Annals of cardiothoracic surgery最新文献

{"title":"Neuromonitoring for descending thoracic and thoracoabdominal aortic aneurysm repair.","authors":"Akiko Tanaka, Hung Nguyen, Holly N Smith, 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":null,"pages":null},"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}

{"title":"Spinal cord injury after frozen elephant trunk procedures-prevention and management.","authors":"Giacomo Murana, Francesco Campanini, Costanza Fiaschini, Giuseppe Barberio, Gianluca Folesani, Davide Pacini","doi":"10.21037/acs-2023-scp-16","DOIUrl":"10.21037/acs-2023-scp-16","url":null,"abstract":"New techniques and devices have broadened the spectrum of therapeutic strategies for patients with complex aortic pathologies. Total arch replacement (TAR) using the frozen elephant trunk (FET) technique is one of the latest approaches to surgically treat complex arch and proximal descending aortic pathologies. Although this technique has showed excellent results, it is associated with several complications, such as spinal cord injury (SCI). This is related to the coverage of an extended portion of descending aorta, including the origin of intercostal arteries. The longer the portion of descending aorta covered, the higher the risk of SCI occurrence. Consequently, knowing the anatomy and vascularization of the spinal cord is crucial (1). Even though coverage of the descending aorta beyond T8 (due to coverage of the Adamkiewicz artery) seems to be one of the most important factors associated with higher risk of SCI, there are other elements involved, such as prolonged spinal cord ischemia observed during hypothermic circulatory arrest and air or corpuscular thromboembolism (2). A higher incidence of this neurological complication after the FET is more often observed in chronic degenerative aneurysms and acute aortic dissections and is less frequently reported in chronic dissections due to the possibility of pre-conditioning of the spinal cord by collateral networks (3,4). Preventive measures can be employed in extended surgical aortic coverage to reduce the occurrence of spinal cord injuries, such as cerebrospinal fluid (CSF) drainage, keeping the mean arterial pressure (MAP) above 90 mmHg, early evaluation of neurological deficits, and the use of moderate hypothermia. CSF drainage allows monitoring of the peridural pressure, as well as the capability of its reduction when it exceeds critical values. However, intrathecal drainage placement can represent a risk and careful examination of the coagulation panel is strongly recommended. In this video article, we present a case of a FET showing how it can be possible in the prevention and management of SCI. A literature review on this subject will describe the incidence and state of the art perspectives on this neurological complication.","PeriodicalId":8067,"journal":{"name":"Annals of cardiothoracic surgery","volume":null,"pages":null},"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/d2/f4/acs-12-05-500.PMC10561344.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41189398","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":"Prophylactic cerebrospinal fluid drainage and spinal cord ischemia in thoracic and thoracoabdominal endovascular procedures: a systematic review and meta-analysis.","authors":"Cheng-Hao Jacky Chen, Henry Jiang, Vinh Dat David Nguyen","doi":"10.21037/acs-2023-scp-17","DOIUrl":"10.21037/acs-2023-scp-17","url":null,"abstract":"Background Spinal cord ischemia (SCI) is one of the most devastating complications of thoracic endovascular aortic repair (TEVAR). Prophylactic cerebrospinal fluid drainage (CSFD) has been shown to decrease the risk of SCI in open thoracic aortic procedures; however, its utility in TEVAR remains uncertain. This systematic review and meta-analysis aim to determine the role of prophylactic CSFD in preventing SCI in TEVAR. Methods A literature search of five databases was performed and all studies published before September 2022 that reported SCI rates in TEVAR patients undergoing prophylactic CSFD were included. A random effects meta-analysis of means or proportions was performed for single-arm data. Odds ratios (ORs) with 95% confidence intervals (CIs) were reported for comparisons between groups. Results A total of 4,793 patients undergoing TEVAR from 40 studies were included. The mean age was 68.8 years and 70.9% of patients were male. The overall SCI rate was 3.5%, with a 1.3% rate of immediate SCI and a 1.9% rate of delayed SCI. There were no significant differences in SCI rates between prophylactic CSFD patients and non-drained patients. Routine CSFD did not have a significant impact on SCI rates compared to non-drained patients. There was an increased rate of transient SCI with selective CSFD compared to non-drained patients (OR 2.08; 95% CI: 1.06–4.08; P=0.03). The most common drain-related complication was spinal headache (4.3%). The major complication rate was 1.6%, of which epidural or spinal hematoma (0.9%) was the most common, followed by intracranial or subdural hemorrhage (0.8%) and paraparesis or paraplegia (0.8%). Conclusions This study found no significant difference in SCI rates between prophylactic CSFD patients and their non-drained counterparts. CSFD is associated with a small but non-negligible risk of serious complications. Multi-center randomized controlled trials (RCTs) are warranted to help stratify the risk of both SCI and CSFD-related complications in patients undergoing endovascular aortic procedures.","PeriodicalId":8067,"journal":{"name":"Annals of cardiothoracic surgery","volume":null,"pages":null},"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/ab/e2/acs-12-05-392.PMC10561335.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41189395","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 for thoracoabdominal aortic aneurysm repair: from bench to bedside.","authors":"Adam M Carroll,&nbsp;R Wilson King,&nbsp;Christian V Ghincea,&nbsp;Muhammad Aftab,&nbsp;T Brett Reece","doi":"10.21037/acs-2023-scp-08","DOIUrl":"10.21037/acs-2023-scp-08","url":null,"abstract":"<p><p>This keynote lecture and corresponding presentation discuss the anatomy and pathophysiology surrounding spinal cord injury in aortic surgery. This article will discuss risk factors and mechanisms for spinal cord injury, including loss of direct and collateral spinal cord perfusion and ischemia-reperfusion injury. This review will examine these elements in both the laboratory and clinical setting, in addition to other neuroprotective strategies applied in clinical practice. Addressing spinal cord injury requires an integrated and considerate approach to simultaneously optimize spinal cord blood flow, promote collateralization and improve ischemic tolerance. Given the catastrophic clinical consequences for both the patient and their caregivers, continuing to investigate and examine spinal cord injury is of the utmost importance.</p>","PeriodicalId":8067,"journal":{"name":"Annals of cardiothoracic surgery","volume":null,"pages":null},"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/a2/12/acs-12-05-438.PMC10561340.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41189400","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":"The outcomes of three decades of the David and Yacoub procedures in bicuspid aortic valve patients-a systematic review and meta-analysis.","authors":"Ashley R Wilson-Smith,&nbsp;Christian J Wilson-Smith,&nbsp;Jemilla Strode Smith,&nbsp;Dominic Ng,&nbsp;Benjamin T Muston,&nbsp;Aditya Eranki,&nbsp;Michael L Williams","doi":"10.21037/acs-2023-avs2-19","DOIUrl":"https://doi.org/10.21037/acs-2023-avs2-19","url":null,"abstract":"<p><strong>Background: </strong>Valve-sparing aortic procedures, including the David and Yacoub procedures, have emerged as the dominant approaches in aortic aneurysm surgery, preserving the native aortic valve and thereby conferring significant prognostic benefits to the patient. Over the years, these procedures have also shown promise in patients with bicuspid valve-related aortopathy. This systematic review and meta-analysis presents the most up-to-date data on perioperative outcomes, freedom from secondary reoperation, and freedom from mortality for bicuspid valve patients undergoing valve-sparing aortic operations.</p><p><strong>Methods: </strong>The methods for this systematic review and meta-analysis adhered to the Preferred Reporting Items for Systematic Reviews and Meta-analyses statement. Four databases were searched, ultimately yielding 19 papers for inclusion, using appropriate search terminology. Meta-analysis using proportions or means, as appropriate, were applied. Kaplan-Meier curves were digitized and aggregated using previously validated techniques.</p><p><strong>Results: </strong>A total of 1,159 patients were included. Males accounted for 87.4% of the cohort. The mean age of the cohort was 44.9 years. The mean aortic root diameter was estimated to be 46.3 mm, with an estimated range from 38 to 54 mm. Thirty-day mortality rate was estimated to be 1.7%. Eighty-five percent of patients in this series received the David approach, with the remainder receiving the Yacoub approach. Overall, there was low heterogeneity observed for the mean length of intensive care stay, while high heterogeneity was observed for the other remaining variables of interest. Kaplan-Meier survival estimation at 5, 10, and 15 years was 96%, 90%, and 87%, respectively. Kaplan-Meier freedom from secondary reoperation at 5, 10, and 15 years was 96%, 91%, and 88%, respectively.</p><p><strong>Conclusions: </strong>This review demonstrates the durability and safety of the David and Yacoub valve-sparing procedures across long-term follow-up in bicuspid aortic valve patients. These procedures offer significant freedom from mortality and secondary reoperations on the aorta and valve and will likely continue to demonstrate excellent results into the future. There is a clear transition towards the David procedure, with the bulk of contemporary literature publishing on this technique.</p>","PeriodicalId":8067,"journal":{"name":"Annals of cardiothoracic surgery","volume":null,"pages":null},"PeriodicalIF":3.1,"publicationDate":"2023-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/87/bf/acs-12-04-286.PMC10405344.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9968184","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":"Annular stabilization in remodelling technique.","authors":"Pichoy Danial,&nbsp;Pouya Youssefi,&nbsp;Mathieu Debauchez,&nbsp;Pierre Demondion,&nbsp;Emmanuel Lansac","doi":"10.21037/acs-2023-avs2-15","DOIUrl":"https://doi.org/10.21037/acs-2023-avs2-15","url":null,"abstract":"Case 1 is a 52-year-old patient with New York Heart Association (NYHA) III dyspnea. Echocardiography demonstrated a tricuspid aortic valve with grade 4 aortic insufficiency (AI), preserved ejection fraction (50%) and a dilated left ventricle with end-diastolic and end-systolic diameters of 63 and 42 mm, respectively. Gated computed tomography (CT) revealed sinuses of Valsalva measuring 57 mm and ascending aorta 44 mm in diameter. Case 2 is a 69-year-old patient with NYHA III dyspnea. Echocardiography demonstrated a bicuspid aortic valve with grade 4 AI, preserved ejection fraction (54%) and a dilated left ventricle with end-diastolic and end-systolic diameters of 59 and 45 mm, respectively. Gated CT revealed sinuses of Valsalva measuring 52 mm and ascending aorta 47 mm in diameter.","PeriodicalId":8067,"journal":{"name":"Annals of cardiothoracic surgery","volume":null,"pages":null},"PeriodicalIF":3.1,"publicationDate":"2023-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/d0/74/acs-12-04-386.PMC10405332.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9968187","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":"Future directions on aortic valve-sparing operations.","authors":"Tirone E David,&nbsp;Gebrine El Khoury","doi":"10.21037/acs-2023-avs2-17","DOIUrl":"https://doi.org/10.21037/acs-2023-avs2-17","url":null,"abstract":"Aortic valve-sparing operations should be key part of the surgeon’s armamentarium to treat patients with aortic root and ascending aortic aneurysms (1). Whilst a useful addition to the surgeon’s capability, there remain a number of unresolved problems. To start, more longitudinal outcomes from multiple centers are needed, not only to demonstrate their reproducibility, but also to determine the limitations of these approaches (1). We believe that in patients with aortic root aneurysms and normal or near normal aortic cusps, the results are entirely dependent on the surgeon’s competence. The manuscripts in these two issues of The Annals of Cardiothoracic Surgery have repeatedly emphasized the importance of meticulous operative technique with whichever type of reconstruction. Technical details, such as having the cusps coapting within the aortic root, well above the nadir of the aortic annulus and with adequate areas of the cusps touching each other during diastole, is one of the most important aspects of these procedures (2). The relationship between the cusp area and the area of the aortic orifice in diastole will have to be better defined in the future, as this affects the size of the graft used for the reconstruction (2). Intuitively, one would assume that using a smaller graft would offer more cusp tissue for coaptation, but it would also cause the cusps to prolapse and more plications of the free margin would be necessary (2). In addition, smaller aortic orifices would be associated with less mechanical stress on the cusps during diastole. Thus, determining the correct size of graft to use for the reconstruction is not as simple as one may assume, and it may play an important role in the durability of the cusps after aortic valve-sparing operations (3). The native semilunar valves (aortic and pulmonary valves) have sinuses of Valsalva and for this reason alone, one must assume that sinuses are important for the function of these valves. The authors of this essay disagree on this issue. Tirone David’s view is that commercially available Valsalva grafts are not a correct reproduction of the native aortic root, because the anatomy of semilunar valves are such that the three cusps are attached to the ventricles along a scalloped shape structure that evolves within a cylinder, and this cylinder contains three bulges that are called aortic sinuses or sinuses of Valsalva (4,5). Reimplanting the aortic valve into a spherical structure such as the Valsalva graft is likely to deform the aortic annulus and affect leaflet coaptation and long-term durability (6). Gebrine El Khoury’s view differs and he has been using Valsalva grafts, but he tailors it to fit the patients’ aortic valve and frequently plicates the spherical space along the sub-commissural triangles to make the graft more tubular in those areas. Further basic studies have to be conducted to examine this issue because the shape of the graft used to reimplant the aortic valve may be important f","PeriodicalId":8067,"journal":{"name":"Annals of cardiothoracic surgery","volume":null,"pages":null},"PeriodicalIF":3.1,"publicationDate":"2023-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/4c/fa/acs-12-04-366.PMC10405335.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9956745","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":"Straight tube versus Valsalva graft for valve-sparing operation.","authors":"Ruggero De Paulis,&nbsp;Mario Torre,&nbsp;Raffaele Scaffa","doi":"10.21037/acs-2023-avs2-10","DOIUrl":"https://doi.org/10.21037/acs-2023-avs2-10","url":null,"abstract":"“ Nothing in nature is without reason ; understand the reason and you don’t need experience .”—Leonardo da Vinci","PeriodicalId":8067,"journal":{"name":"Annals of cardiothoracic surgery","volume":null,"pages":null},"PeriodicalIF":3.1,"publicationDate":"2023-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/99/c2/acs-12-04-358.PMC10405343.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9968186","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":"Outcomes of aortic valve repair with the reimplantation technique and maintenance of commissural orientation.","authors":"John J Kelly,&nbsp;Nimesh D Desai,&nbsp;William L Patrick,&nbsp;Brittany J Cannon,&nbsp;Yu Zhao,&nbsp;Selim Mosbahi,&nbsp;Mikolaj Berezowksi,&nbsp;Amit Iyengar,&nbsp;Wilson Y Szeto,&nbsp;Joseph E Bavaria","doi":"10.21037/acs-2023-avs2-18","DOIUrl":"https://doi.org/10.21037/acs-2023-avs2-18","url":null,"abstract":"<p><strong>Background: </strong>Debate still persists on whether valve-sparing root reimplantation (VSRR) of a very asymmetric bicuspid aortic valve (BAV) should be completed such that the asymmetry of the native commissural orientation is retained, or if it should be made symmetric (180°-180°). Herein, we present our approach, in which the native asymmetry is preserved, and the valve is reimplanted in a 210°-150° orientation.</p><p><strong>Methods: </strong>A retrospective review was performed of 130 patients with BAV who underwent VSRR between January 1, 2004 and March 1, 2023 at a single institution. Of this total, 37 were reimplanted asymmetrically (210°-150°). The primary outcome was > moderate aortic insufficiency (AI). Secondary outcomes included severe aortic stenosis (AS), reintervention, and survival.</p><p><strong>Results: </strong>The included 37 patients were mostly male [94.6% (35/37)] with mean age of 46.3 years, and with low rates of comorbidities. At least moderate AI was present in 40.5% (15/37) prior to surgery. All BAV in this series were Sievers Type 1 with a mean commissural angle of 128.2°. Leaflet repair was required in 81.1% (30/37), most commonly involving central plication of the conjoined cusp [96.7% (29/30)] and raphe release [73.3% (22/30)]. There was no 30-day mortality or stroke. At 10 years, the cumulative incidences of > moderate AI, severe AS, and reintervention were 7.6% (0-17.2%), 7.1% (0-19.7%), and 5.3% (0.3-22%), respectively. There was no mortality for the entire duration of the study period.</p><p><strong>Conclusions: </strong>This series demonstrates excellent 10-year outcomes of maintaining commissural orientation in asymmetric BAV reimplantation procedures. However, further study with additional patients, longer follow-up, and direct comparison to symmetric reimplantation for similar BAV morphology is required.</p>","PeriodicalId":8067,"journal":{"name":"Annals of cardiothoracic surgery","volume":null,"pages":null},"PeriodicalIF":3.1,"publicationDate":"2023-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/bc/ef/acs-12-04-318.PMC10405331.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9968182","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":"David procedure through an upper ministernotomy.","authors":"Tomas Holubec,&nbsp;Mustafa Al-Obaidi,&nbsp;Thomas Walther,&nbsp;Arnaud Van Linden","doi":"10.21037/acs-2022-avs2-174","DOIUrl":"https://doi.org/10.21037/acs-2022-avs2-174","url":null,"abstract":"An asymptomatic 58-year-old patient was referred to our department for aortic root aneurysm of 51 mm with progression of 2 mm in one year. Preoperative evaluation using a computed tomography (CT) scan confirmed the aortic root aneurysm and ruled out any coronary artery disease. A transthoracic echocardiography showed a tricuspid aortic valve (AV) with moderate regurgitation. Valve-sparing aortic root replacement (VSARR) with AV","PeriodicalId":8067,"journal":{"name":"Annals of cardiothoracic surgery","volume":null,"pages":null},"PeriodicalIF":3.1,"publicationDate":"2023-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/22/3b/acs-12-04-380.PMC10405342.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9963092","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}