Extended total arch replacement by means of the open stent-grafting method to treat intimal tears after transluminal stent-graft placement for a ruptured acute type B aortic dissection
Mie University, Tu, Mie, JapanJournal of Thoracic and Cardiovascular Surgery (Impact Factor: 3.99). 03/2002; 123(2):354-6. DOI: 10.1067/mtc.2002.117533
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ABSTRACT: Using a computer simulation, this paper compares the acquisition performance of a digital matched filter PN code synchroniser, based on a simple threshold detector, with that using a maximum likelihood detector under conditions of additive Gaussian noise. Both types of synchroniser have a hard-limiter at their input. It is found that the conventional digital matched filter synchroniser has excellent acquisition performance in relatively good to moderately poor input SNRs, but fails as the input SNR falls below a `threshold' SNR, whereas the maximum likelihood detector system has good acquisition performance over a much wider range of input SNR, even with data modulationSpread Spectrum Techniques and Applications Proceedings, 1996., IEEE 4th International Symposium on; 10/1996
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ABSTRACT: There is still a considerable controversy regarding optimal treatment for patients with acute type B aortic dissection. Patients with complicated disease are particularly challenging for cardiovascular treatment. Early surgery for acute dissections of the descending aorta with life-threatening complications is known to carry a high mortality. Endovascular stent grafting is developing as an alternative treatment mainly for chronic stages of type B aortic dissection. It is not clear whether endovascular stent grafting is safe and effective in emergency treatment of acute type B aortic dissection. In 10 patients (7 men, 3 women; mean age, 59.2 years; range, 46 to 65 years), endovascular stent grafting was performed within 11.0 +/- 5.9 hours (range, 4 to 24 hours) of diagnosis of complications. Indications for acute intervention included contained rupture, hematothorax, life-threatening malperfusion, and refractory pain. Using a retrograde endovascular route after surgical exposure of the femoral artery, self-expanding stent prostheses consisting of polyester-covered Nitinol (Talent, World Medical; mean diameter, 40 +/- 4 mm; length, 10 cm) were placed into the descending aorta distal to the subclavian artery. Before discharge and on follow-up visits, imaging of the aorta was performed using computed tomography. In 9 of 10 patients (90%), the primary entry could be completely occluded with the endovascular stent. Early mortality was 20% (2 of 10): 1 patient died after disruption of the intimal layer distal to the stent, and 1 patient died in hemorrhagic shock after surgical fenestration of the abdominal aorta for persistent malperfusion. Three patients (30%) required consecutive surgical treatment: indications included acute development of retrograde type A aortic dissection, acute stent dislocation by fractured wires and secondary leakage, and late formation of an aneurysm of the descending aorta 6 months after endovascular stent grafting. There were no surgical or late deaths. Our experience provides some evidence that early mortality of life-threatening acute type B aortic dissection may be reduced by emergency endovascular stent grafting and that this form of treatment is a promising therapeutic option. Refinements, especially in stent design and application, may further improve the prognosis of patients in the life-threatening situation of complicated acute type B aortic dissection.The Annals of thoracic surgery 11/2004; 78(4):1261-6; discussion 1266-7. DOI:10.1016/j.athoracsur.2004.03.107 · 3.65 Impact Factor
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