AORTA最新文献

Aortic pseudoaneurysm occurs in 10 to 24% of patients after acute type A aortic dissection repair. We report the case of a 72-year-old female who developed an intraoperative iatrogenic ascending aortic dissection following mitral valve repair. A giant ascending aortic pseudoaneurysm was detected on follow-up imaging. This case emphasizes the importance of close radiological surveillance following acute aortic dissection repair.

Spinal cord ischemia (SCI) is a well-known complication of both open and endovascular repair of the thoracoabdominal aorta. Perioperative maneuvers to increase spinal cord perfusion, including permissive hypertension and lumbar drain placement to control spinal pressure, are commonly used to reduce the risk of SCI. Additional perioperative measures to reduce the susceptibility of the spinal cord to ischemic insult include hypothermia, steroids, and naloxone infusion. Most cases manifest immediately or within days of surgery and improve with the aforementioned maneuvers. We describe a rare occurrence of delayed SCI 20 months after thoracic endovascular aortic aneurysm repair.

Background:  Type A aortic dissection as a highly lethal disease continues being a great challenge for cardiac surgeons worldwide. There are still unanswered questions regarding intraoperative decisions and their impact on the surgical outcomes. The aim of this study is to compare postoperative outcomes according to site of cannulation in patients with acute Type A aortic dissection (ATAAD).

Methods:  This was a retrospective cohort study. We included all ATAAD procedures from January 2002 to November 2023. We defined groups according to site of cannulation (aorta, axillary, femoral, innominate). Data from pre-, intra-, and postoperative variables were collected. Our main outcomes were spinal cord injury (SCI), stroke rate, and in-hospital mortality. Between-group comparisons were performed using standard statistical tests and post hoc tests adjusting for multiple comparisons were performed.

Results:  We identified 127 ATAAD procedures. Reoperation for bleeding was significantly higher in the femoral cannulation group (75%, p = 0.0006). There were no statistically significant differences in acute kidney injury rate (p = 0.012), SCI rate (p = 0.78), or in-hospital mortality (p = 0.75). Our data suggest that there is a lower stroke rate in the axillary cannulation group (3.6%, p = 0.4), which did not reach statistical significance.

Conclusion:  Choosing an adequate cannulation site is a critical step in TAAD surgery. In our series, axillary and innominate cannulation were the preferred methods with relatively low complication rates.

Background/objective:  Acute Type A aortic dissection (ATAAD) is a life-threatening condition requiring timely surgical intervention. Despite successful surgery, postoperative outcomes are frequently suboptimal due to the high frequency of cardiovascular risk factors. This study examines baseline cardiovascular risk factors in a population of ATAAD patients in the Netherlands. Additionally, this study outlines the protocol for a randomized controlled trial, designed to improve postoperative management.

Methods:  Baseline data were collected from patients with ATAAD. Data were gained through the Stichting Aorta Dissectie Nederland, a Dutch association for aortic dissection patients. The data included information on cardiovascular risk factors and health-related quality of life. A survey was further conducted, to gain more insights into the ATAAD postoperative care experiences of cardiac and vascular surgeons.

Results:  Among the 50 ATAAD patients in our study, we found significant cardiovascular risk factors, including smoking (36.7%), obesity (34.2%), and hypertension (51.3%). In the surgeon survey (N = 48), 84% of respondents highlighted the significance of lifestyle changes for patients, underscoring the need for individualized risk management. These findings underscore the need for tailored postoperative management programs aimed at improving patient outcomes.

Conclusion:  The results of our study highlight that ATAAD patients require comprehensive postoperative care management strategies. The ultimate goal is to enhance long-term patient outcomes and improve health-related quality of life. To address this need, the TRAIN (Targeted caRdiovAscular rIsk reductioN) Health Awareness platform seeks to implement personalized eHealth-based lifestyle interventions.

Background:  Aggressive surgical methods for acute type A aortic dissection (ATAD) can cause extended operating times and postoperative complications. less extensive techniques may increase the risk of needing further aortic reintervention. To prevent the need for extensive aortic arch surgery and subsequent re-sternotomy, hemiarch replacement (HAR) with innominate artery (a.) translocation is performed to create a suitable proximal landing zone for future endovascular repair.

Methods:  Retrospective study of 112 patients with ATAD who underwent aortic surgery from January 2009 to December 2020. Forty-one patients underwent HAR with innominate artery translocation, 16 underwent total arch replacement (TAR), and 55 underwent only HAR. Multivariable Cox regression and logistic regression analyses were used to study the outcomes and risk factors.

Results:  The TAR group had a higher incidence of postoperative acute kidney injury. The overall mortality rate of the TAR group was 25%, compared with 20% in the HAR group and 14.6% in the translocation group. The 5-year overall survival rates for the groups were 81.9%, 75.0%, and 77.7%, respectively. False lumen thrombosis at the aortic arch and descending aorta level were factors associated with reduced mortality in both univariable and multivariable analyses. The translocation group had a significantly higher reintervention rate of 41.5% compared with the TAR and HAR groups, with rates of 31.3% and 16.4%, respectively. The median reintervention time for the translocation group was 4.72 years.

Conclusion:  Despite the innominate translocation technique having a higher reintervention rate, it had similar mortality outcomes to HAR and TAR. Thus, it could be a more convenient option for reintervention, including creating a proximal landing zone, which could benefit patients needing endovascular repair.

The distal extent of aortic repair in acute aortic dissection and the management of malperfusion in terms of timing and strategy are still debated topics. We present a case of acute type B dissection with retrograde extension to the ascending aorta, with the most proximal intimal tear in the descending thoracic aorta, associated with both early lower extremity and delayed mesenteric malperfusion syndrome, treated effectively by femoral artery open fenestration and hybrid zone 2 arch repair.

Background:  Acute Type A aortic dissection (TAAD) is a life-threatening condition that carries significant mortality and morbidity; a proportion of the survivors might require further aortic procedures in the mid-/long-term follow-up. Quality of life (QoL) after TAAD is not well studied. Quality of life after Type A Aortic Dissection Surgery (QUADS) is the first multicentre study to assess QoL in survivors of surgically treated TAAD.

Methods:  A tailored questionnaire for survivors of TAAD was designed with patient and public involvement. Patients who underwent surgery from 2018 to 2022 in eight United Kingdom centres were invited to participate. Preoperative, intraoperative, and postoperative prospectively collected data were collated and analyzed retrospectively. The data were analyzed with SPSS v29. Patient's questionnaire was validated with a Cronbach's alpha analysis, exploratory factor analysis, and AMOS confirmatory factor analysis. Three groups were created according to QoL (Good, Fair, Poor).

Results:  A total of 162 patients were recruited. Majority were male with a mean age of 63 years (24-92). Surgical procedures for TAAD were root and ascending aorta replacement (n = 61, 38%), ascending (n = 81, 50%), and/or arch replacement (n = 20, 12%). Eleven patients (7%) required later intervention. Patient's answers regarding overall QoL were good (n = 67, 41%), fair (n = 89, 55%), and poor (n = 6, 4%). Neurological complications, circulatory arrest duration, reoperation for bleeding, postoperative myocardial infraction, arrhythmias, wound infection, and patient destination at discharge have been identified as main variables impacting on QoL after TAAD surgery across different domains of this questionnaire.

Conclusion:  QUADS questionnaire is the first tailored and validated questionnaire for TAAD survivors. Results in the United Kingdom population suggest that it is a useful tool to assess QoL after TAAD surgery.

There has been an increasing number of secondary downstream aorta replacements following aortic arch repair using a frozen elephant trunk (FET). We present an anastomosis technique to join a frozen elephant graft to a downstream prosthetic graft. The FET is inserted into the downstream graft with continuous sutures, with a two-bite Dacron graft added to the frozen elephant side. This technique may prevent anastomotic leakage between two grafts.

Vascular Ehlers-Danlos (vEDS) and Loeys-Dietz syndrome 3 (LDS3) are connective tissue disorders with diverse systemic manifestations. Most notable in these disorders, though, are their aggressive aortopathies, often presenting early in life with aneurysmal disease or dissection. Herein we present the case of a 33-year-old patient, previously lost to follow-up, who underwent complex reoperative arch replacement after ascending and hemiarch replacement for Type A aortic dissection 6 years prior. Postoperative genetic testing revealed both vEDS and LDS, a unique genotype that has not been described before in the literature.