Hybrid Thoracoabdominal Aneurysm Repair With Antegrade Visceral Debranching From the Ascending Aorta: Concomitant Cardiac Surgery and Stent-Grafting

Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute Cleveland Clinic Foundation, 44195 Cleveland, Ohio, USA.
The Annals of thoracic surgery (Impact Factor: 3.65). 12/2011; 92(6):2275-7. DOI: 10.1016/j.athoracsur.2011.06.018
Source: PubMed

ABSTRACT Patients with thoracoabdominal aneurysm that require concomitant cardiac surgery present a complex surgical challenge. A staged hybrid technique including combined cardiac surgery and visceral revascularization from the ascending aorta, followed by endovascular aneurysmal exclusion is reported in four patients. No perioperative death and no neurological complications were observed. The surgical technique is described. (Ann Thorac Surg 2011; 92:2275-7) (C) 2011 by The Society of Thoracic Surgeons

  • [Show abstract] [Hide abstract]
    ABSTRACT: A 45-year old woman with then unknown Loeys-Dietz syndrome (LDS) presented in 2007 with aneurysms involving the entire thoraco-abdominal aorta, but sparing the aortic root and valve. She underwent debranching of the aortic arch, followed by stenting of entire distal ascending aorta, arch and descending aorta. Two years later, a diagnosis of LDS was established. Five years later, she re-presented with severe aortic regurgitation in a dilated aortic root, requiring aortic root replacement. We present the challenges involved in performing aortic root replacement in the presence of stents within the ascending aorta.
    Interactive Cardiovascular and Thoracic Surgery 02/2014; 18(5). DOI:10.1093/icvts/ivu010 · 1.11 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: To compare the outcomes between patients undergoing endovascular (EEC) or open (OEC) approaches to second-stage elephant trunk completion (EC). From 1993 to 2010, 225 patients underwent second-stage EC (EEC, n = 92; OEC, n = 133). Propensity matching was performed for a fair comparison. The EEC patients were older, more likely to have atrial fibrillation, and had a smaller proximal aorta. The 30-day mortality was 6.2% (6.5% EEC vs 6% OEC, P = .88). No difference was found in bleeding (8.8%), stroke (3%), renal failure (4%), or spinal cord injury (4%); however, the OEC patients required tracheostomy more often (10 vs 1, P = .014). Survival after second-stage EC at 6 months and 1 and 5 years was 91%, 90%, and 77%, respectively. Survival and major morbidity did not differ after matching (44 pairs). However, the EEC group had shorter stays (9.9 ± 13 vs 13 ± 9 days, P < .0001) and received less blood (3 ± 8 vs 6 ± 8 U, P = .0001) than did the OEC group. This was maintained after matching. During follow-up, 32 endoleaks (3 type I, 27 type II, 2 type III) occurred; 26 (28%) EEC and 13 of 76 (17%) OEC patients underwent reoperation. The approach was not related to the risk of death in either hazard phase, but a larger descending diameter predicted a greater risk in the early phase. Death and complications occur similarly after OEC or EEC. The early toll might be greater after OEC, at the cost of reintervention for EEC. EEC expands the options to older patients and allows for earlier completion. Second-stage repair should not be delayed, and all patients require lifelong imaging surveillance.
    The Journal of thoracic and cardiovascular surgery 09/2013; 146(6). DOI:10.1016/j.jtcvs.2013.07.070 · 3.99 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: An aging population, increased awareness, high-resolution imaging, and improving access to care all mean that more people are being diagnosed with acute aortic dissection. A better understanding of the role of initial medical therapy, improved surgical techniques, and the addition of endovascular approaches to the treatment algorithm, have resulted in more patients surviving the acute phase of disease. During the chronic phase, patients with residual dissection are challenged by the competing risks of reoperation or death. Open repair for chronic type-B dissection can be performed safely but is a relatively morbid operation. For this reason, surgery is often postponed until patients develop very late complications. Despite encouraging results for thoracic endovascular aortic repair of acute type-B dissection, chronic type-B dissection poses unique challenges that make application of endovascular technology more difficult. As our understanding of the disease and its natural history evolves, the ways in which these 2 methods of treatment complement each other need to be better understood. The benefits and limitations of each therapy, and how and when to apply each in the setting of chronic distal dissection, are discussed. Copyright © 2015 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.