We describe a technique for approaching the distal descending thoracic aorta via median sternotomy and posterior pericardiotomy, which enabled us to perform the extensive aortic repair. While this approach shared the lesser invasiveness of the frozen elephant trunk procedure with less confinement by anatomic features, the advantage was counterbalanced by the high incidence of spinal cord ischemia. This approach can be an option in highly selected patients who require extensive aortic repair but have factors prohibiting other conventional approaches.
{"title":"Transsternal and Transpericardial Approach to Descending Thoracic Aorta via Median Sternotomy-An Option for Extensive Aortic Surgery.","authors":"Kay-Hyun Park","doi":"10.1055/s-0042-1750413","DOIUrl":"https://doi.org/10.1055/s-0042-1750413","url":null,"abstract":"<p><p>We describe a technique for approaching the distal descending thoracic aorta via median sternotomy and posterior pericardiotomy, which enabled us to perform the extensive aortic repair. While this approach shared the lesser invasiveness of the frozen elephant trunk procedure with less confinement by anatomic features, the advantage was counterbalanced by the high incidence of spinal cord ischemia. This approach can be an option in highly selected patients who require extensive aortic repair but have factors prohibiting other conventional approaches.</p>","PeriodicalId":52392,"journal":{"name":"AORTA","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9754876/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10363096","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}
Vicente Orozco-Sevilla, Ginger Etheridge, Joseph S Coselli
Surgical aortic repair has progressed from aneurysm ligation to homografts to Dacron grafts to totally endovascular interventions. These fields will continue to evolve, and new endovascular technology will be used in virtually every part of the aorta, eventually dominating this field of surgery. However, as surgeons, we must be cautious and not let go of our open-surgery skills, as they will always be the ultimate bailout solution.
{"title":"Thoracic Aortic Aneurysm Surgery: DON'T QUIT-JUST DO IT.","authors":"Vicente Orozco-Sevilla, Ginger Etheridge, Joseph S Coselli","doi":"10.1055/s-0042-1750098","DOIUrl":"https://doi.org/10.1055/s-0042-1750098","url":null,"abstract":"<p><p>Surgical aortic repair has progressed from aneurysm ligation to homografts to Dacron grafts to totally endovascular interventions. These fields will continue to evolve, and new endovascular technology will be used in virtually every part of the aorta, eventually dominating this field of surgery. However, as surgeons, we must be cautious and not let go of our open-surgery skills, as they will always be the ultimate bailout solution.</p>","PeriodicalId":52392,"journal":{"name":"AORTA","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9754878/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10363097","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 : 2022-08-01Epub Date: 2022-12-15DOI: 10.1055/s-0042-1750117
Andrea Melloni, Andrea Kahlberg, Enrico Rinaldi, Victor Bilman, Nicola Favia, Germano Melissano, Roberto Chiesa
Open conversion of thoracoabdominal aortic (TAA) disease after failed attempts of endovascular treatment is increasingly required. The main causes are endoleak, endograft failure, infection, disease progression, or persistent false lumen perfusion in dissected aortas. Mortality and morbidity rates are high, higher than after standard TAA open repair. Therefore, this surgery should be performed only in dedicated centers by experienced teams. Specific perioperative organ protection protocols, as well as surgical techniques, are crucial to guarantee acceptable results.
{"title":"Open Thoracoabdominal Aortic Procedures following Endovascular Intervention.","authors":"Andrea Melloni, Andrea Kahlberg, Enrico Rinaldi, Victor Bilman, Nicola Favia, Germano Melissano, Roberto Chiesa","doi":"10.1055/s-0042-1750117","DOIUrl":"10.1055/s-0042-1750117","url":null,"abstract":"<p><p>Open conversion of thoracoabdominal aortic (TAA) disease after failed attempts of endovascular treatment is increasingly required. The main causes are endoleak, endograft failure, infection, disease progression, or persistent false lumen perfusion in dissected aortas. Mortality and morbidity rates are high, higher than after standard TAA open repair. Therefore, this surgery should be performed only in dedicated centers by experienced teams. Specific perioperative organ protection protocols, as well as surgical techniques, are crucial to guarantee acceptable results.</p>","PeriodicalId":52392,"journal":{"name":"AORTA","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9754861/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10363098","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}
Wahaj Munir, Mohamad Bashir, Mohammed Idhrees, Wael I Awad
Risk prediction of adverse outcomes post aortic dissection is dependet not only on the postdissection-associated clinical factors but on the very foundation of the risk factors that lead up to the dissection itself. There are various such risk factors existing prior to the dissection which impact the postdissection outcomes. In this paper, we review the literature to critically analyze various risk models, burdened by their significant limitations, that attempt to stratify risk prediction based on postdissection patient characteristics. We further review several studies across the literature that investigate the diverse set of predissection risk factors impacting postdissection outcomes. We have discussed and appraised numerous studies which attempt to develop a tool to stratify risk prediction by incorporating the impacts of different factors: malperfusion, blood biochemistry, and perioperative outcomes. The well-validated Penn classification has clearly demonstrated in the literature the significant impact that malperfusion has on adverse outcomes postdissection. Other risk models, already severely hindered by their limitations, lack such validation. We further discuss additional alluded risk factors, including the impact of predissection aortic size, the syndromic and nonsyndromic natures of dissection, and the effects of family history and genetics, which collectively contribute to the risk of adverse outcomes postdissection and prognosis. To achieve the goal of a true risk model, there remains the vital need for appreciation and appropriate consideration for all such aforementioned factors, from before and after the dissection, as discussed in this paper. By being able to incorporate the value of true risk prediction for a patient into the decision-making framework, it will allow a new page of precision medical decision-making to be written.
{"title":"Risk Prediction Models for Management of Patients following Acute Aortic Dissection.","authors":"Wahaj Munir, Mohamad Bashir, Mohammed Idhrees, Wael I Awad","doi":"10.1055/s-0042-1756671","DOIUrl":"https://doi.org/10.1055/s-0042-1756671","url":null,"abstract":"<p><p>Risk prediction of adverse outcomes post aortic dissection is dependet not only on the postdissection-associated clinical factors but on the very foundation of the risk factors that lead up to the dissection itself. There are various such risk factors existing prior to the dissection which impact the postdissection outcomes. In this paper, we review the literature to critically analyze various risk models, burdened by their significant limitations, that attempt to stratify risk prediction based on postdissection patient characteristics. We further review several studies across the literature that investigate the diverse set of predissection risk factors impacting postdissection outcomes. We have discussed and appraised numerous studies which attempt to develop a tool to stratify risk prediction by incorporating the impacts of different factors: malperfusion, blood biochemistry, and perioperative outcomes. The well-validated Penn classification has clearly demonstrated in the literature the significant impact that malperfusion has on adverse outcomes postdissection. Other risk models, already severely hindered by their limitations, lack such validation. We further discuss additional alluded risk factors, including the impact of predissection aortic size, the syndromic and nonsyndromic natures of dissection, and the effects of family history and genetics, which collectively contribute to the risk of adverse outcomes postdissection and prognosis. To achieve the goal of a true risk model, there remains the vital need for appreciation and appropriate consideration for all such aforementioned factors, from before and after the dissection, as discussed in this paper. By being able to incorporate the value of true risk prediction for a patient into the decision-making framework, it will allow a new page of precision medical decision-making to be written.</p>","PeriodicalId":52392,"journal":{"name":"AORTA","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9754882/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10367712","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}
Branko Arsić, Smiljana Tomasevic, Miloš Anić, Branko Gakovic, I. Končar, Nenad D Filipović
{"title":"Atherosclerotic Plaque Characterization Using Deep Learning Methods","authors":"Branko Arsić, Smiljana Tomasevic, Miloš Anić, Branko Gakovic, I. Končar, Nenad D Filipović","doi":"10.1055/s-0042-1750994","DOIUrl":"https://doi.org/10.1055/s-0042-1750994","url":null,"abstract":"","PeriodicalId":52392,"journal":{"name":"AORTA","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45478785","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}
M. Matković, N. Aleksić, I. Bilbija, A. Antić, J. Lazovic, M. Cubrilo, A. Milojević, S. Putnik
{"title":"Survival and Quality of Life in Patients with Patient-Prosthesis Mismatch After Aortic Valve Replacement With Biological Prosthesis","authors":"M. Matković, N. Aleksić, I. Bilbija, A. Antić, J. Lazovic, M. Cubrilo, A. Milojević, S. Putnik","doi":"10.1055/s-0042-1750989","DOIUrl":"https://doi.org/10.1055/s-0042-1750989","url":null,"abstract":"","PeriodicalId":52392,"journal":{"name":"AORTA","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47560004","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}
Pauline Gaillard, L. Lootens, Jane Nardella, Y. De Bast
{"title":"Type IA Endoleak Caused by Kissing Struts","authors":"Pauline Gaillard, L. Lootens, Jane Nardella, Y. De Bast","doi":"10.1055/s-0042-1750934","DOIUrl":"https://doi.org/10.1055/s-0042-1750934","url":null,"abstract":"","PeriodicalId":52392,"journal":{"name":"AORTA","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48974991","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}
L. V. Heuvel, J. Meester, Silke Peeters, Romain Alderweireldt, A. Verstraeten, P. Coucke, B. Loeys
{"title":"Genome-Wide Epistasis for Cardiovascular Severity in Marfan Study Design: Patient Organization Driven Research","authors":"L. V. Heuvel, J. Meester, Silke Peeters, Romain Alderweireldt, A. Verstraeten, P. Coucke, B. Loeys","doi":"10.1055/s-0042-1750911","DOIUrl":"https://doi.org/10.1055/s-0042-1750911","url":null,"abstract":"","PeriodicalId":52392,"journal":{"name":"AORTA","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45559478","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}
H. Davies, M. Vleugels, J. Kwan, A. Aerden, L. Wyld, L. Fawcett, R. Anthony, Assad Khan, G. Schurink, B. Mees, D. Scott
{"title":"End of Life Care and Advance Care Planning for Outpatients with Inoperable Aortic Aneurysms—A Multicenter Cohort Study","authors":"H. Davies, M. Vleugels, J. Kwan, A. Aerden, L. Wyld, L. Fawcett, R. Anthony, Assad Khan, G. Schurink, B. Mees, D. Scott","doi":"10.1055/s-0042-1750972","DOIUrl":"https://doi.org/10.1055/s-0042-1750972","url":null,"abstract":"","PeriodicalId":52392,"journal":{"name":"AORTA","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42931659","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}
S. Smorenburg, K. O. Kappe, A. Hoksbergen, J. Wolterink, K. Yeung
{"title":"Artificial Intelligence-Based Intraoperative Endoleak Visualization on Completion Digital Subtraction Angiography during Endovascular Aneurysm Repair","authors":"S. Smorenburg, K. O. Kappe, A. Hoksbergen, J. Wolterink, K. Yeung","doi":"10.1055/s-0042-1750998","DOIUrl":"https://doi.org/10.1055/s-0042-1750998","url":null,"abstract":"","PeriodicalId":52392,"journal":{"name":"AORTA","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46915534","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}