AORTA最新文献

{"title":"Management of Early and Late Malperfusion Syndrome in Acute Type B Aortic Dissection with Retrograde Extension Using Hybrid Zone 2 Arch Repair and Thoracic Endovascular Aortic Repair: A Case Report.","authors":"Daniela Votano, Hector W L de Beaufort, Rob H W van de Mortel, Uday Sonker, Robin H Heijmen, Hans G Smeenk","doi":"10.1055/s-0045-1802992","DOIUrl":"10.1055/s-0045-1802992","url":null,"abstract":"<p><p>The distal extent of aortic repair in acute aortic dissection and the management of malperfusion in terms of timing and strategy are still debated topics. We present a case of acute type B dissection with retrograde extension to the ascending aorta, with the most proximal intimal tear in the descending thoracic aorta, associated with both early lower extremity and delayed mesenteric malperfusion syndrome, treated effectively by femoral artery open fenestration and hybrid zone 2 arch repair.</p>","PeriodicalId":52392,"journal":{"name":"AORTA","volume":" ","pages":"74-76"},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11879488/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143505943","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":"Quality of Life after Type A Aortic Dissection Surgery in the United Kingdom: The QUADS Study.","authors":"Brianda Ripoll, Adeyemi Olayiwola, Sanjeev Kalra, Aidil Syed, Massimo Capoccia, Shaheen Ahmed, Marinos Koulouroudias, Ioan Mocanu, Stephen Clark, Indu Deglurkar, Walid Elmahdy, Jonathan Hyde, Niki Nicou, Nawar Al Attar, Alexander Cale, Mahmoud Loubani, Aung Ye Oo, Ana Lopez-Marco","doi":"10.1055/s-0045-1802991","DOIUrl":"10.1055/s-0045-1802991","url":null,"abstract":"<p><strong>Background: </strong> Acute Type A aortic dissection (TAAD) is a life-threatening condition that carries significant mortality and morbidity; a proportion of the survivors might require further aortic procedures in the mid-/long-term follow-up. Quality of life (QoL) after TAAD is not well studied. Quality of life after Type A Aortic Dissection Surgery (QUADS) is the first multicentre study to assess QoL in survivors of surgically treated TAAD.</p><p><strong>Methods: </strong> A tailored questionnaire for survivors of TAAD was designed with patient and public involvement. Patients who underwent surgery from 2018 to 2022 in eight United Kingdom centres were invited to participate. Preoperative, intraoperative, and postoperative prospectively collected data were collated and analyzed retrospectively. The data were analyzed with SPSS v29. Patient's questionnaire was validated with a Cronbach's alpha analysis, exploratory factor analysis, and AMOS confirmatory factor analysis. Three groups were created according to QoL (Good, Fair, Poor).</p><p><strong>Results: </strong> A total of 162 patients were recruited. Majority were male with a mean age of 63 years (24-92). Surgical procedures for TAAD were root and ascending aorta replacement (<i>n</i> = 61, 38%), ascending (<i>n</i> = 81, 50%), and/or arch replacement (<i>n</i> = 20, 12%). Eleven patients (7%) required later intervention. Patient's answers regarding overall QoL were good (<i>n</i> = 67, 41%), fair (<i>n</i> = 89, 55%), and poor (<i>n</i> = 6, 4%). Neurological complications, circulatory arrest duration, reoperation for bleeding, postoperative myocardial infraction, arrhythmias, wound infection, and patient destination at discharge have been identified as main variables impacting on QoL after TAAD surgery across different domains of this questionnaire.</p><p><strong>Conclusion: </strong> QUADS questionnaire is the first tailored and validated questionnaire for TAAD survivors. Results in the United Kingdom population suggest that it is a useful tool to assess QoL after TAAD surgery.</p>","PeriodicalId":52392,"journal":{"name":"AORTA","volume":" ","pages":"50-59"},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11879486/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143505944","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":"Covering Anastomosis to Frozen Elephant Trunk in Secondary Downstream Aorta Replacement.","authors":"Fumiya Chubachi, Akihiro Yoshitake","doi":"10.1055/s-0045-1802989","DOIUrl":"10.1055/s-0045-1802989","url":null,"abstract":"<p><p>There has been an increasing number of secondary downstream aorta replacements following aortic arch repair using a frozen elephant trunk (FET). We present an anastomosis technique to join a frozen elephant graft to a downstream prosthetic graft. The FET is inserted into the downstream graft with continuous sutures, with a two-bite Dacron graft added to the frozen elephant side. This technique may prevent anastomotic leakage between two grafts.</p>","PeriodicalId":52392,"journal":{"name":"AORTA","volume":" ","pages":"77-79"},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11879483/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143442526","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":"Rapid Aneurysmal Degeneration and Repair of Thoracic Aortic Aneurysm in a Patient with Concomitant Vascular Ehlers-Danlos and Loeys-Dietz Syndromes.","authors":"Arjune S Dhanekula, Sara Zettervall, Ioannis Dimarakis, Scott Deroo","doi":"10.1055/s-0044-1795131","DOIUrl":"10.1055/s-0044-1795131","url":null,"abstract":"<p><p>Vascular Ehlers-Danlos (vEDS) and Loeys-Dietz syndrome 3 (LDS3) are connective tissue disorders with diverse systemic manifestations. Most notable in these disorders, though, are their aggressive aortopathies, often presenting early in life with aneurysmal disease or dissection. Herein we present the case of a 33-year-old patient, previously lost to follow-up, who underwent complex reoperative arch replacement after ascending and hemiarch replacement for Type A aortic dissection 6 years prior. Postoperative genetic testing revealed both vEDS and LDS, a unique genotype that has not been described before in the literature.</p>","PeriodicalId":52392,"journal":{"name":"AORTA","volume":" ","pages":"70-73"},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11879481/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142734572","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":"The Fate of Conventional Elephant Trunk in the Frozen Elephant Trunk Era.","authors":"A. Geragotellis, Matti Jubouri, Mohammed Al-Tawil, Idhrees Mohammed, Mohamad Bashir, Saeid Hosseini","doi":"10.1055/s-0044-1786352","DOIUrl":"https://doi.org/10.1055/s-0044-1786352","url":null,"abstract":"Conventional elephant trunk (cET) and frozen elephant trunk (FET) are two distinct approaches to the surgical treatment of thoracic aortic aneurysms and dissections. With the advent and growing uptake of endovascular technologies, FET is becoming increasingly popular for its potential to be performed as a single-stage operation with better aortic remodeling and less risk of graft kinking than the traditional two-stage cET procedure. However, FET has been associated with a higher risk of spinal cord ischemia and its use in patients with connective tissue disorder remains controversial. The current review aimed to reflect on recent evidence surrounding the application of cET and FET to different types of aortic pathology in both acute and elective settings. Another scope of this review was to compare the characteristics of the currently available FET commercial devices on the global market. Our findings highlight that when the pathology is confined to the proximal descending aorta, such as in Dsine, intervention is often single-staged and false lumen (FL) thrombosis is achieved with good effect. FET remains limited by spinal cord injury and applicability in patients with connective tissue disorder, although some groups have started to circumvent associated complications, likely due to growing surgical expertise. Many other aortic diseases do require second-stage intervention, and even in these cases, there appears to be lower in-hospital mortality when using FET over cET. This is possibly due to the higher rate of endovascular completion facilitated by the completed landing zones created during FET. FET is trending toward becoming the universal treatment modality for extending repair to the descending aorta.","PeriodicalId":52392,"journal":{"name":"AORTA","volume":"40 22","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140971407","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":"Dieulafoy's Lesion: A Rare Cause of Gastrointestinal Bleeding after Interrupted Aortic Arch Repair in an Adult.","authors":"Charlene Tennyson, Abiodun Adigun, Jonathan Ghosh, Isaac Kadir, Ioannis Dimarakis","doi":"10.1055/s-0044-1801294","DOIUrl":"10.1055/s-0044-1801294","url":null,"abstract":"<p><p>Survival into adulthood in patients with an interrupted aortic arch (IAA) is exceedingly rare. A recent literature review found 25 reported cases of IAA in adults. We describe the first case of prolonged, occult, postoperative gastrointestinal bleeding as a major complication following IAA surgery. We discuss the management of a 51-year-old man who underwent repair of an IAA, aortic valve replacement, and replacement of the ascending aorta for a known aortic aneurysm.</p>","PeriodicalId":52392,"journal":{"name":"AORTA","volume":" ","pages":"41-43"},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11688146/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142886502","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":"Relationship between Neovascularization and Aortic Wall Enhancement in Type A Aortic Dissection.","authors":"Eisaku Ito, Takao Ohki, Naoki Toya, Hirokuni Naganuma, Noriyasu Kawada, Koichi Muramatsu, Nei Fukasawa, Misayo Miyake, Miku Maeda, Masayuki Shimoda","doi":"10.1055/s-0044-1791669","DOIUrl":"10.1055/s-0044-1791669","url":null,"abstract":"<p><strong>Background: </strong> Aortic wall enhancement (AWE), evaluated with computed tomography angiography in Type B aortic dissection, is associated with aortic remodeling. This study aimed to evaluate the relationship between AWE and pathological findings of the aortic wall using an aortic wall sample from a Type A aortic dissection (TAD).</p><p><strong>Methods: </strong> We examined patients with TAD treated between January 2012 and February 2023.</p><p><strong>Results: </strong> Twelve cases were examined pathologically: five cases in the hyperacute phase, three in the acute phase, and four in the subacute phase. AWE thickness significantly differed as time progressed (0 vs. 1.7 vs. 2.8 mm, <i>p</i> < 0.001). A significant increase in granulation was observed in the acute and subacute phases (0 vs. 761 vs. 423 µm, <i>p</i> < 0.001). Furthermore, a fibrous complex of internal adventitia (FCIA) developed on the medial side of the adventitia over time since its onset and was found to be thickened (175 vs. 415 vs. 1,078 µm, <i>p</i> < 0.001). The thickness of the granulation tissue and FCIA, where there was abundant neovascularization, was consistent with the thickness of the AWE.</p><p><strong>Conclusion: </strong> AWE was observed in TAD and increased as time progressed. FCIA and granulation tissue developed, and AWE reflected neovascularization at the adventitia.</p>","PeriodicalId":52392,"journal":{"name":"AORTA","volume":"12 2","pages":"25-31"},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11688147/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142911072","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":"\"Martin Mattress\": Surgical Technique for Achieving Hemostasis in Redo Aortic Root Operations.","authors":"Eric I Jeng, Omar M Sharaf, Kevin D Reilly, Thomas M Beaver, Tomas D Martin","doi":"10.1055/s-0044-1795132","DOIUrl":"10.1055/s-0044-1795132","url":null,"abstract":"<p><p>A 71-year-old gentleman with prior bioprosthetic aortic valve replacement was admitted with aortic valve dehiscence and an aortic root abscess. He underwent reoperative sternotomy, aortic root, mitral valve, and hemiarch replacement. To augment hemostasis, we implanted the \"Martin Mattress\"-a pericardial patch sutured to the fibrous ridge within the innominate vein, superior vena cava, right atrium, right ventricular outflow tract, and pulmonary artery-which is preferred to modified Cabrol fistula techniques in infectious root pathology.</p>","PeriodicalId":52392,"journal":{"name":"AORTA","volume":" ","pages":"47-49"},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11688149/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142865908","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":"Chronic Mesenteric Ischemia after a Type A Aortic Dissection Repair.","authors":"Morgan Hardman, Houssam Farres, Santh Prakash Lanka, Young Erben","doi":"10.1055/s-0044-1795146","DOIUrl":"10.1055/s-0044-1795146","url":null,"abstract":"<p><p>A 57-year-old male patient who underwent an open hemiarch repair with a femoral-femoral crossover bypass and right lower extremity fasciotomies for an acute Type A aortic dissection with limb ischemia presented 5 weeks' postrepair with a 20-pound weight loss due to intermittent hemodynamic collapse of the dissection flap over the origin of the superior mesenteric artery. This case highlights the challenges a dissection flap can cause after an urgent Type A aortic dissection repair.</p>","PeriodicalId":52392,"journal":{"name":"AORTA","volume":" ","pages":"44-46"},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11688145/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142734560","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":"Experience with Zone 2 Arch Replacement Followed by Thoracic Endovascular Aortic Repair.","authors":"Arjune Dhanekula, Bret DeGraaff, Rachel Flodin, Anne Reimann-Moody, Manuel De La Garza, Sara Zettervall, Sherene Shalhub, Matthew P Sweet, Christopher R Burke, Scott DeRoo","doi":"10.1055/s-0044-1795130","DOIUrl":"10.1055/s-0044-1795130","url":null,"abstract":"<p><strong>Background: </strong> Transverse open aortic arch replacement remains a complex operation. A simplified arch replacement into zone 2, with debranching the head vessels proximally, creates a suitable landing zone for future endovascular repair and is increasing in popularity as of late. Still, limited data exist to assess contemporary rates of morbidity and mortality. Therefore, we aim to evaluate current outcomes for patients who underwent open zone 2 aortic arch replacement.</p><p><strong>Methods: </strong> All patients who underwent zone 2 arch replacement at a single academic institution from January 2019 to June 2023 were assessed. Indication for operation was either aneurysmal disease (<i>n</i> = 37), acute aortic syndrome (<i>n</i> = 38), or residual arch/descending thoracic aorta dissection (<i>n</i> = 67). Patient demographics and operative characteristics were evaluated, and the frequency of subsequent thoracic endovascular aortic repair (TEVAR) was noted. Mortality and major morbidity were then assessed.</p><p><strong>Results: </strong> A total of 142 patients underwent open zone 2 arch replacement. Median cardiopulmonary bypass, cross-clamp, and deep hypothermic circulatory arrest times for the entire cohort were 195, 122, and 36.5 minutes, respectively. Concomitant frozen elephant trunk was performed in 45.1% of the cohort (<i>n</i> = 64). In-hospital mortality was 7.8% (<i>n</i> = 11) for the entire cohort. Spinal cord ischemia occurred in 3.5% (<i>n</i> = 5); these patients all received frozen elephant trunks and had neurologic recovery by discharge. Stroke occurred in 9.2% (<i>n</i> = 13) of the study cohort. A total of 38.7% (<i>n</i> = 55) went on to get subsequent TEVAR, with median time to TEVAR of 52 days (8, 98.5).</p><p><strong>Conclusion: </strong> Zone 2 arch replacement allows staged repair of the thoracic aorta and readily accommodates future TEVAR therapy. This option for the treatment of the aortic arch can be performed safely in a wide variety of patient pathologies. Given the safety of this operation, cardiac surgeons should utilize this approach more frequently.</p>","PeriodicalId":52392,"journal":{"name":"AORTA","volume":" ","pages":"32-40"},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11688148/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142734570","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}