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ABSTRACT: To describe repair of an ascending type A dissection combining an open ascending tube graft with simultaneous great vessel transposition and antegrade deployment of an endoluminal graft across the arch and into the descending thoracic aorta.
A 50-year-old man was evaluated at an outside hospital and transferred to our service for treatment of an ascending aortic dissection with associated lower extremity ischemia. Imaging identified an aortic dissection extending from the aortic root to the aortic bifurcation and into the right common iliac artery. A hybrid procedure incorporating both open and endovascular techniques successfully repaired the dissection and aneurysm and restored blood flow to the extremity.
Although less invasive procedures are sometimes appropriate for repair in the descending thoracic aorta, surgical correction of an ascending dissection and endoluminal exclusion of the arch and distal aorta may form the basis of future treatment strategies for complex aortic pathologies, possibly eliminating the need for hypothermic cardiac arrest.
Journal of Endovascular Therapy 01/2006; 12(6):660-6. · 2.86 Impact Factor
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ABSTRACT: To report a technique for antegrade delivery of the TAG stent-graft during repair of lesions in the proximal aortic arch.
Via an 8-cm median sternotomy, a bifurcated graft, usually 14 or 16 mm in diameter, is anastomosed to the ascending aorta with 4-0 Prolene suture; a 10-mm straight graft is cut obliquely and anastomosed to the heel of the bifurcated graft for delivery of the endograft antegrade across the aortic arch. The great vessels in turn are clamped, transected at the arch, and sutured to the bypass graft. A 9-F sheath is secured in the conduit, and a 250-cm angled hydrophilic guidewire is passed to the desired iliac artery and exteriorized through the femoral sheath. The conduit is clamped, and the TAG's delivery sheath is substituted for the 9-F sheath. A marker is placed on the conduit to assure that the stent-graft is deployed just beyond the limb origins of the bifurcated graft. The conduit is introduced across the aortic arch, followed by the endograft, which is positioned at the marker as the sheath is withdrawn into the conduit. After completion angiography, the delivery sheath is removed, and the conduit is transected and oversewn. Heparinization is reversed, and the incision is closed, with one mediastinal drainage tube in place.
This technique allows precise delivery of the endoluminal graft at the proximal aortic arch, thus avoiding problems with retrograde delivery.
Journal of Endovascular Therapy 11/2005; 12(5):583-7. · 2.86 Impact Factor
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Nabil Dib,
Robert E Michler,
Francis D Pagani,
Susan Wright,
Dean J Kereiakes,
Rose Lengerich,
Philip Binkley,
Diane Buchele,
Inder Anand,
Cory Swingen, [......],
Vasken Dilsizian,
Bartley P Griffith,
Ronald Korn,
Steven K Kreuger, Marwan Ghazoul,
W Robb MacLellan,
Gregg Fonarow,
Howard J Eisen,
Jonathan Dinsmore,
Edward Diethrich
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ABSTRACT: Successful autologous skeletal myoblast transplantation into infarcted myocardium in a variety of animal models has demonstrated improvement in cardiac function. We evaluated the safety and feasibility of transplanting autologous myoblasts into infarcted myocardium of patients undergoing concurrent coronary artery bypass grafting (CABG) or left ventricular assist device (LVAD) implantation. In addition, we sought to gain preliminary information on graft survival and any associated changes in cardiac function.
Thirty patients with a history of ischemic cardiomyopathy participated in a phase I, nonrandomized, multicenter pilot study of autologous skeletal myoblast transplantation concurrent with CABG or LVAD implantation. Twenty-four patients with a history of previous myocardial infarction and a left ventricular ejection fraction <40% were enrolled in the CABG arm. In a second arm, 6 patients underwent LVAD implantation as a bridge to heart transplantation, and patients donated their explanted native hearts for testing at the time of heart transplantation. Myoblasts were successfully transplanted in all patients without any acute injection-related complications or significant long-term, unexpected adverse events. Follow-up positron emission tomography scans showed new areas of glucose uptake within the infarct scar in CABG patients. Echocardiography measured an average change in left ventricular ejection fraction from 28% to 35% at 1 year and of 36% at 2 years. Histological evaluation in 4 of 6 patients who underwent heart transplantation documented survival and engraftment of the skeletal myoblasts within the infarcted myocardium.
These results demonstrate the survival, feasibility, and safety of autologous myoblast transplantation and suggest that this modality offers a potential therapeutic treatment for end-stage heart disease.
Circulation 09/2005; 112(12):1748-55. · 14.74 Impact Factor
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Nabil Dib,
Patrick McCarthy,
Ann Campbell,
Michael Yeager,
Francis D Pagani,
Susan Wright,
W Robb MacLellan,
Gregg Fonarow,
Howard J Eisen,
Robert E Michler,
Philip Binkley,
Diane Buchele,
Ronald Korn, Marwan Ghazoul,
Jonathan Dinsmore,
Shaun R Opie,
Edward Diethrich
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ABSTRACT: Successful autologous skeletal myoblast transplantation into infarcted myocardium in a variety of animal models has demonstrated improvement in cardiac function. We evaluated the safety and feasibility of transplanting autologous myoblasts into infarcted myocardium of patients undergoing concurrent coronary artery bypass grafting (CABG) or left ventricular assist device implantation (LVAD). In addition, we sought to gain preliminary information on graft survival and any potential improvement of cardiac function. Eighteen patients with a history of ischemic cardiomyopathy participated in a phase I, nonrandomized, multicenter pilot study of autologous skeletal myoblast transplantation concurrent with CABG or LVAD implantation. Twelve patients with a history of previous myocardial infarction (MI) and a left ventricular ejection of less than 30% were enrolled in the CABG arm. In a second arm, six patients underwent LVAD implantation as a bridge to heart transplantation and were required to donate their heart for testing at the time of heart transplant. Myoblasts were successfully transplanted in all patients without any acute injection-related complications or significant long-term unexpected adverse events. Follow-up PET scans showed new areas of viability within the infarct scar in CABG patients. Echocardiography measured an average improvement in left ventricular ejection fraction (LVEF) from 25% to 34%. Histological evaluation in four out of five patients who underwent heart transplantation documented survival and engraftment of the skeletal myoblasts within the infarcted myocardium. These interim results demonstrate survival, feasibility, and safety of autologous myoblast transplantation and suggest that this modality may offer a potential therapeutic treatment for end-stage heart disease.
Cell Transplantation 02/2005; 14(1):11-9. · 5.13 Impact Factor
