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ABSTRACT: Arch replacement combined with antegrade stent grafting of the descending aorta represents a hybrid surgical approach for extensive thoracic aortic disease. This multicentre study evaluates the early results of this method in complex aortic dissection (AD).
Retrospective data acquisition was achieved by institution of an international registry. A hybrid stent graft with integrated vascular prosthesis for arch replacement (E-vita open®) was used. From January 2005 to March 2009, 106 patients (mean age 57; 77% male) with complex AD (55 acute, 51 chronic) were studied.
As many as 49/106 (46%) patients underwent emergency surgery. Stent-graft deployment and arch replacement (95 total, 11 subtotal) were performed under hypothermic circulatory arrest (HCA (8±6min) and selective antegrade cerebral perfusion (SACP) (74±23min). Stent-graft placement into the true lumen was successful in all but one case (99%). Ascending aortic replacement was performed in 91/106 (86%), aortic valve repair/replacement in 49/106 (46%), coronary artery bypass grafting (CABG) in 17/106 (16%) and mitral valve repair in 2/106 (2%). Cardiopulmonary bypass (CPB) and cardiac arrest times were 242±64 and 144±44min, respectively. In-hospital mortality was 12% (13/106; six acute, seven chronic AD) and new strokes observed in 5/106 (5%). The false lumen (FL) was evaluated in 96/106 (91%) patients postoperatively. At first follow-up computed tomography (CT)-examination, thoracic FL thrombosis was 93% (76 complete, 13 partial) and 58% (31 complete, 25 partial) in the thoraco-abdominal aorta.
By combining arch replacement with downstream stent grafting, one-stage repair of complex aortic dissection with almost unanimous thoracic FL thrombosis can be achieved at acceptable perioperative risk.
European journal of cardio-thoracic surgery: official journal of the European Association for Cardio-thoracic Surgery 01/2011; 39(1):87-93; discussion 93-4. · 2.40 Impact Factor
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ABSTRACT: In acute type A aortic dissection, the extension of repair to downstream aorta has been controversially discussed. We present the early results of a multicenter study using a hybrid stent graft prosthesis.
Between January 2005 and January 2010, the data from 191 patients after combined proximal aortic replacement and antegrade stent grafting were collected in the database of the International E-vita open Registry. Of the 191 patients, 68 underwent surgery for acute aortic dissection and were included in the present study. Hypothermic circulatory arrest and selective cerebral perfusion were routinely used. Computed aortic imaging was performed for false lumen evaluation during follow-up.
The in-hospital mortality rate was 13% (9/68). Along the stent graft, the rate of immediate complete false lumen thrombosis was 86% (51/59) and increased during follow-up (23 ± 17 months) to 94% (46/49). Distally, complete or partial false lumen thrombosis was initially observed in 61% (36/59) and in 82% (40/49) after follow-up. The 1- and 3-year actuarial survival rate was 82% and 74%, respectively.
Extended thoracic aortic repair of acute aortic dissection with a hybrid stent graft is feasible at acceptable early mortality and promotes false lumen thrombosis around the stent graft and below.
The Journal of thoracic and cardiovascular surgery 12/2010; 140(6 Suppl):S116-20; discussion S142-S146. · 3.41 Impact Factor
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ABSTRACT: Aortic dissection occurs in Turner syndrome with substantially higher frequency in comparison to the general population, and its prevention is one of the main aims of cardiologic follow-up. Findings of cystic medial necrosis in the aortic wall and a high prevalence of aortic dilation suggest that a form of aortopathy exists in Turner syndrome. However, little is known about natural development of aortic dilation prior to dissection. We present a 16-year-old girl with Turner syndrome with a bicuspid aortic valve, aortic stenosis, and dilation of ascending aorta, who underwent annual echocardiographic examinations from early childhood. Significant progressions of proximal aortic dilation occurred twice at the age of 10 and 15 years. Thereafter, another rapid progression was observed during 8 months and within 3 weeks preceding dissection. Acute aortic dissection was diagnosed while the girl was waiting for elective surgery. She was successfully operated. Frequent estimations of aortic diameter in Turner patients with abnormal findings may help to anticipate this life-threatening event. Additionally, we learned that rapid progression of aortic dilation should lead to immediate surgery to prevent more risky urgent intervention following the dissection.
European Journal of Pediatrics 10/2010; 169(10):1283-6. · 1.88 Impact Factor
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ABSTRACT: We present our initial experience in 10 patients operated on using a modified Ross operation. In our modification of the Ross operation the pulmonary autograft root was inserted in the Gelweave Valsalva graft to prevent dilatation of the neoaortic root. This type of graft was selected to match the discrepancy between diameters of the annulus and the sinotubular junction of the autograft and to preserve the characteristic configuration of the native root. In our group of 10 patients operated consecutively by this technique there was no change in the geometry of the neoaortic root in the follow-up 3-19 months (mean 14.6 months).
European journal of cardio-thoracic surgery: official journal of the European Association for Cardio-thoracic Surgery 05/2009; 36(1):195-7. · 2.40 Impact Factor
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ABSTRACT: Uncontrolled bleeding post root, ascending aorta and aortic arch operations can occur. Various techniques for getting bleeding under control have already been published in the literature. This life-threatening complication happens especially during acute aortic dissection and acute endocarditis operations, the former sometimes requiring complex mobilization of the aortic arch and the use of branched prosthetic grafts. In this report we describe the simple innovation of the technique which creates a relatively small space surrounding the aortic graft by its wrapping with use of the pericardium. Decompression of this space is maintained to a low-pressure system.
Interactive cardiovascular and thoracic surgery 12/2008; 8(2):230-1.
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ABSTRACT: Two patients with congenital atresia of the left coronary artery ostium underwent myocardial revascularization at the age of three years and three months, respectively. The patients were admitted to the hospital with a clinical history of sudden chest pain or short apnea not necessitating resuscitation. Non-invasive examinations and hemodynamic studies revealed dysfunction of the left ventricle and ostial atresia of the left coronary artery. Surgical revascularization-bypass grafts were performed using the left internal mammary artery and saphenous vein graft in the first case and the left internal mammary artery in the second child. Both patients survived surgery and good patency of the grafts was confirmed by coronary angiograms during hospital stay. These cases are interesting because of their rarity and diagnostic and therapeutic difficulties.
Interactive cardiovascular and thoracic surgery 09/2008; 7(6):1174-5.
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ABSTRACT: Leukocyte-mediated reperfusion injury to cardiac allograft in the perioperative period is most likely associated with the early and late mortality after heart transplantation (Htx). Our aim is to determine the efficacy and safety of using leukocyte-depleting filters in a cardiopulmonary bypass (CPB) and secondary blood cardioplegia (SBC) circuit in Htx.
A prospective, randomized trial was performed in 40 patients undergoing orthotopic Htx. These patients were divided into two groups, to be treated with either leukocyte-depleted (LD) reperfusion (n=20) in the LD group, or whole blood reperfusion (n=20) in the Control group. The SBC was used in both groups.
Intraoperatively, the LD group presented the reduced markers of reperfusion injury. The course of the creatine kinase MB (CK-MB) releases was significantly lower in the LD group (p<0.05). The LD hearts showed better spontaneous rhythm resumption (60% vs 10%; p<0.001), and lower need for isoprenaline (0.02+/-0.01 microg/(kg min) vs 0.03+/-0.02 microg/(kg min); p<0.05) and epicardial pacing (25% vs 60%; p<0.05) for weaning off CPB. Postoperatively, lower and shorter need for inotropic support (48+/-46, median=35 h vs 131+/-68, median=109 h; p<0.001), shorter temporary epicardial pacing (6+/-14, median=0 h vs 25+/-52, median=1 h; p<0.01), and lower 24-h chest drainage (551+/-274, median=500 ml vs 973+/-836, median=665 ml; p<0.05) in the LD group contributed to the shorter mechanical ventilation time (8+/-3, median=7.5 h vs 14+/-12, median=8.5 h; p<0.05) and the shorter stay at an intensive care unit (ICU) (70+/-24 h vs 116+/-73 h; p<0.05). The 30-day mortality was zero in both groups.
The use of leukocyte depleting filters in heart transplantation is an effective, easy and safe method of myocardial protection, reducing significant myocardial reperfusion injury and improving posttransplant graft functional recovery.
European Journal of Cardio-Thoracic Surgery 10/2006; 30(4):621-7. · 2.55 Impact Factor
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ABSTRACT: The following case report describes an unusual example of aortic valve damage caused by iatrogenic stent-graft rupture (disconnection of the proximal uncovered part of a stent-graft) during delivery of a proximal extension, resulting in the displacement of a stent-graft wire to the aortic root. The wire was extracted under cardiopulmonary bypass, using circulatory arrest, and the damaged aortic valve replaced by a mechanical valve.
European Journal of Cardio-Thoracic Surgery 08/2006; 30(1):196-8. · 2.55 Impact Factor
