Prosthetic Graft Dilation at the Aortic Arch in the Era of Hybrid Aortic Surgery

Abstract

Objective: This study aims to evaluate the chronological size changes of the prosthetic graft in the aortic arch, which is used as a landing zone for a subsequent stent grafting in hybrid aortic surgery. Materials and Methods: Eighty-five patients who underwent total aortic arch replacement followed by computed tomography follow-up for at least 30 months after the surgery were included in the study. Results: Prosthetic grafts used were Hemashield (Maquet, Rastatt, Germany), J-Graft (Japan Lifeline Inc., Tokyo, Japan) and Triplex (Terumo, Tokyo, Japan). There was an initial increase in diameter compared to package size after implantation (Hemashield, 1.04±0.035 vs. J-Graft, 1.06±0.027 vs. Triplex, 1.04±0.023, p=0.13). Significant difference in graft dilation ratio was observed in Triplex (1.18±0.062) at long-term compared to Hemashield (1.07±0.052, p<0.001) and J-Graft (1.10±0.071, p<0.001). Multivariate analysis showed that age (r=0.002; 95% confidence interval [CI], 0.0001-0.0037; p=0.035), knitted-type prosthesis (r=0.089; 95% CI, 0.0610-0.1163; p<0.0001), and prevalence of cerebral vascular disease (r=0.038; 95% CI, 0.0030-0.0732; p=0.034) were independently associated with graft dilation after surgery. Conclusion: Prosthetic graft selection and appropriate sizing of the stent graft should be considered for each individual undergoing hybrid aortic surgery to maintain sufficient oversizing of the stent graft.

A Systematic Review of Individualized Heart Surgery with a Personalized Prosthesis

“…The review not only explores the significance of personalization but also delves into the intricacies of the personalization process and the various interventional methods employed and offers a qualitative assessment of its efficacy. Presently, the landscape of cardiovascular intervention devices available in the commercial market remains devoid of individualization [25,37]. Specifically, the vast majority of prosthetic heart valves are offered in a limited range of three or fewer predefined sizes, further compounded by the constraints imposed by the hospital's inventory management system.…”

“…Furthermore, prosthetic devices come in a few predetermined sizes and are offered off-the-shelf during the surgical procedure itself, based on rough eyeballing or subjective assessments [20][21][22][23]. Similarly, aortic surgery and concomitant cardiac procedures like left atrial appendage occlusion are not addressed in precision but rather largely dominated by the standardized prosthesis and subjective assessment [24,25]. Hence, this review of the application of personalization in cardiovascular replacement surgery will help identify opportunities for expanded surgical adaptation and future research directions that can address the rational challenges in this field.…”

Which Gelatin and Antibiotic Should Be Chosen to Seal a Woven Vascular Graft?

“…However, even when using the same plain weaving method, the overall pattern and permeability of the fabric depend on the configuration and density of the fibers in the thread, as well as on the weaving equipment and technique [11]. Knitted prostheses are softer, more flexible, and stretchable compared to woven ones, which, on the one hand, is an advantage, but on the other, often leads to dilatation and aneurysms of the prostheses [8,12].…”