[Show abstract][Hide abstract] ABSTRACT: Background: Which graft material is the optimal graft material for the treatment of infected aortic aneurysms and aortic graft infections is still a matter of controversy. Orthotopic aortic reconstruction with intraoperatively prepared xenopericardial roll grafts without omentopexy was performed as the "initial" operation to treat aortic infection or as a "rescue" operation to treat graft infection. Mid-term outcomes were evaluated. Methods: Between 2009 and 2013, orthotopic xenopericardial roll graft replacement was performed to treat eight patients (male/female: 6/2; mean age: 69.5 [55-80] yr). Graft material: equine/bovine pericardium: 2/6; type of operation: initial 4/rescue 4; omentopexy 0. Additional operation: esophagectomy 2. Mean follow-up period: 2.6 ± 1.6 (1.1-5.1) years. Results: Replacement: ascending 3, arch 1 (reconstruction of neck vessels with small xenopericardial roll grafts), descending 3, and thoracoabdominal 1. Pathogens: MRSA 2, MSSA 1, Candida 1, E. coli 1, oral bacillus 1, and culture negative 2. Postoperative local recurrence of infection: 0. Graft-related complications: stenosis 0, calcification 0, non-infectious pseudoaneurysm of anastomosis 2 (surgical repair: 1/TEVAR 1). In-hospital mortality: 2 (MOF: initial 1/rescue 1); Survival rate exclusive of in-hospital deaths (~3 y): 100 %, but one patient died of lung cancer (3.6 yr). Conclusions: Because xenopericardial roll grafts are not composed of synthetic material, the replacement procedure is simpler and less invasive than the standard procedure. Based on the favorable results obtained, this procedure may have the possibility to serve as an option for the treatment of aortic infections and aortic graft infections not only as a "rescue" treatment but as an "initial" treatment as well.
Full-text · Article · Dec 2015 · Journal of Cardiothoracic Surgery
[Show abstract][Hide abstract] ABSTRACT: Retropharyngeal hematoma is a rare form of pharyngeal pathology and can present as acute airway obstruction. Among the many causes of retropharyngeal hematoma, thoracic aortic rupture is extremely rare.Methods and results: A 78-year-old female with airway obstruction by a retropharyngeal hematoma secondary to thoracic aortic aneurysm rupture was successfully treated by total aortic arch replacement and open stent-graft insertion.
Rupture of the thoracic aorta should be considered as a rare but important cause of retropharyngeal hematoma and airway obstruction.
Full-text · Article · Dec 2013 · Journal of Cardiothoracic Surgery
[Show abstract][Hide abstract] ABSTRACT: The standard procedure for treating infected aortic aneurysms is to resect the infected aorta, debridement of the surrounding tissue, in situ graft replacement, and omentopexy. However, the question of which graft material is optimal is still a matter of controversy. We recently treated a patient with an infected ascending aortic aneurysm. Because of previous abdominal surgery, the omentum was unavailable. The ascending aorta was replaced in situ with equine pericardial roll grafts. The patient is alive and well 29 months after the operation.
Full-text · Article · Jun 2012 · Journal of Cardiothoracic Surgery
[Show abstract][Hide abstract] ABSTRACT: Resection of the infected aorta, debridement of the surrounding tissue, in situ graft replacement, and omentopexy is the standard procedure for treating infected aortic aneurysms, but the question of which graft material is optimal is still a matter of controversy. We recently treated a patient with an infected thoracic aortic aneurysm. The aneurysm was located in the proximal aortic arch. Because the patients had previously undergone abdominal surgery, the aortic arch were replaced in situ with a branched equine pericardial roll grafts. The patient is alive and well 23 months after the operation.
Full-text · Article · May 2012 · Journal of Cardiothoracic Surgery
[Show abstract][Hide abstract] ABSTRACT: OBJECTIVE: During aortic surgery under hypothermic circulatory arrest, retrograde cerebral perfusion (RCP) is commonly used as a cerebroprotective method to extend the duration of circulatory arrest safely. Kitahori and colleagues described a novel protocol of RCP using intermittent pressure augmented (IPA)-RCP in 2005. The aim of the present study was to determine the clinical effectiveness of this novel protocol. METHODS: A total of 20 consecutive patients undergoing total replacement of the aortic arch were assigned to a conventional RCP (n = 10) or an IPA-RCP group (n = 10). Cerebral perfusion was provided at a continuous venous pressure of 25 mm Hg in the conventional RCP, and venous pressure was intermittently provided at 20 mm Hg for 120 seconds and at 45 mm Hg for 30 seconds in the IPA-RCP group. The clinical outcomes were compared between the 2 groups. Regional cerebral oxygen saturation (rSO(2)) was measured using near infrared spectroscopy every 10 minutes from the beginning of RCP initiation. To represent the brain oxygen consumption, the decline ratio of rSO(2) was calculated. RESULTS: There was no surgical mortality or major neurologic complications in either group. The interval from the end of surgery to full wakefulness was significantly shorter in the IPA-RCP group (85 ± 64 minutes) than in the conventional RCP group (310 ± 282 minutes; P < .05). Although the initial rSO(2) value did not show significant difference in both groups, the rSO(2) with IPA-RCP was greater than that with conventional RCP from 10 to 70 minutes (P < .05). The decline ratio of rSO(2) was lower in the IPA-RCP group than in the RCP perfusion group at all points (P < .05). CONCLUSIONS: IPA-RCP might provide more homogenous cerebral perfusion and a more effective oxygen supply to the brain with better clinical results than conventional RCP.
No preview · Article · Apr 2012 · The Journal of thoracic and cardiovascular surgery
[Show abstract][Hide abstract] ABSTRACT: To reduce the risk of stroke during open surgery for the treatment of descending thoracic or thoracoabdominal aortic diseases, we attempted to insert a proximal elephant trunk to stabilize the atherosclerosis at the site of the proximal anastomosis. Although the patients had dense atherosclerotic lesions, they recovered well without neurologic complications. This technique is simple and may be effective for preventing stroke when replacing the descending thoracic or thoracoabdominal aorta through a left thoracotomy.
No preview · Article · Oct 2011 · Heart Surgery Forum