PH is a strong short-term negative prognostic factor for patients with mitral regurgitation. The surgical procedure should be performed in the early stages of PH. Echocardiographic examination has useful, simple, and reproducible tools for classifying operative risks. An ischemic etiology and a need for concomitant CABG surgery are additional risk factors for patients with mitral regurgitation and PH.

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Background: Our retrospective single-center study aimed to evaluate the safety of the carotid endarterectomy (CEA) in comparison to patients with untreated asymptomatic carotid stenosis ≥60% before CABG. Methods: This single-center retrospective study included 174 patients with asymptomatic unilateral carotid stenosis treated between 2004 and 2017 with CABG. Thereof 106 patients had CEA before cardiac surgery either by a simultaneous (n = 62) or staged (n = 44) approach. Patients with untreated carotid stenosis served as control (no-CEA group; n = 68). Results: The mean stenosis grade was higher in the CEA group (CEA 83% (±1), no-CEA 71% (±1) p < 0.0001). The overall stroke rate was 5/174 (3%) and was due to a high incidence of stroke in the no-CEA group (CEA: 0/106 (0%); No-CEA 5/68 (7%) p = 0.0083). The overall mortality was 1% and comparable between the groups (CEA: 2/106 (2%); No-CEA 0/68 (0%) p = 0.5211). Stroke related mortality was not observed. The groups were similar regarding the incidence of myocardial infarction (p = 1.0), atrial fibrillation (p = 0.1931), delirium (p = 0.2106) and IMC/ICU stay (p = 0.1542). No significant difference in the subgroup analysis was found between the simultaneous and staged approach regarding the myocardial infarction (simultaneous: 1/62 (1%); staged: 1/44 (1%); p = 1.0). Conclusions: CEA performed as a staged procedure in local anesthesia or a simultaneous procedure in general anesthesia, may reduce the stroke risk prior to CABG.

OBJECTIVES Our aim was to compare aortic remodelling in type B dissections after thoracic endovascular aortic repair (TEVAR) or conservative treatment. METHODS We conducted a retrospective analysis of computed tomography (CT) data sets at dissection onset and at the last follow-up in a group with conservative (group A) and TEVAR treatment (group B). An additional analysis of the preoperative CT images was performed in patients from group A, who were converted to TEVAR during follow-up. Diameters and lengths of all aortic segments were measured and growth rates were calculated. RESULTS We included 74 patients: 50 patients in group A (follow-up time: 1625 ± 209 days) and 24 patients in group B (follow-up time: 554 ± 129 days). The mean aortic diameter growth rate was significantly higher in group A than in group B in the mid-descending aorta (A: +7 mm/year; B: −4 mm/year; P = 0.003). Length growth difference was only present in the abdominal aortic segment and was more pronounced in group A (+2 vs ±0 mm/year; P = 0.009). The conversion rate from conservative treatment to TEVAR was 36% (n = 18). A false lumen diameter of &gt;22 mm at baseline was associated with a higher rate of conversion (P = 0.036). After conversion, the mean growth rate in the proximal descending and mid-descending aorta decreased from preoperative +11 and +18 mm/year to postoperative −9 and −14 mm/year, respectively (P &lt; 0.001). CONCLUSIONS In acute type B dissections, TEVAR stops aortic enlargement in the thoracic aorta, but promotes distal dilatation compared to the conservative treatment group. After conversion to TEVAR in conservatively pretreated chronic type B dissections, a more pronounced diameter decrease in the descending aorta was observed than in patients treated in the acute phase.

Introduction: Iliac artery aneurysms may pose therapeutic challenges when considering an endovascular approach. The ideal treatment scenario involves preservation of both internal and external iliac arteries while ensuring an adequate fixation of the endograft. To this purpose iliac branched devices (IBDs) have been developed with several reports demonstrating good technical results and short-term durability. Distal landing in the internal iliac artery may take place with a balloonexpandable or a self-expandable bridging stent-graft (BSG). Our aim was to report mid-term results of patients treated with IBDs in combination with a self-expandable BSG. Methods: We analyzed a prospectively maintained database including all patients with iliac artery aneurysms that underwent IBD implantation within the period January 2004-January 2014 in a vascular institution experienced in endovascular techniques. Results: A total of 72 patients (66 male, mean age 71 AE 8.1 years) were treated with 89 IBDs in the aforementioned period. In 67 cases (75.3%) treatment was carried out due to a common iliac artery aneurysm, in 5 cases (5.6%) due to an internal iliac artery aneurysm and in 17 cases (19.1%) due to a combination of both. Technical success was achieved in 85 cases (95.5%). In 81 cases self-expandable BSGs were used for the internal iliac artery. Additional endolining of the BSG with a self-expandable stent was carried out in 41/81 (50.6%) cases. In-hospital mortality was 2 patients (2.8%) and perioperative morbidity 6 patients (8.4%). Mean follow-up (FU) was 46.3 AE 15.5 months. An in-stent stenosis of the internal iliac BSG was detected in 3 (3.7%) and an occlusion in another 3 (3.7%) IBDs during FU. Endoleaks were detected in 6 (7.4%) cases, (Type Ib n¼4; Type II n¼2). Reinterventions were carried out in 8 (9.8%) cases due to a stenosis or endoleak. Buttock claudication occurred in 3 patients. Conclusion: Implantation of IBDs for iliac artery aneurysms is associated with low perioperative mortality and morbidity. Mid-term results demonstrate a high patency rate and a low rate of endoleaks and reinterventions for IBDs in combination with self-expandable BSGs for the internal iliac artery.