{"title":"Editorial: looking for the best treatment of bicuspid aortic valves.","authors":"Ruggero De Paulis","doi":"10.1093/icvts/ivac253","DOIUrl":"10.1093/icvts/ivac253","url":null,"abstract":"","PeriodicalId":13621,"journal":{"name":"Interactive cardiovascular and thoracic surgery","volume":"35 5","pages":""},"PeriodicalIF":1.6,"publicationDate":"2022-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9583848/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33504489","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Thierry Carrel, Juri Sromicki, Martin Schmiady, Raed Aser, Ahmed Ouda, Paul Robert Vogt
Aortic wrapping is a controversial repair in patients presenting with acute type A aortic dissection or intramural haematoma, but this method may be a potential alternative to medical treatment or conventional repair in patients aged >80 years and in those presenting with prohibitive co-morbidities such as stroke, circulatory collapse, full oral anticoagulation with the last generation drugs. We report on 5 high-risk and/or patients over 80 years who received external aortic wrapping with or without cardiopulmonary bypass during the last 18 months. All survived the procedure and could be extubated early postoperatively. No patient remained on the intensive care longer than 2 days and all were discharged without additional complications. Postoperative radiological control was acceptable and no patient had any new aortic event up to 18 months postoperatively.
{"title":"Aortic wrapping is life-saving in high-risk acute aortic dissection and intramural haematoma.","authors":"Thierry Carrel, Juri Sromicki, Martin Schmiady, Raed Aser, Ahmed Ouda, Paul Robert Vogt","doi":"10.1093/icvts/ivac254","DOIUrl":"https://doi.org/10.1093/icvts/ivac254","url":null,"abstract":"<p><p>Aortic wrapping is a controversial repair in patients presenting with acute type A aortic dissection or intramural haematoma, but this method may be a potential alternative to medical treatment or conventional repair in patients aged >80 years and in those presenting with prohibitive co-morbidities such as stroke, circulatory collapse, full oral anticoagulation with the last generation drugs. We report on 5 high-risk and/or patients over 80 years who received external aortic wrapping with or without cardiopulmonary bypass during the last 18 months. All survived the procedure and could be extubated early postoperatively. No patient remained on the intensive care longer than 2 days and all were discharged without additional complications. Postoperative radiological control was acceptable and no patient had any new aortic event up to 18 months postoperatively.</p>","PeriodicalId":13621,"journal":{"name":"Interactive cardiovascular and thoracic surgery","volume":"35 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9580516/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33492579","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
We read with interest Dr. David’s commentary [1] about our recently published paper entitled ‘Transapical beating heart mitral valve repair versus conventional surgery: a propensity-matched study’ [2]. We would like to clarify some aspects that in our opinion are crucial. We are afraid that Dr. David missed one of the key points of our study that, despite its intrinsic limitations that limit the generalizability of our results, shows that in patients with favourable anatomy (prolapse of the P2 segment), there seem to be no differences in terms of freedom from recurrent mitral regurgitation and of freedom from reoperation. Therefore, despite the worse outcomes in the overall population (this is what Dr. David refers to in his commentary), in well-selected patients, transapical beating heart mitral valve repair with neochords implantation (NC) provides similar outcomes to conventional surgery up to 5 years. We respectfully disagree with Dr. David when he states that NC should be selected in inoperable patients only after excluding the feasibility of a transcatheter Mitraclip (Abbott laboratories, Chicago, IL, USA). There are no data supporting this statement since there are no studies comparing NC and Mitraclip. However, in a recently published article about 100 NC patients with 5-year follow-up (including technical and patient-selection learning curves), we found an incidence of reoperation and of severe mitral regurgitation (MR), in patients with favourable anatomy, of 14.7% and 14.7%, respectively [3]. On the other hand, in the EVEREST-II study (therefore in highly selected patients), rates of reoperation and 3+ or 4+ MR at 5 years in the percutaneous repair group were 43% and 19%, respectively [4]. Noteworthy, 3+ and 4+ MR do not include moderate MR but only moderate– severe and severe MR and also, the EVEREST-II included both degenerative and functional MR. Another important aspect to consider is that so far over 100,000 patients over a 17-year period have been treated with Mitraclip, demonstrating the perseverance of our interventional cardiology colleagues (and some surgeons) that, despite the poor initial outcomes of this procedure, have worked to transform a suboptimal conventional surgical procedure (edge to edge with no annular stabilization) into a successful microinvasive alternative, optimizing technology, technique and patient selection [5, 6]. Meanwhile, NC procedures have been performed only in 1000 patients and we are still using the first-generation device. There are still many aspects that may be improved in order to achieve better results. We certainly agree that conventional surgery so far provides unsurpassed optimal outcomes for degenerative MR, especially if performed in high-volume centres and by highly committed surgeons or, even better, by world-recognized Masters as Dr. David. His results are impressive but the real world is a different thing and such numbers are difficult to replicate. The truth is that not all tennis
{"title":"A word to the wise ….","authors":"Augusto D'Onofrio, Gino Gerosa","doi":"10.1093/icvts/ivac252","DOIUrl":"https://doi.org/10.1093/icvts/ivac252","url":null,"abstract":"We read with interest Dr. David’s commentary [1] about our recently published paper entitled ‘Transapical beating heart mitral valve repair versus conventional surgery: a propensity-matched study’ [2]. We would like to clarify some aspects that in our opinion are crucial. We are afraid that Dr. David missed one of the key points of our study that, despite its intrinsic limitations that limit the generalizability of our results, shows that in patients with favourable anatomy (prolapse of the P2 segment), there seem to be no differences in terms of freedom from recurrent mitral regurgitation and of freedom from reoperation. Therefore, despite the worse outcomes in the overall population (this is what Dr. David refers to in his commentary), in well-selected patients, transapical beating heart mitral valve repair with neochords implantation (NC) provides similar outcomes to conventional surgery up to 5 years. We respectfully disagree with Dr. David when he states that NC should be selected in inoperable patients only after excluding the feasibility of a transcatheter Mitraclip (Abbott laboratories, Chicago, IL, USA). There are no data supporting this statement since there are no studies comparing NC and Mitraclip. However, in a recently published article about 100 NC patients with 5-year follow-up (including technical and patient-selection learning curves), we found an incidence of reoperation and of severe mitral regurgitation (MR), in patients with favourable anatomy, of 14.7% and 14.7%, respectively [3]. On the other hand, in the EVEREST-II study (therefore in highly selected patients), rates of reoperation and 3+ or 4+ MR at 5 years in the percutaneous repair group were 43% and 19%, respectively [4]. Noteworthy, 3+ and 4+ MR do not include moderate MR but only moderate– severe and severe MR and also, the EVEREST-II included both degenerative and functional MR. Another important aspect to consider is that so far over 100,000 patients over a 17-year period have been treated with Mitraclip, demonstrating the perseverance of our interventional cardiology colleagues (and some surgeons) that, despite the poor initial outcomes of this procedure, have worked to transform a suboptimal conventional surgical procedure (edge to edge with no annular stabilization) into a successful microinvasive alternative, optimizing technology, technique and patient selection [5, 6]. Meanwhile, NC procedures have been performed only in 1000 patients and we are still using the first-generation device. There are still many aspects that may be improved in order to achieve better results. We certainly agree that conventional surgery so far provides unsurpassed optimal outcomes for degenerative MR, especially if performed in high-volume centres and by highly committed surgeons or, even better, by world-recognized Masters as Dr. David. His results are impressive but the real world is a different thing and such numbers are difficult to replicate. The truth is that not all tennis ","PeriodicalId":13621,"journal":{"name":"Interactive cardiovascular and thoracic surgery","volume":"35 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9585944/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33492580","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Paige Newell, Richard Tartarini, Sameer Hirji, Morgan Harloff, Siobhan McGurk, Olena Cherkasky, Tsuyoshi Kaneko
Objectives: Mitral valve repair (MVP) is the gold standard treatment for degenerative mitral regurgitation. With the expansion of transcatheter technologies, this study compares the outcome of MVP in low-risk and non-low-risk patients to serve as a benchmark.
Methods: This retrospective, single-institution study examined all patients who underwent MVP for primary mitral regurgitation from 2005 to 2018. Patients were stratified into 2 risk categories: low-risk [Society of Thoracic Surgeons (STS) Predicted Risk of Mortality (STS-PROM) ≤2%] and non-low risk (STS-PROM > 2% or age > 75), with a subgroup of very low risk (STS-PROM ≤1%, age <75).
Results: A total of 1207 patients were included, and 1053 patients were classified as low risk and 154 as non-low risk. The non-low-risk group was significantly older, more likely to be female, and had a higher comorbidity burden than the low-risk group (all P < 0.01). For the low-risk group, the observed-to-expected (O:E) STS mortality ratio was 0.4 and the composite morbidity and mortality ratio was 0.6, whereas for the non-low risk, the O:E mortality was 1.5 and the composite morbidity and mortality was 0.9. When the subgroup of very low-risk group was assessed, the mortality O:E ratio was 0.
Conclusions: The observed composite morbidity and mortality of patients undergoing MVP were persistently lower in low-risk patients, mainly driven by the very low-risk group. The excellent outcome of MVP in low-risk patients should be validated on a national level to determine how transcatheter technologies can be utilized in these patients.
{"title":"Observed versus expected morbidity and mortality in patients undergoing mitral valve repair.","authors":"Paige Newell, Richard Tartarini, Sameer Hirji, Morgan Harloff, Siobhan McGurk, Olena Cherkasky, Tsuyoshi Kaneko","doi":"10.1093/icvts/ivac241","DOIUrl":"https://doi.org/10.1093/icvts/ivac241","url":null,"abstract":"<p><strong>Objectives: </strong>Mitral valve repair (MVP) is the gold standard treatment for degenerative mitral regurgitation. With the expansion of transcatheter technologies, this study compares the outcome of MVP in low-risk and non-low-risk patients to serve as a benchmark.</p><p><strong>Methods: </strong>This retrospective, single-institution study examined all patients who underwent MVP for primary mitral regurgitation from 2005 to 2018. Patients were stratified into 2 risk categories: low-risk [Society of Thoracic Surgeons (STS) Predicted Risk of Mortality (STS-PROM) ≤2%] and non-low risk (STS-PROM > 2% or age > 75), with a subgroup of very low risk (STS-PROM ≤1%, age <75).</p><p><strong>Results: </strong>A total of 1207 patients were included, and 1053 patients were classified as low risk and 154 as non-low risk. The non-low-risk group was significantly older, more likely to be female, and had a higher comorbidity burden than the low-risk group (all P < 0.01). For the low-risk group, the observed-to-expected (O:E) STS mortality ratio was 0.4 and the composite morbidity and mortality ratio was 0.6, whereas for the non-low risk, the O:E mortality was 1.5 and the composite morbidity and mortality was 0.9. When the subgroup of very low-risk group was assessed, the mortality O:E ratio was 0.</p><p><strong>Conclusions: </strong>The observed composite morbidity and mortality of patients undergoing MVP were persistently lower in low-risk patients, mainly driven by the very low-risk group. The excellent outcome of MVP in low-risk patients should be validated on a national level to determine how transcatheter technologies can be utilized in these patients.</p>","PeriodicalId":13621,"journal":{"name":"Interactive cardiovascular and thoracic surgery","volume":"35 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9553224/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33492735","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ilker Iskender, Ylenia Pecoraro, Paula Moreno Casado, Bartosz Kubisa, Marco Schiavon, Eleonora Faccioli, Jonas Ehrsam, Francesco Damarco, Mario Nosotti, Ilhan Inci, Federico Venuta, Dirk Van Raemdonck, Laurens J Ceulemans
Objectives: History of anatomical lung resection complicates lung transplantation (LTx). Our aim was to identify indications, intraoperative approach and outcome in these challenging cases in a retrospective multicentre cohort analysis.
Methods: Members of the ESTS Lung Transplantation Working Group were invited to submit data on patients undergoing LTx after a previous anatomical native lung resection between January 2005 and July 2020. The primary end point was overall survival (Kaplan-Meier estimation).
Results: Out of 2690 patients at 7 European centres, 26 (1%) patients (14 males; median age 33 years) underwent LTx after a previous anatomical lung resection. The median time from previous lung resection to LTx was 12 years. The most common indications for lung resection were infections (n = 17), emphysema (n = 5), lung tumour (n = 2) and others (n = 2). Bronchiectasis (cystic fibrosis or non-cystic fibrosis related) was the main indication for LTx (n = 21), followed by COPD (n = 5). Two patients with a previous pneumonectomy underwent contralateral single LTx and 1 patient with a previous lobectomy had ipsilateral single LTx. The remaining 23 patients underwent bilateral LTx. Clamshell incision was performed in 12 (46%) patients. Moreover, LTx was possible without extracorporeal life support in 13 (50%) patients. 90-Day mortality was 8% (n = 2) and the median survival was 8.7 years.
Conclusions: The history of anatomical lung resection is rare in LTx candidates. The majority of patients are young and diagnosed with bronchiectasis. Although the numbers were limited, survival after LTx in patients with previous anatomical lung resection, including pneumonectomy, is comparable to reported conventional LTx for bronchiectasis.
{"title":"Lung transplantation in patients with a history of anatomical native lung resection.","authors":"Ilker Iskender, Ylenia Pecoraro, Paula Moreno Casado, Bartosz Kubisa, Marco Schiavon, Eleonora Faccioli, Jonas Ehrsam, Francesco Damarco, Mario Nosotti, Ilhan Inci, Federico Venuta, Dirk Van Raemdonck, Laurens J Ceulemans","doi":"10.1093/icvts/ivac256","DOIUrl":"https://doi.org/10.1093/icvts/ivac256","url":null,"abstract":"<p><strong>Objectives: </strong>History of anatomical lung resection complicates lung transplantation (LTx). Our aim was to identify indications, intraoperative approach and outcome in these challenging cases in a retrospective multicentre cohort analysis.</p><p><strong>Methods: </strong>Members of the ESTS Lung Transplantation Working Group were invited to submit data on patients undergoing LTx after a previous anatomical native lung resection between January 2005 and July 2020. The primary end point was overall survival (Kaplan-Meier estimation).</p><p><strong>Results: </strong>Out of 2690 patients at 7 European centres, 26 (1%) patients (14 males; median age 33 years) underwent LTx after a previous anatomical lung resection. The median time from previous lung resection to LTx was 12 years. The most common indications for lung resection were infections (n = 17), emphysema (n = 5), lung tumour (n = 2) and others (n = 2). Bronchiectasis (cystic fibrosis or non-cystic fibrosis related) was the main indication for LTx (n = 21), followed by COPD (n = 5). Two patients with a previous pneumonectomy underwent contralateral single LTx and 1 patient with a previous lobectomy had ipsilateral single LTx. The remaining 23 patients underwent bilateral LTx. Clamshell incision was performed in 12 (46%) patients. Moreover, LTx was possible without extracorporeal life support in 13 (50%) patients. 90-Day mortality was 8% (n = 2) and the median survival was 8.7 years.</p><p><strong>Conclusions: </strong>The history of anatomical lung resection is rare in LTx candidates. The majority of patients are young and diagnosed with bronchiectasis. Although the numbers were limited, survival after LTx in patients with previous anatomical lung resection, including pneumonectomy, is comparable to reported conventional LTx for bronchiectasis.</p>","PeriodicalId":13621,"journal":{"name":"Interactive cardiovascular and thoracic surgery","volume":"35 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/06/24/ivac256.PMC9583932.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33500609","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Dong Zhang, Gui-Jun Zhu, Xiang-Yang Wei, Bin Li, Jie Hu, Wei-Guo Ma, Xing-Peng Chen
As an approach to coronary artery ostial injury in type A aortic dissection and infective endocarditis, we describe a technique of coronary ostial repair using a ring-shaped bovine pericardial patch. The inner and outer rims of the patch were sutured to the involved coronary ostium (to close the ostial tear) and to the aortic wall (to cover the sinus), respectively. Four patients were successfully managed and computed tomographic coronary arteriogram at follow-up showed patent coronary ostia and arteries. The favourable preliminary results imply that this technique is a simple, safe and effective approach to coronary ostial repair in patients with type A aortic dissection or infective endocarditis.
{"title":"Repair of coronary artery ostium with a ring-shaped bovine pericardial patch.","authors":"Dong Zhang, Gui-Jun Zhu, Xiang-Yang Wei, Bin Li, Jie Hu, Wei-Guo Ma, Xing-Peng Chen","doi":"10.1093/icvts/ivac251","DOIUrl":"https://doi.org/10.1093/icvts/ivac251","url":null,"abstract":"<p><p>As an approach to coronary artery ostial injury in type A aortic dissection and infective endocarditis, we describe a technique of coronary ostial repair using a ring-shaped bovine pericardial patch. The inner and outer rims of the patch were sutured to the involved coronary ostium (to close the ostial tear) and to the aortic wall (to cover the sinus), respectively. Four patients were successfully managed and computed tomographic coronary arteriogram at follow-up showed patent coronary ostia and arteries. The favourable preliminary results imply that this technique is a simple, safe and effective approach to coronary ostial repair in patients with type A aortic dissection or infective endocarditis.</p>","PeriodicalId":13621,"journal":{"name":"Interactive cardiovascular and thoracic surgery","volume":"35 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9583934/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33503606","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Anatol Prinzing, Johannes Böhm, Konstantinos Sideris, Keti Vitanova, Rüdiger Lange, Markus Krane
Objectives: Calcified or fibrotic cusps in patients with bicuspid aortic valves and aortic regurgitation complicate successful aortic valve (AV)-repair. Aortic valve neocuspidization (AVNeo) with autologous pericardium offers an alternative treatment to prosthetic valve replacement. We compared patients with regurgitant bicuspid valves undergoing AV-repair or AVNeo.
Methods: We retrospectively analysed patients with regurgitant bicuspid valves undergoing AV-repair or AVNeo. We focused on residual regurgitation, pressure gradients and effective orifice area, determined preoperatively and at discharge.
Results: AV-repair was performed in 61 patients (mean age: 43.2 ± 11.3 years) and AVNeo in 22 (45.7 ± 14.1). Prior to the operation patients of the AV-repair group showed severe regurgitation in 38 cases (62.3%) and moderate in 23 (37.6%); in the AVNeo group, all patients exhibited severe regurgitation. Postoperatively, 57 patients (93.4%) patients had no or mild regurgitation after AV-repair and 21 (95.4%) after AVNeo. In AVNeo-patients, peak (10.6 ± 3.1 mmHg vs 22.7 ± 11 mmHg, P< 0.001) and mean pressure gradients (5.9 ± 2 mmHg vs 13.8 ± 7.3 mmHg, P < 0.001) were significantly lower and the orifice area significantly larger (2.9 ± 0.8 cm2 vs 1.9 ± 0.7 cm2, P < 0.001) compared to repair.
Conclusions: Compared to AV-repair, patients AVNeo showed lower mean pressure gradients and larger orifice areas at discharge. The functional result was not different.
{"title":"AVNeo improves early haemodynamics in regurgitant bicuspid aortic valves compared to aortic valve repair.","authors":"Anatol Prinzing, Johannes Böhm, Konstantinos Sideris, Keti Vitanova, Rüdiger Lange, Markus Krane","doi":"10.1093/icvts/ivac226","DOIUrl":"10.1093/icvts/ivac226","url":null,"abstract":"<p><strong>Objectives: </strong>Calcified or fibrotic cusps in patients with bicuspid aortic valves and aortic regurgitation complicate successful aortic valve (AV)-repair. Aortic valve neocuspidization (AVNeo) with autologous pericardium offers an alternative treatment to prosthetic valve replacement. We compared patients with regurgitant bicuspid valves undergoing AV-repair or AVNeo.</p><p><strong>Methods: </strong>We retrospectively analysed patients with regurgitant bicuspid valves undergoing AV-repair or AVNeo. We focused on residual regurgitation, pressure gradients and effective orifice area, determined preoperatively and at discharge.</p><p><strong>Results: </strong>AV-repair was performed in 61 patients (mean age: 43.2 ± 11.3 years) and AVNeo in 22 (45.7 ± 14.1). Prior to the operation patients of the AV-repair group showed severe regurgitation in 38 cases (62.3%) and moderate in 23 (37.6%); in the AVNeo group, all patients exhibited severe regurgitation. Postoperatively, 57 patients (93.4%) patients had no or mild regurgitation after AV-repair and 21 (95.4%) after AVNeo. In AVNeo-patients, peak (10.6 ± 3.1 mmHg vs 22.7 ± 11 mmHg, P< 0.001) and mean pressure gradients (5.9 ± 2 mmHg vs 13.8 ± 7.3 mmHg, P < 0.001) were significantly lower and the orifice area significantly larger (2.9 ± 0.8 cm2 vs 1.9 ± 0.7 cm2, P < 0.001) compared to repair.</p><p><strong>Conclusions: </strong>Compared to AV-repair, patients AVNeo showed lower mean pressure gradients and larger orifice areas at discharge. The functional result was not different.</p>","PeriodicalId":13621,"journal":{"name":"Interactive cardiovascular and thoracic surgery","volume":"35 5","pages":""},"PeriodicalIF":1.6,"publicationDate":"2022-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/ed/ec/ivac226.PMC9615556.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33439789","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Isaac Wamala, Mir Timo Zadegh Nazari-Shafti, Roland Heck, Adam Penkalla, Matteo Montagner, Steven J Staffa, Volkmar Falk, Semih Buz
Objectives: The goal of this study was to describe the factors affecting mid and late aortic remodelling following thoracic endovascular aortic repair with the PETTICOAT (Provisional Extension To Induce Complete Attachment) technique among patients with complicated acute or subacute type B aortic dissection.
Methods: A retrospective single-centre study that evaluates clinical and morphological outcomes among 65 consecutive patients. The area and diameter of the true and false lumen, overall aortic diameter and false lumen perfusion were evaluated.
Results: Concomitant direct visceral artery stenting was successfully conducted in 32 (49%) patients. There was one (1.5%) postoperative stroke; three (4.6%) patients developed spinal cord ischaemia; two (3%) patients suffered retrograde type A dissection; and two (3%) patients had mesenteric ischaemia, despite successful reperfusion, that required a bowel resection. Median postoperative follow-up was 63.1 (interquartile range, 32.1- 91.8) months. The probability of survival was 96.9% [95% confidence interval (CI) 88.3%-99.2%] at 30 days, 93.9% (95% CI 84.4%-97.6%) at 1 year, 78.0 (95% CI 64.2%-87.0%) at 5 years and 72.8% (95% CI at 57.9%-83.2%) at 10 years postoperatively. There was a statistically significant postoperative increase in true-lumen area, diameter and true-lumen index in all five aortic levels measured. Complete false lumen (FL) thrombosis at the coeliac trunk, renal arteries and aortic bifurcation levels was observed in 47%, 15% and 24% of patients at midterm (6-15 months) and in 29%, 21% and 29% on late (later than 21 months) computed tomography angiograms (CTA). Persistent false lumen (FL) perfusion at the coeliac level on midterm CTA was associated with a larger extent of late aortic growth (P = 0.042) and was, in the majority of cases, caused by iliac re-entries either alone (28.57) or in combination with visceral and lumbar (28.57%) or distal aortic (10.71%) re-entries. A larger abdominal aortic diameter at midterm was associated with an increased probability of distal aortic reinterventions (hazard ratio 7.26, 95% CI 2.41-21.9, P < 0.001).
Conclusions: Persistent FL perfusion of the distal aorta at midterm following TEVAR with the PETTICOAT technique among patients with acute and subacute type B dissection is caused mainly by iliac, visceral, lumber and distal aorta re-entries. Patients with persistent FL perfusion have an increased risk of aortic aneurysmal growth at late follow-up.
目的:本研究的目的是描述在并发急性或亚急性B型主动脉夹层患者中,应用PETTICOAT(临时延伸诱导完全附着)技术进行胸腔血管内主动脉修复术后中晚期主动脉重构的影响因素。方法:回顾性单中心研究,评估65例连续患者的临床和形态学结果。评估真、假腔面积、直径、主动脉总直径及假腔灌注情况。结果:32例(49%)患者成功行直接内脏动脉支架植入术。术后卒中1例(1.5%);3例(4.6%)患者发生脊髓缺血;2例(3%)患者发生逆行A型夹层;2例(3%)患者有肠系膜缺血,尽管再灌注成功,但需要肠切除术。术后中位随访时间为63.1个月(四分位数间距为32.1 ~ 91.8个月)。术后30天生存率为96.9%[95%可信区间(CI) 88.3% ~ 99.2%], 1年生存率为93.9% (95% CI 84.4% ~ 97.6%), 5年生存率为78.0 (95% CI 64.2% ~ 87.0%), 10年生存率为72.8% (95% CI 57.9% ~ 83.2%)。术后真腔面积、直径和真腔指数均有统计学意义的增加。在中期(6-15个月),47%、15%和24%的患者在腹腔干、肾动脉和主动脉分叉水平观察到完全假腔(FL)血栓形成,在晚期(21个月以上)ct血管造影(CTA)中观察到29%、21%和29%的患者出现完全性假腔血栓形成。中期CTA显示腹腔水平持续假腔(FL)灌注与较大程度的晚期主动脉生长相关(P = 0.042),并且在大多数情况下,由髂再入引起,单独(28.57%)或合并内脏和腰椎(28.57%)或远端主动脉(10.71%)再入。中期腹主动脉直径增大与主动脉远端再介入的可能性增加相关(风险比7.26,95% CI 2.41-21.9, P)。结论:急性和亚急性B型夹层患者采用PETTICOAT技术进行TEVAR后中期远端主动脉持续FL灌注主要是由髂、内脏、腰椎和远端主动脉再进入引起的。持续FL灌注的患者在后期随访时动脉瘤生长的风险增加。
{"title":"Aortic remodelling and late outcomes following thoracic endovascular repair with a bare-metal stent distal extension among patients with complicated type-B aortic dissection.","authors":"Isaac Wamala, Mir Timo Zadegh Nazari-Shafti, Roland Heck, Adam Penkalla, Matteo Montagner, Steven J Staffa, Volkmar Falk, Semih Buz","doi":"10.1093/icvts/ivac244","DOIUrl":"https://doi.org/10.1093/icvts/ivac244","url":null,"abstract":"<p><strong>Objectives: </strong>The goal of this study was to describe the factors affecting mid and late aortic remodelling following thoracic endovascular aortic repair with the PETTICOAT (Provisional Extension To Induce Complete Attachment) technique among patients with complicated acute or subacute type B aortic dissection.</p><p><strong>Methods: </strong>A retrospective single-centre study that evaluates clinical and morphological outcomes among 65 consecutive patients. The area and diameter of the true and false lumen, overall aortic diameter and false lumen perfusion were evaluated.</p><p><strong>Results: </strong>Concomitant direct visceral artery stenting was successfully conducted in 32 (49%) patients. There was one (1.5%) postoperative stroke; three (4.6%) patients developed spinal cord ischaemia; two (3%) patients suffered retrograde type A dissection; and two (3%) patients had mesenteric ischaemia, despite successful reperfusion, that required a bowel resection. Median postoperative follow-up was 63.1 (interquartile range, 32.1- 91.8) months. The probability of survival was 96.9% [95% confidence interval (CI) 88.3%-99.2%] at 30 days, 93.9% (95% CI 84.4%-97.6%) at 1 year, 78.0 (95% CI 64.2%-87.0%) at 5 years and 72.8% (95% CI at 57.9%-83.2%) at 10 years postoperatively. There was a statistically significant postoperative increase in true-lumen area, diameter and true-lumen index in all five aortic levels measured. Complete false lumen (FL) thrombosis at the coeliac trunk, renal arteries and aortic bifurcation levels was observed in 47%, 15% and 24% of patients at midterm (6-15 months) and in 29%, 21% and 29% on late (later than 21 months) computed tomography angiograms (CTA). Persistent false lumen (FL) perfusion at the coeliac level on midterm CTA was associated with a larger extent of late aortic growth (P = 0.042) and was, in the majority of cases, caused by iliac re-entries either alone (28.57) or in combination with visceral and lumbar (28.57%) or distal aortic (10.71%) re-entries. A larger abdominal aortic diameter at midterm was associated with an increased probability of distal aortic reinterventions (hazard ratio 7.26, 95% CI 2.41-21.9, P < 0.001).</p><p><strong>Conclusions: </strong>Persistent FL perfusion of the distal aorta at midterm following TEVAR with the PETTICOAT technique among patients with acute and subacute type B dissection is caused mainly by iliac, visceral, lumber and distal aorta re-entries. Patients with persistent FL perfusion have an increased risk of aortic aneurysmal growth at late follow-up.</p>","PeriodicalId":13621,"journal":{"name":"Interactive cardiovascular and thoracic surgery","volume":"35 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9553225/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33478734","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Xavier Ruyra, Eduard Permanyer, Marina Huguet, Giuliana Maldonado
This study sought to evaluate the impact of virtual reality (VR) tools in procedural planning of transcatheter aortic valve replacement. A prospective study involving 11 patients referred for transcatheter aortic valve replacement was conducted. A multidetector computed tomography was used to acquire and segment the anatomy of the access route and landing zone. From the information obtained with the multidetector computed tomography in DICOM format, we built a virtual platform (VisuaMed, Techer Team, Valencia, Spain) that contains all the clinical information of the patients and a virtualized model of their anatomy. Wearing VR devices, the professional was able to 'walk inside' the anatomy in an interactive and immersive way. Decisions after the evaluation of routine clinical images were compared with those after experience with VR models and intraprocedural findings.
{"title":"Use of virtual reality for procedural planning of transcatheter aortic valve replacement.","authors":"Xavier Ruyra, Eduard Permanyer, Marina Huguet, Giuliana Maldonado","doi":"10.1093/icvts/ivac248","DOIUrl":"https://doi.org/10.1093/icvts/ivac248","url":null,"abstract":"<p><p>This study sought to evaluate the impact of virtual reality (VR) tools in procedural planning of transcatheter aortic valve replacement. A prospective study involving 11 patients referred for transcatheter aortic valve replacement was conducted. A multidetector computed tomography was used to acquire and segment the anatomy of the access route and landing zone. From the information obtained with the multidetector computed tomography in DICOM format, we built a virtual platform (VisuaMed, Techer Team, Valencia, Spain) that contains all the clinical information of the patients and a virtualized model of their anatomy. Wearing VR devices, the professional was able to 'walk inside' the anatomy in an interactive and immersive way. Decisions after the evaluation of routine clinical images were compared with those after experience with VR models and intraprocedural findings.</p>","PeriodicalId":13621,"journal":{"name":"Interactive cardiovascular and thoracic surgery","volume":"35 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/f8/49/ivac248.PMC9639804.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33493854","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Emma van der Weijde, Michiel Kuijpers, Wobbe Bouma, Massimo A Mariani, Theo J Klinkenberg
Objectives: Our goal was to investigate the safety, feasibility, success rate, complication rate and side effects of staged single-port thoracoscopic R2 sympathicotomy in the treatment of severe facial blushing. Facial blushing is considered a benign condition; however, severe facial blushing can have a major impact on quality of life. When nonsurgical options such as medication and psychological treatments offer no or insufficient relief, surgical treatment with thoracoscopic sympathicotomy should be considered.
Methods: All patients who underwent a staged thoracoscopic sympathicotomy at level R2 for severe facial blushing between January 2016 and September 2021 were included. Clinical and surgical data were prospectively collected and analysed.
Results: A total of 16 patients with low operative risk (American Society of Anesthesiologists class 1) were treated. No major perioperative complications were encountered. One patient experienced postoperative unilateral Horner's syndrome that resolved completely after 1 week. Two patients experienced compensatory hyperhidrosis. The success rate was 100%. One patient experienced a slight recurrence of blushing symptoms after 3 years that did not interfere with their quality of life. All patients were satisfied with the results and had no regrets of having undergone the procedure.
Conclusions: Staged single-port thoracoscopic R2 sympathicotomy is a reproducible, safe and highly effective surgical treatment option with low compensatory hyperhidrosis rates and the potential to significantly improve quality of life in carefully selected patients suffering from severe facial blushing. We would like to increase awareness among healthcare professionals for debilitating facial blushing and suggest timely referral for surgical treatment.
{"title":"Staged single-port thoracoscopic R2 sympathicotomy as a reproducible, safe and effective treatment option for debilitating severe facial blushing.","authors":"Emma van der Weijde, Michiel Kuijpers, Wobbe Bouma, Massimo A Mariani, Theo J Klinkenberg","doi":"10.1093/icvts/ivac257","DOIUrl":"https://doi.org/10.1093/icvts/ivac257","url":null,"abstract":"<p><strong>Objectives: </strong>Our goal was to investigate the safety, feasibility, success rate, complication rate and side effects of staged single-port thoracoscopic R2 sympathicotomy in the treatment of severe facial blushing. Facial blushing is considered a benign condition; however, severe facial blushing can have a major impact on quality of life. When nonsurgical options such as medication and psychological treatments offer no or insufficient relief, surgical treatment with thoracoscopic sympathicotomy should be considered.</p><p><strong>Methods: </strong>All patients who underwent a staged thoracoscopic sympathicotomy at level R2 for severe facial blushing between January 2016 and September 2021 were included. Clinical and surgical data were prospectively collected and analysed.</p><p><strong>Results: </strong>A total of 16 patients with low operative risk (American Society of Anesthesiologists class 1) were treated. No major perioperative complications were encountered. One patient experienced postoperative unilateral Horner's syndrome that resolved completely after 1 week. Two patients experienced compensatory hyperhidrosis. The success rate was 100%. One patient experienced a slight recurrence of blushing symptoms after 3 years that did not interfere with their quality of life. All patients were satisfied with the results and had no regrets of having undergone the procedure.</p><p><strong>Conclusions: </strong>Staged single-port thoracoscopic R2 sympathicotomy is a reproducible, safe and highly effective surgical treatment option with low compensatory hyperhidrosis rates and the potential to significantly improve quality of life in carefully selected patients suffering from severe facial blushing. We would like to increase awareness among healthcare professionals for debilitating facial blushing and suggest timely referral for surgical treatment.</p>","PeriodicalId":13621,"journal":{"name":"Interactive cardiovascular and thoracic surgery","volume":"35 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/aa/bb/ivac257.PMC9596140.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33512314","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}