AORTA最新文献

Survival into adulthood in patients with an interrupted aortic arch (IAA) is exceedingly rare. A recent literature review found 25 reported cases of IAA in adults. We describe the first case of prolonged, occult, postoperative gastrointestinal bleeding as a major complication following IAA surgery. We discuss the management of a 51-year-old man who underwent repair of an IAA, aortic valve replacement, and replacement of the ascending aorta for a known aortic aneurysm.

Background:  Aortic wall enhancement (AWE), evaluated with computed tomography angiography in Type B aortic dissection, is associated with aortic remodeling. This study aimed to evaluate the relationship between AWE and pathological findings of the aortic wall using an aortic wall sample from a Type A aortic dissection (TAD).

Methods:  We examined patients with TAD treated between January 2012 and February 2023.

Results:  Twelve cases were examined pathologically: five cases in the hyperacute phase, three in the acute phase, and four in the subacute phase. AWE thickness significantly differed as time progressed (0 vs. 1.7 vs. 2.8 mm, p < 0.001). A significant increase in granulation was observed in the acute and subacute phases (0 vs. 761 vs. 423 µm, p < 0.001). Furthermore, a fibrous complex of internal adventitia (FCIA) developed on the medial side of the adventitia over time since its onset and was found to be thickened (175 vs. 415 vs. 1,078 µm, p < 0.001). The thickness of the granulation tissue and FCIA, where there was abundant neovascularization, was consistent with the thickness of the AWE.

Conclusion:  AWE was observed in TAD and increased as time progressed. FCIA and granulation tissue developed, and AWE reflected neovascularization at the adventitia.

A 71-year-old gentleman with prior bioprosthetic aortic valve replacement was admitted with aortic valve dehiscence and an aortic root abscess. He underwent reoperative sternotomy, aortic root, mitral valve, and hemiarch replacement. To augment hemostasis, we implanted the "Martin Mattress"-a pericardial patch sutured to the fibrous ridge within the innominate vein, superior vena cava, right atrium, right ventricular outflow tract, and pulmonary artery-which is preferred to modified Cabrol fistula techniques in infectious root pathology.

A 57-year-old male patient who underwent an open hemiarch repair with a femoral-femoral crossover bypass and right lower extremity fasciotomies for an acute Type A aortic dissection with limb ischemia presented 5 weeks' postrepair with a 20-pound weight loss due to intermittent hemodynamic collapse of the dissection flap over the origin of the superior mesenteric artery. This case highlights the challenges a dissection flap can cause after an urgent Type A aortic dissection repair.

Background:  Transverse open aortic arch replacement remains a complex operation. A simplified arch replacement into zone 2, with debranching the head vessels proximally, creates a suitable landing zone for future endovascular repair and is increasing in popularity as of late. Still, limited data exist to assess contemporary rates of morbidity and mortality. Therefore, we aim to evaluate current outcomes for patients who underwent open zone 2 aortic arch replacement.

Methods:  All patients who underwent zone 2 arch replacement at a single academic institution from January 2019 to June 2023 were assessed. Indication for operation was either aneurysmal disease (n = 37), acute aortic syndrome (n = 38), or residual arch/descending thoracic aorta dissection (n = 67). Patient demographics and operative characteristics were evaluated, and the frequency of subsequent thoracic endovascular aortic repair (TEVAR) was noted. Mortality and major morbidity were then assessed.

Results:  A total of 142 patients underwent open zone 2 arch replacement. Median cardiopulmonary bypass, cross-clamp, and deep hypothermic circulatory arrest times for the entire cohort were 195, 122, and 36.5 minutes, respectively. Concomitant frozen elephant trunk was performed in 45.1% of the cohort (n = 64). In-hospital mortality was 7.8% (n = 11) for the entire cohort. Spinal cord ischemia occurred in 3.5% (n = 5); these patients all received frozen elephant trunks and had neurologic recovery by discharge. Stroke occurred in 9.2% (n = 13) of the study cohort. A total of 38.7% (n = 55) went on to get subsequent TEVAR, with median time to TEVAR of 52 days (8, 98.5).

Conclusion:  Zone 2 arch replacement allows staged repair of the thoracic aorta and readily accommodates future TEVAR therapy. This option for the treatment of the aortic arch can be performed safely in a wide variety of patient pathologies. Given the safety of this operation, cardiac surgeons should utilize this approach more frequently.

Aortic aneurysms represent the 15^th leading cause of death in men and women over 55 years of age. Where historically these lesions were all addressed via an open approach, endovascular aortic repair has entirely altered the way that surgeons approach aortic lesions. Although it was initially employed for patients who were poor surgical candidates, endovascular repair is now standard for abdominal aortic aneurysms and aneurysms in the descending thoracic aorta. Open surgery remains the gold standard for management of ascending aneurysms, in part due to the limitations portended by the anatomy of the ascending aorta, although increasing evidence suggests that endovascular approaches are feasible and may sometimes be optimal for patient outcomes. Here, we present some of the anatomical and technical challenges of the endovascular approach to these "Zone 0" aneurysms, the associated complications, and the current state of device development.

Background:  Patients receive many different recommendations after thoracic aortic surgery. Unfortunately, there is much variation in recommendations between different surgical centers. This variation in recommendations creates uncertainty and anxiety in patients. Therefore, we aimed to provide an overview with clear lifestyle recommendations for patients before and after thoracic aortic surgery.

Methods:  Documentary research and a framework analysis were used to analyze brochures, website texts, and health care protocols. These documents consisted of lifestyle recommendations for patients before and after thoracic aortic surgery (direct information) or cardiac surgery (indirect information). An analytical framework was constructed and all lifestyle recommendations for patients before and after thoracic aortic surgery were coded through indexing, charting, and mapping by two researchers (N.K. and H.v.Z.). The first draft with lifestyle recommendations was prepared by two researchers (N.K. and H.v.Z.). Feedback from all authors involved patients and consulted health care professionals was processed in the final draft.

Results:  In total, 170 documents were analyzed. Indexing revealed 414 lifestyle recommendations, which were included in the first draft. Charting, mapping, removal of duplicates, and processing of feedback resulted in a final draft with 52 lifestyle recommendations about behavioral change, body weight, nutrition, cessation of alcohol and drug use, cessation of smoking, wound healing, sedentary behavior and physical activity, mental well-being, and family and close relatives.

Conclusion:  This study provides an overview of clear lifestyle recommendations for patients before and after thoracic aortic surgery. This overview is the first step because follow-up research is needed on which lifestyle recommendations are necessary and evidence-based. The overview of lifestyle recommendations serves as a foundation, after which individual customization can be provided.

The development of pseudoaneurysms increases with time since the original operation, with incidence 0.2 to 25%. The axillofemoral bypass is employed to treat selective aortoiliac obstructions. Rarely, it is used in reverse form and always for treatment of occlusive arterial disease. We report a para-anastomotic aortic arch pseudoaneurysm and add to the literature a successful hybrid treatment, with bilateral femoroaxillary bypasses, thromboexclusion of all supra-aortic trunks, and aortic arch covering with an endograft.

Aortic floating thrombus is a rare, life-threatening disease. Most cases of aortic thrombus are diagnosed after embolic events; however, on rare occasion we may diagnose this condition incidentally during routine examinations as in our case.

The common genetic underpinnings of thoracic aortic aneurysms and aneurysms and dissections of several other major arterial circuits have been described in the literature. These include thoracic and abdominal aortic aneurysms, thoracic and intracranial aneurysms, thoracic aortic aneurysms, and spontaneous coronary artery dissections. In this study, we provide a unified report of these observations and investigate any genetic commonality between the above four arterial circulations.