Annals of cardiothoracic surgery最新文献

{"title":"Hybrid repair of a thoracoabdominal aortic aneurysm in female patient with Loeys-Dietz syndrome.","authors":"Sabine Helena Wipper, Tilo Kölbel, Bernhard Dorweiler, Julia Dumfarth, Alexandra Gratl, Olaf Gorny, Anthony L Estrera, Harleen K Sandhu, E Sebastian Debus","doi":"10.21037/acs-2023-adw-10","DOIUrl":"https://doi.org/10.21037/acs-2023-adw-10","url":null,"abstract":"","PeriodicalId":8067,"journal":{"name":"Annals of cardiothoracic surgery","volume":null,"pages":null},"PeriodicalIF":3.1,"publicationDate":"2023-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10711409/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138798533","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":"Thoracic endograft repair for a complicated type B aortic dissection.","authors":"Carolyn R Postol, Eanas S Yassa","doi":"10.21037/acs-2023-adw-12","DOIUrl":"https://doi.org/10.21037/acs-2023-adw-12","url":null,"abstract":"","PeriodicalId":8067,"journal":{"name":"Annals of cardiothoracic surgery","volume":null,"pages":null},"PeriodicalIF":3.1,"publicationDate":"2023-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10711403/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138798615","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":"Trends in sex-specific differences following aortic arch repair: results from the Canadian Thoracic Aortic Collaborative.","authors":"Jennifer Chia-Ying Chung, Nitish Bhatt, Louis-Mathieu Stevens, Rashmi Nedadur, Marina Ibrahim, Kiera Liblik, Michael W A Chu, Maral Ouzounian","doi":"10.21037/acs-2023-adw-0163","DOIUrl":"https://doi.org/10.21037/acs-2023-adw-0163","url":null,"abstract":"<p><strong>Background: </strong>Previous data have shown that sex-related differences exist in aortic arch surgery, with female patients experiencing worse outcomes. Over time, as surgical techniques and strategies have improved, these improvements have benefitted female patients. Using a multicenter national aortic registry from the Canadian Thoracic Aortic Collaborative (CTAC), we aimed to determine the relationship between sex and outcomes following aortic arch repair and to examine how these have changed over time.</p><p><strong>Methods: </strong>The multicenter prospective CTAC database of all aortic procedures performed under circulatory arrest from participating centers across Canada (n=9) was used. Patients were included who underwent elective or urgent/emergency arch reconstruction under circulatory arrest from 2002 to 2021. The primary composite endpoint was defined as the occurrence of one of the following endpoints: in-hospital mortality, stroke, dialysis-dependent renal failure, deep sternal wound infection, reoperation, or prolonged ventilation of >40 hours. Secondary endpoints included in-hospital mortality, in-hospital stroke, and a modified version of the Society of Thoracic Surgeons-defined composite endpoint for mortality and major morbidity (MMOM).</p><p><strong>Results: </strong>A total of 2,592 patients who underwent aortic arch repair between 2002 and 2021 (31.4% female and 68.6% male patients). Operative mortality decreased through the study period for female patients. No change in operative mortality was observed in male patients or following elective repair. The composite endpoint improved for female patients over time in both elective and urgent surgery, while for male patients, rates improved for elective surgery and remained stable for urgent. Ultimately, female sex was not an independent predictor of adverse outcomes following aortic arch repair.</p><p><strong>Conclusions: </strong>Our results are congruent with existing data and are highly encouraging. It shows that multilevel improvements in our approach to aortic arch surgery have helped to serve female patients who were previously disadvantaged.</p>","PeriodicalId":8067,"journal":{"name":"Annals of cardiothoracic surgery","volume":null,"pages":null},"PeriodicalIF":3.1,"publicationDate":"2023-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10711408/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138798619","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":"Obstetric considerations for aortopathy in pregnancy.","authors":"Anna R Whelan, Myles E Ringel, Sherene Shalhub, Melissa L Russo","doi":"10.21037/acs-2023-adw-0164","DOIUrl":"https://doi.org/10.21037/acs-2023-adw-0164","url":null,"abstract":"<p><p>Aortic dissection (AD) associated with pregnancy can have catastrophic consequences for the mother and/or fetus. AD occurs in 4-5 per 1,000,000 pregnancies and, despite its rarity, is the third most frequent maternal cardiovascular cause of death. AD associated with pregnancy is most likely to occur in the third trimester or postpartum period. In individuals with genetic aortopathy, pregnancy is considered a high-risk time for AD. There are management strategies in the preconception, antepartum, delivery and postpartum periods to optimize patient care. A multi-disciplinary team that includes capability to perform cardiovascular surgery is critical. Imaging modalities including maternal echocardiogram and magnetic resonance imaging can be safely performed in pregnancy for surveillance of the aortic size. Computed tomography (CT) scan is reserved for scenarios where there is a high index of suspicion for AD in a pregnant person to limit fetal exposure to radiation. After counseling about the potential risks of a pregnancy, the decision to pursue pregnancy is ultimately at the discretion of the individual. The duty of the cardio-obstetric team is to ensure that the patient and their family understand the risks of a pregnancy and the plan of care.</p>","PeriodicalId":8067,"journal":{"name":"Annals of cardiothoracic surgery","volume":null,"pages":null},"PeriodicalIF":3.1,"publicationDate":"2023-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10711402/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138798549","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 role of sex hormones in abdominal aortic aneurysms: a topical review.","authors":"Rebecka Hultgren","doi":"10.21037/acs-2023-adw-17","DOIUrl":"https://doi.org/10.21037/acs-2023-adw-17","url":null,"abstract":"<p><p>Sex discrepancies have been reported for patients with abdominal aortic aneurysm (AAA) for decades. Men have a higher prevalence of disease, earlier onset, less morphological features obstructing eligibility for repair and better survival, both short and long term. In more recent years, several attempts have been made to identify the biologic or pathogenic factors contributing to these sex differences, including socioeconomic factors though all have failed. The greatest challenge is to reveal the variable mechanism for development of disease for both women and men, and secondly to identify the factors contributing to the progression of disease, and eventual rupture. Evaluations of diagnosed patients have failed to detect any factors associated with development of disease which would give a distinct explanation for the profound sex differences. Considering the obvious earlier trigger for development in men compared to women, excluding smoking, hypertension, hyperlipidemia as certified sole triggers, the remaining factors to explore are sex hormones or biological mechanisms. This topical review explores the contemporary publications on sex hormones and their association with AAA in women and men. The findings confirm the lack of scientific evidence for the influence of female and male sex hormones on development or progression of aneurysm disease. Weak indications support that women probably benefit from a longer reproductive history as a contributing protection against AAA development, influenced by smoking and heredity. There is some evidence that could support that, as for other manifestations of cardiovascular diseases, low testosterone levels in men, can contribute to an increased risk for AAA development. The influence of higher circulating levels of female sex hormones on risk development in men remains to be evaluated. In conclusion, this area will expand during the next decade, by combining registry-based and translational databases in stratified analysis for women and men, giving us more evidence that will contribute to important risk factor estimations for future cohorts at risk of AAA development.</p>","PeriodicalId":8067,"journal":{"name":"Annals of cardiothoracic surgery","volume":null,"pages":null},"PeriodicalIF":3.1,"publicationDate":"2023-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10711405/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138798614","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":"Endovascular repair of thoracoabdominal aortic aneurysms.","authors":"Matthew J Rossi, Christian C Shults, Javairiah Fatima","doi":"10.21037/acs-2023-adw-0078","DOIUrl":"https://doi.org/10.21037/acs-2023-adw-0078","url":null,"abstract":"","PeriodicalId":8067,"journal":{"name":"Annals of cardiothoracic surgery","volume":null,"pages":null},"PeriodicalIF":3.1,"publicationDate":"2023-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10711415/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138798529","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":"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":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/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,&nbsp;Michael Z Tong,&nbsp;Patrick R Vargo,&nbsp;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":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/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":"Current perioperative management of cerebrospinal fluid drains.","authors":"Shao-Feng Zhou,&nbsp;Akiko Tanaka,&nbsp;Anthony Estrera","doi":"10.21037/acs-2023-scp-19","DOIUrl":"https://doi.org/10.21037/acs-2023-scp-19","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/25/a0/acs-12-05-487.PMC10561331.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41189388","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":"Minimally invasive staged segmental artery coil embolization (MIS²ACE) for spinal cord protection.","authors":"Josephina Haunschild,&nbsp;Tilo Köbel,&nbsp;Martin Misfeld,&nbsp;Christian D Etz","doi":"10.21037/acs-2023-scp-21","DOIUrl":"https://doi.org/10.21037/acs-2023-scp-21","url":null,"abstract":"<p><p>Minimally invasive staged segmental artery coil embolization (MIS²ACE) is an emerging technology for priming of the paraspinous collateral network prior to open or endovascular thoracoabdominal aortic aneurysm (TAAA) repair. Its safety and efficacy have been previously proven in various experimental settings and confirmed in numerous multicentric pilot studies for open and endovascular repair. MIS²ACE is safe and has the potential to decisively reduce the risk of postoperative paraplegia, the most devastating complication of open and endovascular TAAA repair, still affecting up to 20% of patients. Up to now, MIS²ACE has been clinically implemented with excellent results, and is currently being investigated in the international, multicenter, randomized controlled trial PAPAartis, funded by the German Research foundation, and the European Union. MIS²ACE can be performed under local anesthesia, enabling continuous monitoring of neurological function, and in case of clinical signs of imminent ischemia, preemptive interruption of the procedure. A thorough evaluation of preoperative computed tomography (CT) imaging for identification of open and accessible segmental arteries (SAs) is critical. Segmental artery occlusion can be achieved with either micro coils, or vascular plugs. A maximum number of seven SAs is currently recommended to be occluded in the same session, and a minimum interval of 5 days should be awaited between either two MIS²ACE sessions or between MIS²ACE and the final repair. Adjuvant side-effects of MIS²ACE are the reduction in segmental back-bleeding during open repair leading to harmful steal phenomenon and the reduction of the incidence of type II endoleaks in endovascular repair. Current contraindications for MIS²ACE are emergency cases, hostile anatomy, and a shaggy aorta. Other neuroprotective adjuncts such as cerebrospinal fluid (CSF) drainage, permissive hypertension, motor-evoked potentials (MEP)/somato-sensory evoked potentials (SSEP) and monitoring of paraspinous muscle oxygenation by near-infrared spectroscopy should also be applied independent of prior MIS²ACE procedure.</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/cb/fd/acs-12-05-492.PMC10561336.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41189391","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}