Annals of cardiothoracic surgery最新文献

{"title":"Open repair of a thoracoabdominal aortic aneurysm using hypothermic cardiopulmonary bypass and circulatory arrest.","authors":"Nicholas T Kouchoukos","doi":"10.21037/acs-2023-scp-07","DOIUrl":"https://doi.org/10.21037/acs-2023-scp-07","url":null,"abstract":"","PeriodicalId":8067,"journal":{"name":"Annals of cardiothoracic surgery","volume":"12 5","pages":"506-508"},"PeriodicalIF":3.1,"publicationDate":"2023-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/c6/15/acs-12-05-506.PMC10561346.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41189393","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Spinal cord protection: lessons learned from open repair.","authors":"Frank S Cikach, Michael Z Tong, Patrick R Vargo, Lars G Svensson","doi":"10.21037/acs-2023-scp-22","DOIUrl":"https://doi.org/10.21037/acs-2023-scp-22","url":null,"abstract":"Thoracoabdominal aortic aneurysm repair techniques and perioperative management have undergone many iterations and attempts to reduce complication rates. While respiratory and renal failure are some of the most common complications following aneurysm repair (1), lower extremity paresis/paraplegia is most feared. In an early, large series, the rate of spinal cord injury was as high as 16% (1). Multivariate analysis in this series demonstrated that extent of aneurysm resection and cross-clamp time were significant predictors of paraplegia or paraparesis, among these patients (1). Multiple adjuncts have been attempted in order to reduce or eliminate spinal cord ischemia, with early attempts focused on cardiopulmonary or atriofemoral bypass with systemic cooling, resulting in modest reductions in paraplegia/paraparesis rates (2). The addition of cerebrospinal fluid drainage via intrathecal drain placement either alone, or in combination with intrathecal papaverine administration have shown significant promise in reducing paraplegia/paraparesis in this population and is a surgical adjunct we use at the Cleveland Clinic. Early studies on aortic cross-clamping in baboons demonstrated the combination of cerebrospinal fluid drainage and intrathecal papaverine administration eliminated paraplegia through a combination of dilation and increased blood flow to the lower anterior spinal artery (3). This technique was subsequently tested in a small randomized control trial in thirty-three patients with extent I and II thoracoabdominal aortic aneurysms (4). Only two of 17 patients who received cerebrospinal fluid drainage plus intrathecal papaverine developed spinal cord injury, while seven of 16 developed neurologic injury in the control group (4). Multivariate analysis revealed longer aortic crossclamp time, failure to actively cool with bypass, and postoperative hypotension were associated with neurologic injury, while cerebrospinal fluid drainage plus intrathecal papaverine administration was protective (4). Significant discussion and research has focused on the preservation of segmental blood supply to the spinal cord via re-implantation of intercostal and lumbar arteries at the time of thoracoabdominal aortic repair (2). Contemporary management of intercostal and lumbar arteries during aneurysm repair focuses on re-implantation of patent vessels, when technically feasible, below the sixth thoracic vertebra. Early analysis focusing on this problem found that rates of paraparesis/paraplegia increase if patent intercostals are oversewn, particularly between the levels of T7-L1 (2). However, which arteries to reimplant is debatable and has led some to perform pre-operative selective angiography to determine the key intercostals/lumbars supplying the spinal cord. While re-implantation of these vessels seems important, it comes at the cost of longer aortic cross-clamp times. Thus, surgeons must keep in mind a balance between maintaining blood supply to the spina","PeriodicalId":8067,"journal":{"name":"Annals of cardiothoracic surgery","volume":"12 5","pages":"489-491"},"PeriodicalIF":3.1,"publicationDate":"2023-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/58/31/acs-12-05-489.PMC10561339.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41189402","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intercostal artery reattachment for prevention of spinal cord ischaemia.","authors":"Ana Lopez-Marco, Myat Soe Thet, Sarvananthan Sajiram, Benjamin Adams, Aung Y Oo","doi":"10.21037/acs-2023-scp-09","DOIUrl":"https://doi.org/10.21037/acs-2023-scp-09","url":null,"abstract":"Herein, we illustrate different techniques for intercostal artery (ICA) reimplantation during thoracoabdominal aortic (TAA) surgery (1). Case 1 (loop graft): 23-year-old female with Marfan syndrome who presented with a type B aortic dissection during pregnancy, managed conservatively. On surveillance, the proximal descending diameters expanded significantly, and an extent II TAA repair from distal to left subclavian artery (LSA) to infrarenal aorta was planned. The proximal clamp was placed proximal to the LSA, which was snugged, in order to resect the dissection flap that originated within the arch. Case 2 (island patch): 37-year-old male with Marfan syndrome who presented with a type B aortic dissection two years prior, initially managed conservatively until the proximal thoracic diameters began expanding. He was planned for an extent II TAA replacement from the distal to LSA to individual iliacs. Case 3 (end graft): 65-year-old male with degenerative extent IV TAA aneurysm. Planned extent IV TAA replacement from lower to iliac bifurcation. Motor-evoked potential (MEP) signal decreased intraoperatively during opening of the visceral segment and a single large lumbar artery was reimplanted to the main graft using an end graft technique.","PeriodicalId":8067,"journal":{"name":"Annals of cardiothoracic surgery","volume":"12 5","pages":"511-513"},"PeriodicalIF":3.1,"publicationDate":"2023-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/df/35/acs-12-05-511.PMC10561330.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41189390","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of preoperative identification of the artery of Adamkiewicz on spinal cord injury after descending aortic and thoracoabdominal aortic repair.","authors":"Toshiki Fujiyoshi,&nbsp;Toru Iwahashi,&nbsp;Hitoshi Ogino","doi":"10.21037/acs-2023-scp-18","DOIUrl":"10.21037/acs-2023-scp-18","url":null,"abstract":"<p><strong>Background: </strong>Some recent reports have demonstrated that preoperative Adamkiewicz artery (AKA) identification and its targeted reconstruction has provided satisfactory outcomes with respect to spinal cord protection. This paper investigates the impact of preoperative identification of the AKA on reducing the incidence of spinal cord injury (SCI) in open repair (OR) and endovascular repair (EVR) of descending thoracic aortic (dTA) and thoracoabdominal aortic aneurysm (TAA) repair.</p><p><strong>Methods: </strong>The clinical data of patients with dTA and TAA treated between 2011 and 2022 were investigated. A total of 256 patients comprising of 201 males and 55 females, with a mean age of 72.1±10.0 years, were included. OR was used in 102 patients and EVR in 154 patients whose distal landing zone was below T8, all of which needed preoperative identification of the AKA.</p><p><strong>Results: </strong>The AKA was identified in 207 (80.9%) patients, and was located in the level between T8 and T12 in 81.2%. In OR, the responsible arteries, including the identified AKA, were promptly reconstructed in 66 (64.7%) patients. In EVR, 65 (42.2%) patients had the AKA covered by an endovascular prosthesis. Deaths prior to 30 days occurred in seven (2.7%, four in OR and three in EVR) patients. In OR, SCI occurred in six (5.9%) patients including three (2.9%) with paraplegia and three (2.9%) with paraparesis, whereas in EVR ten (6.5%) patients had SCI, including two (1.3%) with paraplegia and eight (5.2%) with paraparesis. The incidence of SCI was significantly higher in patients with the AKA covered than those without it covered [13.8% (9 of 65) <i>vs.</i> 1.1% (1 of 89); P=0.002], whereas no significant differences were found between patients with or without the AKA reconstructed.</p><p><strong>Conclusions: </strong>Preoperative identification of the AKA was useful enough to determine treatment strategies with less likelihood of SCI in both OR and EVR for dTA and TAA pathologies.</p>","PeriodicalId":8067,"journal":{"name":"Annals of cardiothoracic surgery","volume":"12 5","pages":"468-475"},"PeriodicalIF":3.1,"publicationDate":"2023-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/3f/17/acs-12-05-468.PMC10561334.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41189389","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rationale of the PAPAartis trial.","authors":"Martin Misfeld,&nbsp;Josephina Haunschild,&nbsp;David Petroff,&nbsp;Michael A Borger,&nbsp;Christian D Etz","doi":"10.21037/acs-2023-scp-0062","DOIUrl":"https://doi.org/10.21037/acs-2023-scp-0062","url":null,"abstract":"<p><p>Surgical and interventional repair of thoracoabdominal aortic aneurysms improve survival significantly compared to the natural history of the disease. However, both strategies are associated with a substantial risk of spinal cord ischemia, which has been reported to occur-even in contemporary series by expert centers-in up to 12% of patients, depending on the extent of the disease. Following improved neurological outcomes after staged approaches in extensive clinical and long-term large animal studies, and the description of the \"collateral network\", the concept of \"Minimally Invasive Staged Segmental Artery Coil Embolization\" (MIS²ACE) was introduced by Etz <i>et al.</i> This concept of priming the collateral network in order to improve spinal cord blood supply showed promising experimental and early clinical outcomes, and consequently led to the initiation of the randomized controlled multicenter PAPAartis trial (Paraplegia Prevention in Aortic Aneurysm Repair by Thoracoabdominal Staging). This <i>Keynote Lecture</i> describes the background and rationale for this trial and gives an update on the current status.</p>","PeriodicalId":8067,"journal":{"name":"Annals of cardiothoracic surgery","volume":"12 5","pages":"463-467"},"PeriodicalIF":3.1,"publicationDate":"2023-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/75/c8/acs-12-05-463.PMC10561337.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41189396","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Collateral network concept in 2023.","authors":"Suguru Ohira,&nbsp;Steven L Lansman,&nbsp;David Spielvogel","doi":"10.21037/acs-2023-scp-15","DOIUrl":"https://doi.org/10.21037/acs-2023-scp-15","url":null,"abstract":"<p><p>Extensive thoracoabdominal aortic aneurysm repair can cause spinal cord ischemia which significantly impacts survival and quality of life. Although this complication is uncommon, it is important to recognize the pathophysiology and preventative measures. In the 1990s, Dr. Griepp and colleagues proposed the existence of an extensive collateral network that supports spinal cord perfusion, \"the collateral network concept\". This includes an interconnecting complex of vessels in the intraspinal, paraspinous, and epidural spaces, and in the paravertebral muscles, involving the intercostal and lumbar segmental arteries as well as the subclavian and hypogastric (iliac) arteries. In this concept, as opposed to the one major segmental input model such as the Adamkiewicz artery, recognition of the importance of multiple inputs to the spinal circulation is paramount to maintaining the spinal blood flow and preventing spinal cord ischemia. In this article, we review the current evidence of the collateral concept and its application in aortic surgery.</p>","PeriodicalId":8067,"journal":{"name":"Annals of cardiothoracic surgery","volume":"12 5","pages":"450-462"},"PeriodicalIF":3.1,"publicationDate":"2023-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/62/b7/acs-12-05-450.PMC10561329.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41189386","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Current approaches to spinal cord protection during open thoracoabdominal aortic aneurysm repair.","authors":"Joseph S Coselli, Scott A LeMaire, Vicente Orozco-Sevilla, Ourania Preventza, Marc R Moon, Lauren M Barron, Subhasis Chatterjee","doi":"10.21037/acs-2023-scp-10","DOIUrl":"10.21037/acs-2023-scp-10","url":null,"abstract":"<p><p>Spinal cord deficit (SCD) is a feared complication after thoracoabdominal aortic aneurysm repair. Vigilant management throughout the perioperative period is necessary to reduce the risk of SCD. Measures for preventing SCD during the intraoperative period include preoperative optimization and recognizing patients at a higher risk of SCD. In this manuscript, we discuss intraoperative adjuncts including utilization of cerebrospinal fluid drainage, left heart bypass, mild hypothermia, selective reimplantation of intercostal and lumbar arteries, and renal and visceral vessel perfusion. From the operative to the postoperative period, careful attention to avoiding hypotension and anemia is important. If SCD is recognized early, therapeutic intervention may be implemented to mitigate injury.</p>","PeriodicalId":8067,"journal":{"name":"Annals of cardiothoracic surgery","volume":"12 5","pages":"429-437"},"PeriodicalIF":3.3,"publicationDate":"2023-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/2d/39/acs-12-05-429.PMC10561332.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41189387","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Safety of cerebrospinal fluid drainage in descending and thoracoabdominal aortic replacement surgery.","authors":"Afsheen Nasir, Mohammad A Zafar, Mohamed Abdelbaky, Dimitra Papanikolaou, Hesham Ellauzi, Maryam Shaikh, Bulat A Ziganshin, John A Elefteriades","doi":"10.21037/acs-2023-scp-0121","DOIUrl":"10.21037/acs-2023-scp-0121","url":null,"abstract":"<p><strong>Background: </strong>Spinal cord injury (SCI) remains a significant morbidity of surgical repair of descending thoracic aortic aneurysms (DTAA) and thoracoabdominal aortic aneurysms (TAAA). We present our 17-year experience with cerebrospinal fluid drainage (CSFD) as a protective strategy during open surgical repair of descending and thoracoabdominal aortic disease.</p><p><strong>Methods: </strong>We conducted a retrospective chart review of 132 patients who underwent open surgical repair of DTAA and TAAA and dissections with concurrent use of CSFD for spinal cord protection. Information regarding survival, postoperative course, and complications related to CSFD use were extracted from electronic health records (EHR) and analyzed.</p><p><strong>Results: </strong>Mean patient age was 65.4±13.0 years, and 82 (62.1%) were male. A CSFD was successfully inserted in all patients. The mean hospital length of stay after surgery was 12.2±11.2 days, and in-hospital mortality was 7.6%. Postoperative transient paresis was observed in 5 patients (3.8%), and permanent paraplegia was seen in 4 (3.0%). CSFD related complications were reported in 25 patients (19%). Complications included persistent cerebrospinal fluid (CSF) leakage, blood-tinged CSF (with subdural hematoma reported in 3 patients) and spinal cutaneous fistula in 9 (7%), 14 (11%), and 1 (1%), respectively. Long term survival was 50.9% at 15 years.</p><p><strong>Conclusions: </strong>CSFD is associated with minor complications, without major sequalae. It is a safe practice and likely contributes innocuously to decreased SCI in patients undergoing open repair of DTAA and TAAA.</p>","PeriodicalId":8067,"journal":{"name":"Annals of cardiothoracic surgery","volume":"12 5","pages":"476-483"},"PeriodicalIF":3.1,"publicationDate":"2023-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/87/ee/acs-12-05-476.PMC10561341.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41189397","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A new hybrid graft for open thoracoabdominal aortic aneurysm repair.","authors":"Sabine Helena Wipper,&nbsp;Tilo Kölbel,&nbsp;Julia Dumfarth,&nbsp;Hubert Schelzig,&nbsp;Anthony L Estrera,&nbsp;Harleen K Sandhu,&nbsp;Florian Enzmann,&nbsp;E Sebastian Debus","doi":"10.21037/acs-2023-scp-12","DOIUrl":"10.21037/acs-2023-scp-12","url":null,"abstract":"The Thoracoflo graft was developed as a new hybrid device for thoracoabdominal aortic aneurysm (TAAA) repair. The aim was to offer strategies to mitigate perioperative mortality/morbidity through a combined endovascular thoracic and open abdominal aortic singlestage operation. The SPIDER technique for graft implantation allows temporary, pulsatile distal perfusion of visceral, renal, and iliac arteries via a side-branch attached to the common iliac artery following the deployment of the stent-supported part of the device. Thoracotomy, radiation, and extracorporeal circulation (ECC) can be avoided, while enabling reimplantation of visceral, renal, and lumbar arteries (1-5).","PeriodicalId":8067,"journal":{"name":"Annals of cardiothoracic surgery","volume":"12 5","pages":"503-505"},"PeriodicalIF":3.1,"publicationDate":"2023-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/a6/ea/acs-12-05-503.PMC10561343.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41189385","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Neuromonitoring for descending thoracic and thoracoabdominal aortic aneurysm repair.","authors":"Akiko Tanaka,&nbsp;Hung Nguyen,&nbsp;Holly N Smith,&nbsp;Anthony L Estrera","doi":"10.21037/acs-2023-scp-11","DOIUrl":"https://doi.org/10.21037/acs-2023-scp-11","url":null,"abstract":"","PeriodicalId":8067,"journal":{"name":"Annals of cardiothoracic surgery","volume":"12 5","pages":"509-510"},"PeriodicalIF":3.1,"publicationDate":"2023-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/87/99/acs-12-05-509.PMC10561338.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41189392","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}