Pub Date : 2025-04-17DOI: 10.1053/j.optechstcvs.2025.03.005
Tedy Sawma MD, Hartzell V. Schaff MD
Hypertrophic cardiomyopathy is a relatively common cardiac disorder, and associated left ventricular outflow tract (LVOT) obstruction may significantly impair quality of life and long-term survival. A comprehensive understanding of the anatomy and physiology of the disease is important in planning surgical septal reduction (septal myectomy) in order to minimize operative risk and achieve optimal late outcomes. Depending on the location of the obstruction, surgical relief may involve a transaortic, transapical, or a combined approach. In the present article, we illustrate our operative techniques derived from an experience in the surgical management of more than 4000 patients with HCM.
{"title":"Step-by-Step Approach for Septal Myectomy in Patients With Obstructive Hypertrophic Cardiomyopathy","authors":"Tedy Sawma MD, Hartzell V. Schaff MD","doi":"10.1053/j.optechstcvs.2025.03.005","DOIUrl":"10.1053/j.optechstcvs.2025.03.005","url":null,"abstract":"<div><div>Hypertrophic cardiomyopathy<span> is a relatively common cardiac disorder, and associated left ventricular outflow tract (LVOT) obstruction may significantly impair quality of life<span> and long-term survival. A comprehensive understanding of the anatomy and physiology of the disease is important in planning surgical septal reduction (septal myectomy) in order to minimize operative risk and achieve optimal late outcomes. Depending on the location of the obstruction, surgical relief may involve a transaortic, transapical, or a combined approach. In the present article, we illustrate our operative techniques derived from an experience in the surgical management of more than 4000 patients with HCM.</span></span></div></div>","PeriodicalId":35965,"journal":{"name":"Operative Techniques in Thoracic and Cardiovascular Surgery","volume":"30 3","pages":"Pages 184-197"},"PeriodicalIF":0.0,"publicationDate":"2025-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144892281","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Seventeen years have passed since the Ozaki procedure started in 2007. In the first series we reported in 2010, we used the first generation template and sizer, and we had already achieved excellent outcomes with them. Many surgeons worldwide have started using the Ozaki procedure, and their reports are now being published from all over the world. However, with the conventional templates, actual points to suture on the new cusp could vary depending on the surgeons because the dots on the template were not the actual suture points. We also experienced 3 cases in which coronary artery occlusion by the valve cusps occurred after releasing the aortic cross-clamp. The previous sizer also had some issues because of the position of the handle and the top corner height. And it might cause inaccurate measurements of each cusp size. Based on the above experience, we have gradually upgraded the template and sizer to improve the outcomes and standardize the procedure. The current ones are the third generation, and each shape is completely different from the previous ones. With this new template and sizer, the tips for actual procedures have also changed. Here, we will once again describe the Ozaki procedure using the third generation sizer and template as the “New Ozaki Procedure.”
{"title":"New Ozaki Procedure Overview","authors":"Takuya Fujikawa MD, Shigeyuki Ozaki MD, PhD, Nagaki Kiyohara MD, Masami Goda MD, Mikio Takatoo MD, Shinichiro Shimura MD, PhD","doi":"10.1053/j.optechstcvs.2025.03.003","DOIUrl":"10.1053/j.optechstcvs.2025.03.003","url":null,"abstract":"<div><div>Seventeen years have passed since the Ozaki procedure started in 2007. In the first series we reported in 2010, we used the first generation template and sizer, and we had already achieved excellent outcomes with them. Many surgeons worldwide have started using the Ozaki procedure, and their reports are now being published from all over the world. However, with the conventional templates, actual points to suture on the new cusp could vary depending on the surgeons because the dots on the template were not the actual suture points. We also experienced 3 cases in which coronary artery occlusion by the valve cusps occurred after releasing the aortic cross-clamp. The previous sizer also had some issues because of the position of the handle and the top corner height. And it might cause inaccurate measurements of each cusp size. Based on the above experience, we have gradually upgraded the template and sizer to improve the outcomes and standardize the procedure. The current ones are the third generation, and each shape is completely different from the previous ones. With this new template and sizer, the tips for actual procedures have also changed. Here, we will once again describe the Ozaki procedure using the third generation sizer and template as the “New Ozaki Procedure.”</div></div>","PeriodicalId":35965,"journal":{"name":"Operative Techniques in Thoracic and Cardiovascular Surgery","volume":"30 4","pages":"Pages 246-274"},"PeriodicalIF":0.0,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145610246","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-21DOI: 10.1053/j.optechstcvs.2025.01.004
Muhammed Hebala FRCS(CTh) , Mohamed Nassar FRCS(CTh) , Conal Austin FRCS(CTh) , Louise Kenny FRCS(CTh)
The ROSS-PEARS describes the addition of a Personalized External Aortic Root Support to the pulmonary autograft in the aortic position. It is well documented that the vulnerability of the free root Ross is autograft dilatation, and various techniques have been described to prophylactically manage this. A bespoke PEARS prosthesis supporting the autograft when performing an elective Ross in patients with adult size aortic root may avoid such vulnerability. Here we describe our indications, rationale and technical considerations.
{"title":"Personalized External Root Support for the Pulmonary Autograft in the Aortic Position: The ROSS-PEARS Procedure","authors":"Muhammed Hebala FRCS(CTh) , Mohamed Nassar FRCS(CTh) , Conal Austin FRCS(CTh) , Louise Kenny FRCS(CTh)","doi":"10.1053/j.optechstcvs.2025.01.004","DOIUrl":"10.1053/j.optechstcvs.2025.01.004","url":null,"abstract":"<div><div>The ROSS-PEARS describes the addition of a Personalized External Aortic Root Support to the pulmonary autograft<span> in the aortic position. It is well documented that the vulnerability of the free root Ross is autograft<span> dilatation, and various techniques have been described to prophylactically manage this. A bespoke PEARS prosthesis supporting the autograft when performing an elective Ross in patients with adult size aortic root may avoid such vulnerability. Here we describe our indications, rationale and technical considerations.</span></span></div></div>","PeriodicalId":35965,"journal":{"name":"Operative Techniques in Thoracic and Cardiovascular Surgery","volume":"30 3","pages":"Pages 232-243"},"PeriodicalIF":0.0,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144891851","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-01DOI: 10.1053/j.optechstcvs.2024.07.006
Yishay Orr MBBS BSc (med) PhD FRACS , Richard B. Chard MBBS FRACS
The Ross Konno procedure is a technically demanding operation in neonates and infants, particularly in small babies and those with significant aortic annular and left ventricular outflow tract hypoplasia. There are several key technical considerations for harvesting the pulmonary autograft with care to preserve the left main coronary artery and the septal perforating arteries in addition to ensuring an optimal muscle cuff on the base of the autograft. Accommodation of the autograft deep within the native aortic valve annulus by performing an appropriate Konno incision and ensuring correct suture placement is essential. Adequate epicardial mobilisation and subsequent reimplantation of the coronary arteries into the autograft neo-aortic root is also a key consideration given the significant radial displacement of the coronary arteries required to accommodate the often much larger autograft into the space of a previously very small aortic root. Although the overall technical details of the Ross Konno procedure have previously been described by others the specific granular technical detail and meticulous approach required for a successful procedural outcome in neonates and infants remains to be fully elucidated. Key technical considerations such as suture spacing, positioning of the autograft with in the Konno incision and management of the coronary arteries require detailed description. We describe our institutional approach to the Ross Konno procedure in neonates and infants to clarify these important technical considerations.
Ross Konno手术是一项对新生儿和婴儿技术要求很高的手术，特别是对小婴儿和那些有明显主动脉环和左心室流出道发育不全的婴儿。除了确保自体移植物底部有最佳的肌套外，还有几个关键的技术考虑因素，要小心地保留左主干冠状动脉和间隔穿动脉。通过适当的Konno切口和确保正确的缝线放置，将自体移植物安置在原有主动脉瓣环的深处是必不可少的。适当的心外膜活动和随后的冠状动脉再植入术也是一个关键的考虑因素，因为冠状动脉需要显著的径向位移来容纳通常更大的自体移植物进入先前非常小的主动脉根的空间。虽然罗斯·科诺手术的整体技术细节已经被其他人描述过，但在新生儿和婴儿中取得成功的手术结果所需的具体技术细节和细致的方法仍有待充分阐明。关键的技术考虑，如缝线间距，自体移植物与Konno切口的定位和冠状动脉的处理需要详细的描述。我们描述我们的机构方法罗斯科诺程序在新生儿和婴儿澄清这些重要的技术考虑。
{"title":"Comprehensive surgical technique for the neonatal and infant Ross Konno procedure – technical pearls","authors":"Yishay Orr MBBS BSc (med) PhD FRACS , Richard B. Chard MBBS FRACS","doi":"10.1053/j.optechstcvs.2024.07.006","DOIUrl":"10.1053/j.optechstcvs.2024.07.006","url":null,"abstract":"<div><div>The Ross Konno procedure is a technically demanding operation in neonates and infants, particularly in small babies and those with significant aortic annular and left ventricular outflow tract hypoplasia. There are several key technical considerations for harvesting the pulmonary autograft with care to preserve the left main coronary artery and the septal perforating arteries in addition to ensuring an optimal muscle cuff on the base of the autograft. Accommodation of the autograft deep within the native aortic valve annulus by performing an appropriate Konno incision and ensuring correct suture placement is essential. Adequate epicardial mobilisation and subsequent reimplantation of the coronary arteries into the autograft neo-aortic root is also a key consideration given the significant radial displacement of the coronary arteries required to accommodate the often much larger autograft into the space of a previously very small aortic root. Although the overall technical details of the Ross Konno procedure have previously been described by others the specific granular technical detail and meticulous approach required for a successful procedural outcome in neonates and infants remains to be fully elucidated. Key technical considerations such as suture spacing, positioning of the autograft with in the Konno incision and management of the coronary arteries require detailed description. We describe our institutional approach to the Ross Konno procedure in neonates and infants to clarify these important technical considerations.</div></div>","PeriodicalId":35965,"journal":{"name":"Operative Techniques in Thoracic and Cardiovascular Surgery","volume":"30 1","pages":"Pages 46-66"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143642917","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-01DOI: 10.1053/j.optechstcvs.2024.09.001
Nicholas G. Smedira MD
{"title":"Commentary: The more the merrier. Another technique to treat left ventricular outflow tract obstruction","authors":"Nicholas G. Smedira MD","doi":"10.1053/j.optechstcvs.2024.09.001","DOIUrl":"10.1053/j.optechstcvs.2024.09.001","url":null,"abstract":"","PeriodicalId":35965,"journal":{"name":"Operative Techniques in Thoracic and Cardiovascular Surgery","volume":"30 1","pages":"Pages 11-12"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143642915","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-01DOI: 10.1053/j.optechstcvs.2025.01.003
Alexander P. Nissen MD, Bradley G. Leshnower MD
{"title":"Commentary: Avoid Flying Blind During TEVAR for Acute Type B Aortic Dissection","authors":"Alexander P. Nissen MD, Bradley G. Leshnower MD","doi":"10.1053/j.optechstcvs.2025.01.003","DOIUrl":"10.1053/j.optechstcvs.2025.01.003","url":null,"abstract":"","PeriodicalId":35965,"journal":{"name":"Operative Techniques in Thoracic and Cardiovascular Surgery","volume":"30 1","pages":"Pages 44-45"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143642911","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-01DOI: 10.1053/j.optechstcvs.2025.03.001
{"title":"Adult Articles in AATS Journals","authors":"","doi":"10.1053/j.optechstcvs.2025.03.001","DOIUrl":"10.1053/j.optechstcvs.2025.03.001","url":null,"abstract":"","PeriodicalId":35965,"journal":{"name":"Operative Techniques in Thoracic and Cardiovascular Surgery","volume":"30 1","pages":"Pages e4-e6"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143642921","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-01DOI: 10.1053/j.optechstcvs.2024.07.002
Liranne Bitton BSc , Rohan Suresh Daniel BSc , Mariana Flaifel BSc , Christian A. Than PhD , George Shiakos MD , Ioannis Tzanavaros MD
Pulmonary valve replacement is traditionally performed using cardioplegia in order to induce cardiac arrest during the operation. However, the induction of cardiac arrest is known to be associated with several postoperative complications. Therefore, over the years new cardioprotective techniques have been introduced: one of which is the on-pump beating heart technique. The technique of pulmonary valve replacement on a beating heart could be efficacious in reducing the incidence of cardiac dysfunction or injury which can be associated with the use of cardioplegia. Such as the avoidance of aortic cross-clamping observed in the beating heart technique may be linked with lower risks of stroke and other aortic complications. Therefore, the technique that we present combines the advantages of operating on a beating heart and being on-pump in the context of complex re-do operations of the pulmonary valve.
{"title":"Beating Heart Pulmonary Valve Replacement: Technique of Pulmonary Valve Replacement with a Biological Valve","authors":"Liranne Bitton BSc , Rohan Suresh Daniel BSc , Mariana Flaifel BSc , Christian A. Than PhD , George Shiakos MD , Ioannis Tzanavaros MD","doi":"10.1053/j.optechstcvs.2024.07.002","DOIUrl":"10.1053/j.optechstcvs.2024.07.002","url":null,"abstract":"<div><div>Pulmonary valve replacement is traditionally performed using cardioplegia in order to induce cardiac arrest during the operation. However, the induction of cardiac arrest is known to be associated with several postoperative complications. Therefore, over the years new cardioprotective techniques have been introduced: one of which is the on-pump beating heart technique. The technique of pulmonary valve replacement on a beating heart could be efficacious in reducing the incidence of cardiac dysfunction or injury which can be associated with the use of cardioplegia. Such as the avoidance of aortic cross-clamping observed in the beating heart technique may be linked with lower risks of stroke and other aortic complications. Therefore, the technique that we present combines the advantages of operating on a beating heart and being on-pump in the context of complex re-do operations of the pulmonary valve.</div></div>","PeriodicalId":35965,"journal":{"name":"Operative Techniques in Thoracic and Cardiovascular Surgery","volume":"30 1","pages":"Pages 13-25"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143642916","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-01DOI: 10.1053/j.optechstcvs.2024.07.003
David A. Heimansohn MD, James Hermiller MD, Peter A. Walts MD, Giorgio Zanotti MD
Hypertrophic cardiomyopathy (HCM) is the most common heritable cardiomyopathy, and presents with left ventricular hypertrophy resulting in left ventricular outflow tract (LVOT) obstruction in 60% of patients. Standard surgical therapy for the relief of outflow tract obstruction is septal myectomy which can effectively reduce the outflow tract gradient to normal levels.
Several challenges exist when performing septal myectomy, especially in the cases of less basilar septal hypertrophy and elongated mitral leaflets. These include creation of a ventricular septal defect, injury to the conduction system requiring a permanent pacemaker, and failure to completely relieve the obstruction. In patients with elongated mitral leaflets, as is common in HCM, septal myectomy alone may be ineffective in completely relieving outflow tract obstruction. Mitral valve repair may be necessary to effectively eliminate any residual outflow tract gradient. Shortening the posterior leaflet with neochords is a repair technique that can move the mitral valve coaptation line posteriorly away from the septum and prevent anterior leaflet systolic motion into the outflow tract, thus relieving the outflow tract gradient. This can be achieved simply by placing neochords to the posterior leaflet through the aortic root and securing them to half the length of the existing cords. The posterior leaflet height is reduced, allowing the coaptation line to move away from the septum, and prevent systolic anterior motion of the anterior leaflet of the mitral valve. The obstruction is prevented, and normal mitral valve function is achieved. This repair technique is especially helpful when the basil ventricular septal thickness is less than 2 cm and the mitral valve leaflets are elongated.
{"title":"Posterior Leaflet Mitral Valve Repair with Septal Myectomy For Hypertrophic Cardiomyopathy","authors":"David A. Heimansohn MD, James Hermiller MD, Peter A. Walts MD, Giorgio Zanotti MD","doi":"10.1053/j.optechstcvs.2024.07.003","DOIUrl":"10.1053/j.optechstcvs.2024.07.003","url":null,"abstract":"<div><div>Hypertrophic cardiomyopathy (HCM) is the most common heritable cardiomyopathy, and presents with left ventricular hypertrophy resulting in left ventricular outflow tract (LVOT) obstruction in 60% of patients. Standard surgical therapy for the relief of outflow tract obstruction is septal myectomy which can effectively reduce the outflow tract gradient to normal levels.</div><div>Several challenges exist when performing septal myectomy, especially in the cases of less basilar septal hypertrophy and elongated mitral leaflets. These include creation of a ventricular septal defect, injury to the conduction system requiring a permanent pacemaker, and failure to completely relieve the obstruction. In patients with elongated mitral leaflets, as is common in HCM, septal myectomy alone may be ineffective in completely relieving outflow tract obstruction. Mitral valve repair may be necessary to effectively eliminate any residual outflow tract gradient. Shortening the posterior leaflet with neochords is a repair technique that can move the mitral valve coaptation line posteriorly away from the septum and prevent anterior leaflet systolic motion into the outflow tract, thus relieving the outflow tract gradient. This can be achieved simply by placing neochords to the posterior leaflet through the aortic root and securing them to half the length of the existing cords. The posterior leaflet height is reduced, allowing the coaptation line to move away from the septum, and prevent systolic anterior motion of the anterior leaflet of the mitral valve. The obstruction is prevented, and normal mitral valve function is achieved. This repair technique is especially helpful when the basil ventricular septal thickness is less than 2 cm and the mitral valve leaflets are elongated.</div></div>","PeriodicalId":35965,"journal":{"name":"Operative Techniques in Thoracic and Cardiovascular Surgery","volume":"30 1","pages":"Pages 2-10"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143642914","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-01DOI: 10.1053/j.optechstcvs.2024.08.002
Giacomo Murana MD, PhD , Francesco Campanini MD , Silvia Snaidero MD , Valentina Orioli MD , Francesco Buia MD , Luca Di Marco MD, PhD , Davide Pacini MD, PhD
Type B acute aortic dissection (TBAAD) is a severe condition that requires urgent intervention to minimize complications and improve outcomes. Endovascular treatment has emerged as an effective approach for managing this challenging condition in acute complicated type B dissections or in case of high-risk features for later adverse event. This involves placing stent grafts to seal the tear, redirect blood flow, and promote clot formation. Endovascular treatment reduces mortality and complication rates, allowing for a faster recovery.
The benefits of endovascular repair in complicated TBAAD have been extensively demonstrated, showing lower morbidity and in-hospital mortality (5%-8% vs 15%-30%) rates compared to traditional open surgery. This technique offers better control over the extent of the dissection, leading to improved patient outcomes and shorter hospital stays.
It is essential to optimize antihypertensive therapy and provide proper patients education. Regular angio-CT scans should be done to monitor disease progression and ensure long-term success.
Endovascular treatment has revolutionized the management of TBAAD by providing a less invasive, more effective approach, enhancing patient care and prognosis.
B型急性主动脉夹层（TBAAD）是一种严重的疾病，需要紧急干预以减少并发症和改善预后。血管内治疗已成为一种有效的方法来管理这种具有挑战性的条件在急性复杂B型夹层或在高风险的情况下，为以后的不良事件。这包括放置支架来密封撕裂，重新引导血液流动，促进血栓形成。血管内治疗降低了死亡率和并发症发生率，允许更快的恢复。血管内修复对复杂TBAAD的益处已得到广泛证实，与传统的开放手术相比，其发病率和住院死亡率较低（5%-8% vs 15%-30%）。该技术可以更好地控制剥离的程度，从而改善患者的预后并缩短住院时间。优化降压治疗和提供适当的患者教育是至关重要的。应定期进行血管ct扫描以监测疾病进展并确保长期成功。血管内治疗提供了一种侵入性更小、更有效的方法，改善了患者的护理和预后，彻底改变了TBAAD的管理。
{"title":"Endovascular Therapy for Acute Type B Aortic Dissection","authors":"Giacomo Murana MD, PhD , Francesco Campanini MD , Silvia Snaidero MD , Valentina Orioli MD , Francesco Buia MD , Luca Di Marco MD, PhD , Davide Pacini MD, PhD","doi":"10.1053/j.optechstcvs.2024.08.002","DOIUrl":"10.1053/j.optechstcvs.2024.08.002","url":null,"abstract":"<div><div>Type B acute aortic dissection (TBAAD) is a severe condition that requires urgent intervention to minimize complications and improve outcomes. Endovascular treatment has emerged as an effective approach for managing this challenging condition in acute complicated type B dissections or in case of high-risk features for later adverse event. This involves placing stent grafts to seal the tear, redirect blood flow, and promote clot formation. Endovascular treatment reduces mortality and complication rates, allowing for a faster recovery.</div><div>The benefits of endovascular repair in complicated TBAAD have been extensively demonstrated, showing lower morbidity and in-hospital mortality (5%-8% vs 15%-30%) rates compared to traditional open surgery. This technique offers better control over the extent of the dissection, leading to improved patient outcomes and shorter hospital stays.</div><div>It is essential to optimize antihypertensive therapy and provide proper patient<del>s</del> education. Regular angio-CT scans should be done to monitor disease progression and ensure long-term success.</div><div>Endovascular treatment has revolutionized the management of TBAAD by providing a less invasive, more effective approach, enhancing patient care and prognosis.</div></div>","PeriodicalId":35965,"journal":{"name":"Operative Techniques in Thoracic and Cardiovascular Surgery","volume":"30 1","pages":"Pages 26-43"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143642910","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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