1,721,264 research outputs found
Dalle origini allo studio SYNTAX: 50 anni (e più) di bypass aortocoronarico
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La chirurgia dell'aorta toracica alla luce delle nuove linee guida europee = Surgical treatment of the thoracic aorta according to the 2014 European guidelines
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Innominate artery cannulation during aortic surgery
Full text linkDuring aortic surgery, the cannulation of arteries preserving an antegrade flow in the thoracic aorta [ascending aorta, axillary artery, innominate artery (IA) and carotid artery] has been associated with superior survival and neurological outcomes compared with the cannulation of the femoral artery. However, the ideal site of cannulation for both cardiopulmonary bypass (CPB) and antegrade selective cerebral perfusion remains under debate. Here, we present our technique of IA cannulation for CPB and antegrade selective cerebral perfusion during surgery of the thoracic aorta
Protezione cerebrale nella chirurgia dell'arco aortico
No full textNelle ultime decadi l’oucome dei pazienti sottoposti a chirurgia dell’aorta toracica è nettamente migliorato. Ciononostante, la chirurgia dell’aorta toracica e, in particolare, dell’arco aortico è ancora associata a una mortalità e morbilità significativamente elevate a causa di complicanze neurologiche derivanti dall’interruzione della circolazione cerebrale. I danni cerebrovascolari nella chirurgia dell’aorta toracica possono essere provocati da un’inadeguata protezione cerebrale, dall’embolia cerebrale e, in caso di dissezione aortica acuta di tipo A, da malperfusione cerebrale. L’outcome neurologico di questi pazienti dipende dalla qualità della protezione del sistema nervoso centrale durante il periodo critico di interruzione della circolazione cerebrale. Varie tecniche sono state proposte per la protezione cerebrale dal danno ischemico, come l’arresto di circolo in ipotermia profonda, la perfusione cerebrale retrograda e la perfusione cerebrale selettiva anterograda. Questa rassegna prende in esame queste tre tecniche e le strategie di protezione cerebrale evidenziandone i relativi vantaggi e limiti
When and how to replace the aortic arch for type A dissection
No full textAcute type A aortic dissection (AAAD) remains one of the most challenging diseases in cardiothoracic surgery and despite numerous innovations in medical and surgical management, early mortality remains high. The standard treatment of AAAD requires emergency surgery of the proximal aorta, preventing rupture and consequent cardiac tamponade. Resection of the primary intimal tear and repair of the aortic root and aortic valve are well-established surgical principles. However, the dissection in the aortic arch and descending untreated aorta remains. This injury is associated with the risk of subsequent false lumen dilatation potentially progressing to rupture, true lumen compression and distal malperfusion. Additionally, the dilatation of the aortic arch, the presence of a tear and retrograde dissection can all be considered indication for a total arch replacement in AAAD. In such cases a more aggressive strategy may be used, from the classic aortic arch operation to a single stage frozen elephant trunk (FET) technique or a two-stage approach such as the classical elephant trunk (ET) or the recent Lupiae technique. Although these are all feasible solutions, they are also complex and time demanding techniques requiring experience and expertise, with an in the length of cardiopulmonary bypass and both myocardial and visceral ischemia. Effective methods of cerebral, myocardial as well visceral protection are necessary to obtain acceptable results in terms of hospital mortality and morbidity. Moreover, a correct assessment of the anatomy of the dissection, through the preoperative angio CT scan, in addition to the clinical condition of the patients, remain the decision points for the best arch repair strategy to use in AAAD
Reply to "Ismail Selcuk, Baris Durgun, Murat Kadan, Mevlut Kobuk, Ozgur Aykut, Suat Doganci Tailoring the surgical procedure is a delicate process to have optimal gain from the surgery, Ann Thorac Surg, 101(3), 2016"
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The frozen elephant trunk technique: European association for cardio-thoracic surgery position and bologna experience
Full text linkComplex lesions of the thoracic aorta are traditionally treated in 2 surgical steps with the elephant trunk technique. A relatively new approach is the frozen elephant trunk (FET) technique, which potentially allows combined lesions of the thoracic aorta to be treated in a 1-stage procedure combining endovascular treatment with conventional surgery using a hybrid prosthesis. These are very complex and time-consuming operations, and good results can be obtained only if appropriate strategies for myocardial, cerebral, and visceral protection are adopted. However, the FET technique is associated with a non-negligible incidence of spinal cord injury, due to the extensive coverage of the descending aorta with the excessive sacrifice of intercostal arteries. The indications for the FET technique include chronic thoracic aortic dissection, acute or chronic type B dissection when endovascular treatment is contraindicated, chronic aneurysm of the thoracic aorta, and chronic aneurysm o f the distal a rch. T he F ET t echnique i s also i ndicated i n acute type A a ortic dissection, especially when the tear is localized in the aortic arch; in cases of distal malperfusion; and in young patients. In light of the great interest in the FET technique, the Vascular Domain of the European Association for cardio-thoracic Surgery published a position paper reporting the current knowledge and the state of the art of the FET technique. Herein, we describe the surgical techniques involved in the FET technique a nd w e report o ur e xperience with the F ET t echnique f or t he t reatment o f complex aortic d isease of the thoracic aorta
Frozen versus conventional elephant trunk technique: application in clinical practice
No full textSummaryTreating complex aortic arch disease with proximal and distal aortic segment involvement is challenging. In recent years, different surgical and endovascular techniques have been applied in a single or multiple-stage approach with the aim to cure and simplify these conditions. The first procedure available for this purpose was the conventional elephant trunk technique. Its recent evolution is the frozen elephant trunk, which treats the descending thoracic aorta using the antegrade release of a self-expandable stent graft. In the following review article, we analyse the advantages and drawbacks of both techniques from clinical and practical perspectives
Total Arch Replacement Versus More Conservative Management in Type A Acute Aortic Dissection
No full textBackground Surgical management of aortic arch in type A acute dissection (TAAD) is controversial. This study compared short-term and long-term outcomes of total arch replacement (TAR) interventions versus more conservative arch management (CAM). Methods Between 1997 and 2012, 240 patients underwent TAAD surgery in our institution; 53 (22.1%) received TAR and 187 (77.9%) received CAM. Compared with CAM patients, those undergoing TAR were younger (59.1 vs 64.4 years, p = 0.004) and were less likely to present with cardiogenic shock (3.8 vs 14.4, p = 0.02). Distal site of intimal tear (arch or descending aorta) was predictive of TAR management (odds ratio [OR], 9.1; p < 0.001). Results Hospital mortality was similar in the groups (24.1% vs 22.6%; p = 0.45), and no other significant differences were observed in terms of major postoperative complications. Age (OR, 1.047; p = 0.007) and cardiopulmonary bypass time (OR, 1.005 per minute; p = 0.05) emerged as independent predictors of hospital death. The TAR management did not affect hospital mortality (propensity score [PS] adjusted OR: 1.51, p = 0.36). On Kaplan-Meier analysis, 7-year survival (TAR, 52.1% ± 0.9% vs CAM, 57.2% ± 4.2%, log-rank p = 0.9) and freedom from aortic re-intervention (TAR, 71.6% ± 1.3% vs CAM, 85.4% ± 3.9%, log-rank p = 0.3) were similar. The PS-adjusted Cox regression showed no relationship between type of arch management and follow-up survival (hazard ratio [HR], 1.001; p = 0.8) or need for re-intervention (HR, 1.507; p = 0.4). Conclusions In our experience TAR and CAM were associated with similar hospital mortality and morbidity rates. Nevertheless, the more extensive arch interventions were not protective for long-term survival and freedom from aortic re-intervention. Thus, in TAAD patients TAR remains indicated by site of intimal tear and patient-specific factors
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