patient socioeconomic and demographic factors. This study expands on our prior work by incorporating SVI and ethnicity to analyze patient presentation and outcomes in aortic arch surgery.We utilized a single-institution database of patients who underwent total arch replacement or hemiarch repair between 2009 and 2022. A total of 837 patients were placed into five cohorts based on their self-reported race: African American, Asian, Caucasian, Hispanic, and Other, with further subdivision based on SVI (high social vulnerability, ≥75%, normal social vulnerability < 75%). Additional analyses were performed using SVI alone. We compared patient presentation, operative variables, and outcomes based on the above cohorts.African American and Hispanic patients were underrepresented compared with city demographics. High SVI and minority patients presented at younger ages (<i>p</i> = 0.007) with higher blood pressures (<i>p</i> = 0.002). These groups also had more urgent/emergent presentations (<i>p</i> < 0.001) with aortic dissections (<i>p</i> = 0.006). Operatively, high SVI groups had longer cardiopulmonary bypass (<i>p</i> = 0.018), cross-clamp (<i>p</i> = 0.020), and circulatory arrest times (<i>p</i> = 0.002) but fewer adjunctive procedures (<i>p</i> = 0.018). High SVI patients more often required total arch replacement (<i>p</i> = 0.048) and postoperative mechanical circulatory support (<i>p</i> = 0.025). After discharge, African Americans had more emergency department (ED) visits within a year (<i>p</i> < 0.001), although no significant differences were observed in readmission rates or cardiovascular follow-up.Underrepresented groups face barriers to care, as reflected in disparities in demographics, surgical acuity, and postdischarge ED usage. Analyses-based solely on ethnicity overlooked critical differences between normal and high SVI groups, emphasizing the need for care strategies that are both tailored to high SVI groups and racially sensitive applied across all levels of health care.</p>","PeriodicalId":52392,"journal":{"name":"AORTA","volume":" ","pages":"29-38"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12202025/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144217493","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evolution of Native Aortic Valve Function following Ascending Aorta Replacement for Acute Type A Dissection.","authors":"Nicolas Everaert, Thierry Bové, Isabelle Claus, Jens Czapla, Thomas Martens, Tine Philipsen, Katrien François","doi":"10.1055/s-0045-1809171","DOIUrl":"10.1055/s-0045-1809171","url":null,"abstract":"<p><p>This study investigates the evolution of aortic valve function following supracoronary ascending aorta replacement (SCR) for acute type A aortic dissection (ATAAD). Factors contributing to aortic valve stability and progression of aortic valve insufficiency (AI) were examined.Patients who survived SCR for ATAAD between 2000 and 2021 were included. Univariable analyses to identify risk factors for AI grade ≥ 2 were performed, including anatomical parameters, perioperative findings, and follow-up root diameters. Evolution of aortic root dimensions was also investigated.Seventy-eight patients were included. AI grade ≥ 2 was observed in 20 (29.4%) patients during follow-up. Cumulative incidence of AI grade ≥ 2 was 4.7 ± 2.2%, 7.9 ± 3.4%, and 15.1 ± 5.5% at 1, 5, and 10 years, respectively. Aortic root reoperation was performed in three patients (4.0%) within 3 years of the index operation. Significant predictors of AI grade ≥ 2 included preoperative AI grade ≥2 (<i>p</i> = 0.037, odds ratio [OR] 1.46, 95% confidence interval [CI]: 1.02-2.09) and significant preoperative AI grade ≥ 2 in presence of at least two dissected sinuses (<i>p</i> = 0.039, OR: 2.88, 95% CI: 1.05-7.89). Diameters of the sinus of Valsalva (<i>p</i> < 0.001), sinotubular junction (<i>p</i> < 0.001), and ascending aorta graft (<i>p</i> < 0.001) increased over time. Absence of sinus of Valsalva ≥ 45 mm was 90.9, 84.9, and 80.3% at 1, 5, and 10 years, respectively.Preserving the aortic valve after ATAAD offers a viable long-term surgical option with a low need for proximal root reoperations in patients without aortic root dilatation. Significant preoperative AI, particularly in presence of extensive root dissection, are significant predictors of late AI grade ≥ 2, suggesting valve-sparing root replacement in these patients.</p>","PeriodicalId":52392,"journal":{"name":"AORTA","volume":" ","pages":"14-23"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12202026/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144318676","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early Outcomes of Thoracofemoral Bypass for Aortoiliac Occlusive Disease: A 10-Year Single-Center Experience.","authors":"Anil Sharma, Sunil Dixit, Mohit Sharma, Sourabh Mittal, Apurva Shah, Shefali Goyal","doi":"10.1055/s-0045-1809704","DOIUrl":"10.1055/s-0045-1809704","url":null,"abstract":"<p><p>Thoracofemoral bypass is primarily utilized as a secondary intervention for juxtarenal aortoiliac occlusive disease, with limited instances of its application as an initial treatment, leading to uncertain long-term outcomes. This analysis aims to scrutinize the 10-year experience and early outcomes of 90 patients who underwent thoracofemoral bypass as a primary procedure.A retrospective analysis was conducted on patients undergoing thoracofemoral bypass for severe aortoiliac occlusive disease between August 2012 and August 2022. The primary indication was complete abdominal aorta obstruction at the renal artery level with an unsuitable site for aorta clamping. The BARD IMPRA expanded polytetrafluoroethylene vascular graft was employed for thoracobifemoral bypass surgery.Among the 90 patients, 83 (92.22%) were male, and 7 (7.78%) were female, with ages ranging from 51 to 77 years. Intraoperative and postoperative data were analyzed, and the mean follow-up duration was 30 days. The 30-day mortality rate was 3.33% (<i>n</i> = 3). Major morbidities included graft occlusion in one patient, managed by embolectomy, and ascites in another patient, addressed conservatively.This study demonstrates that thoracic aorta to femoral artery bypass, as a simple extra-anatomic bypass technique, can yield favorable outcomes when chosen as the initial treatment for patients with juxtarenal total aortoiliac occlusive disease. Thoracofemoral bypass exhibits a safe, acceptable outcome with reliable patency.</p>","PeriodicalId":52392,"journal":{"name":"AORTA","volume":" ","pages":"24-28"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12202022/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144287043","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Root Remodeling versus Root Reimplantation in Patients with Bicuspid Aortic Valve and Root Aneurysm.","authors":"Fei Xiang, Lin Chen, Eric E Roselli, Brian Griffin, Milind Desai, Jeevanantham Rajeswaran, Austin Firth, Eugene H Blackstone, Lars G Svensson","doi":"10.1055/s-0045-1809688","DOIUrl":"10.1055/s-0045-1809688","url":null,"abstract":"<p><p>Valve-sparing root replacements are increasingly being performed in patients with bicuspid aortic valve (BAV) and root aneurysm. This study aims to compare the outcomes of patients who underwent root remodeling versus root reimplantation.From 2000 to 2022, 206 adults with BAV and root aneurysm (mean age: 47 ± 12 years, 183 [89%] male) underwent root remodeling (<i>n</i> = 32) or reimplantation (<i>n</i> = 174) at Cleveland Clinic. Compared with remodeling, patients in the reimplantation group had more aortic regurgitation (severe 61/174 [35%] vs. 3/32 [9.4%]) and smaller aortic roots (sinus diameter: 4.3 ± 0.56 vs. 4.6 ± 0.47 cm). Operative mortality and morbidity, durability, and time-related mortality were compared.Patients in both groups underwent additional aortic valve repair (reimplantation vs. remodeling group: figure-of-8 hitch-up stitch 10/174 [5.7%] vs. 14/32 [44%], <i>p</i> < 0.001; cusp plication 91/174 [52%] vs. 11/32 [34%], <i>p</i> = 0.06). Compared with the remodeling group, aortic clamp time was longer in the reimplantation group (median 136 vs. 76 minutes, <i>p</i> < 0.001). Two in-hospital reoperations occurred after remodeling from valve dysfunction. One operative death occurred in each group. At 5 years, severe aortic regurgitation was 16% after remodeling versus 5.0% after reimplantation (<i>p</i> = 0.06), mean gradient 11 versus 10 mm Hg (<i>p</i> = 0.12), aortic valve reoperation 23% versus 6.0% (<i>p</i> = 0.14), and survival 97% versus 95%, respectively (<i>p</i> = 0.71).Both root remodeling and reimplantation can be safely performed in patients with BAV and root aneurysms with similar midterm outcomes. Although root remodeling is a shorter surgery, less late aortic valve regurgitation and fewer valve reoperations lead us to recommend root reimplantation.</p>","PeriodicalId":52392,"journal":{"name":"AORTA","volume":" ","pages":"1-8"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12202024/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144287044","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Rare Encounter: Incidental Ectopic Origin of the Right Pulmonary Artery in an Adult.","authors":"Rupali Jain, Maruti Kumaran, Achala Donuru","doi":"10.1055/a-2572-4238","DOIUrl":"10.1055/a-2572-4238","url":null,"abstract":"<p><p>Ectopic origin of the right pulmonary artery (RPA) from the aorta is a rare congenital anomaly typically found in infants. We report an adult female presenting with shortness of breath diagnosed incidentally with ectopic RPA via computed tomography angiography. This case underscores the need to consider rare congenital anomalies in adults presenting with unexplained pulmonary symptoms.</p>","PeriodicalId":52392,"journal":{"name":"AORTA","volume":" ","pages":"162-163"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12185163/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143991793","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"High Flow, High-Pressure Retrograde Cerebral Perfusion at 28°C is Safe and Effective for Hemiarch Replacement of the Ascending Aorta.","authors":"R Wilson King, Adam M Carroll, Michal Schäfer, Zihan Feng, Jintong W Liu, George A Justison, Joseph C Cleveland, Jessica Y Rove, Muhammad Aftab, T Brett Reece","doi":"10.1055/a-2564-0323","DOIUrl":"10.1055/a-2564-0323","url":null,"abstract":"<p><p>Traditional retrograde cerebral perfusion (RCP) parameters may be suboptimal for washout of debris during hemiarch replacement of the ascending aorta, so we have designed a protocol of increased RCP pressure and flow at moderate hypothermia. We hypothesize that higher RCP pressure is safe in neurological outcomes in cases utilizing circulatory arrest at 28°C in elective hemiarch replacement.A retrospective review of a single-institution prospective database was used to search for all patients with elective hemiarch surgery from 2015 to 2022. Two cohorts were created-patients who received RCP only during circulatory arrest at 28°C and patients who received selective antegrade cerebral perfusion (SACP) during circulatory arrest. Neurological and postoperative outcomes were compared. Arterial blood gas measurements during RCP were taken from the left carotid of 34 patients, which were compared with the arterial blood gas from the bypass circuit to ensure adequate oxygen extraction. Propensity score matching was used to adjust for perioperative indices and patient characteristics.A total of 248 patients were in the SACP cohort and 79 patients in the RCP cohort. The two groups were similar based on patient demographics and relevant comorbidities. The cohorts differed in nadir bladder temperature, circulatory arrest time, and cardiopulmonary bypass time. After propensity matching, nadir bladder temperature, circulatory arrest, and cardiopulmonary bypass times were similar. Neurological postoperative outcomes were similar in the unmatched and matched analysis. The median pressure in the RCP group during circulatory arrest was 40 mm Hg. The median change in oxygen from bypass circuit to the carotids is 398 mm Hg with a mean oxygen extraction of 93.3%.These data demonstrate that a more aggressive approach to RCP beyond traditional constraints at 28°C is safe for short periods of circulatory arrest. Even with the new RCP parameters and after adjusting for standard patient and perioperative characteristics, there is no difference between SACP and RCP in neurological outcomes. Further, adequate oxygen extraction is achieved during RCP.</p>","PeriodicalId":52392,"journal":{"name":"AORTA","volume":" ","pages":"138-143"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12185165/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144056805","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intraoperative Autologous Blood Transfusion in Aortic Surgery.","authors":"Shao Feng Zhou, Akiko Tanaka, Anthony Estrera","doi":"10.1055/s-0045-1809172","DOIUrl":"10.1055/s-0045-1809172","url":null,"abstract":"<p><p>Aortic surgeries are associated with intraoperative blood loss, often requiring allogeneic blood transfusion. Therefore, blood must be viewed as a scarce resource that carries risks and benefits. Many preoperative and perioperative interventions are likely to reduce bleeding and blood transfusion. Perioperative blood conservation strategies in cardiovascular surgery are highly recommended and often necessary. In 2019, nearly 11 million units of whole blood and red blood cell units and more than 2.2 million apheresis and whole blood-derived platelet units were transfused in the United States. Intraoperative autologous blood transfusion techniques include saving red blood cells with cell saver, sparing whole blood through the acute, normovolemic hemodilution techniques, reducing hemodilution with retrograde autologous priming on cardiopulmonary bypass, and protection and reservation of coagulation factors and platelets through autologous platelet-rich plasma techniques. More than 80% of blood transfusions occur within the first 24 hours after surgical incision-with most intraoperative blood transfusions occurring between postcardiopulmonary bypass and reversed heparin before surgical closing. Intraoperative autologous blood transfusion techniques remain an important method in blood conservation strategies in aortic surgeries. Intraoperative cell savers are considered a cost-effective tool for most cardiovascular procedures or other surgeries in which substantial blood loss is expected (>500 mL).</p>","PeriodicalId":52392,"journal":{"name":"AORTA","volume":" ","pages":"153-161"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12185167/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144112401","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes of a Standardized Protocol on the Management of Acute Type A Aortic Dissection: A Retrospective Cohort Study.","authors":"Supitchaya Philippoz, Dionysios Adamopoulos, Tornike Sologashvili, Mathieu van Steenberghe, Jalal Jolou, Christoph Huber, Mustafa Cikirikcioglu","doi":"10.1055/s-0045-1809170","DOIUrl":"10.1055/s-0045-1809170","url":null,"abstract":"<p><p>Acute Type A aortic dissection (AAAD) is a life-threatening condition, with surgery being the recommended treatment. However, there is ongoing debate regarding the optimal surgical procedure. This study aimed to evaluate the impact of implementing a standardized protocol, introduced in our institution in 2016, on AAAD management.A retrospective cohort study was conducted involving patients treated surgically for AAAD between 2010 and 2021 in our department. Patients were divided into two groups: those who underwent surgery before 2016 using operator-dependent techniques, and those who underwent surgery starting in 2016 using a standardized protocol.A total of 104 patients were included in this study. The mean age was 66.5 ± 11.4 years and 55.8% were male. Demographics and preoperative data were similar in both groups. Arterial and venous cannulation site of both groups were different (<i>p</i> < 0.001): femoral artery and vein cannulation for group 1 versus subclavian artery and central venous canulation for group 2. Alone ascending aorta replacement versus ascending aorta plus hemiarch replacement were the preferred techniques in groups 1 and 2, respectively (<i>p</i> < 0.001). Hypothermic circulatory arrest and cerebral perfusion were largely performed in group 2 compared with group 1 (<i>p</i> < 0.001). The total time of surgery, the cardiopulmonary bypass, and aortic cross-clamping times were longer in group 2 (<i>p</i> < 0.05). Both groups had similar rates of postoperative complications, except for late reoperation and aortic dilatation rates, which were less frequent in group 2 (<i>p</i> < 0.05).The implementation of a standardized institutional protocol can transform AAAD surgery from a \"surgeon-tailored\" to a \" patient-tailored\" approach. The use of a standardized protocol in our institution resulted in a significant reduction of aortic reoperation and aortic dilation rates, suggesting that the introduction of standardized protocols in low-volume centers may improve AAAD management.</p>","PeriodicalId":52392,"journal":{"name":"AORTA","volume":" ","pages":"144-152"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12185164/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144008107","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}