Reoperations on the total aortic arch in 119 patients: Short- and mid-term outcomes, focusing on composite adverse outcomes and survival analysis

Preventza, Ourania; García, Andrea; Cooley, Denton A.; Tuluca, Alexandra; Simpson, Keith; Bakaeen, Faisal G.; Omer, Shuab; Cornwell, Lorraine D.; Rosengart, Todd K.; Coselli, Joseph S.

doi:10.1016/j.jtcvs.2014.06.095

Cited by 23 publications

(21 citation statements)

References 13 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The follow-up data were obtained from clinic visits, telephone conversations with patients, and the Social Security Death Index. Our definitions of cardiopulmonary bypass (CPB) time, cardiac ischemia time, antegrade cerebral perfusion time, and circulatory arrest time are described in previous reports [11], as are our definitions of the preoperative variables (Table 1), operative mortality, stroke, and the composite endpoint (operative mortality or permanent hemodialysis at discharge, or permanent neurologic event) [11,12]. Table 2 shows the intraoperative variables.…”

Section: Methodsmentioning

confidence: 99%

“…It is very important, when we evaluate patients for major proximal reoperation, to be able to estimate not only their mortality risk but also their overall risk of permanent neurologic or renal deficit, which can affect their quality of life. We have previously studied this composite endpoint only in patients who have undergone total arch reoperations [12]. The current study differs from our previous ones in that it is focused solely on hemiarch and total arch repair in patients with previous type I aortic dissection.…”

Section: Commentmentioning

confidence: 96%

“…The axillary, innominate, and femoral arteries were variously used as the cannulation site for arterial inflow; the choice of site depended on the situation. Near-infrared spectroscopy monitoring was used throughout the procedure, as described previously [12].…”

Section: Surgical Techniquementioning

confidence: 99%

“…The steps we use in performing these procedures have been described in detail in previous reports [12,13]. Briefly, when we use the Y-graft, we expose the brachiocephalic vessels during cooling.…”

Section: Surgical Techniquementioning

confidence: 99%

See 3 more Smart Citations

Hemiarch and Total Arch Surgery in Patients With Previous Repair of Acute Type I Aortic Dissection

Preventza

Price

Simpson

et al. 2015

The Annals of Thoracic Surgery

Self Cite

View full text Add to dashboard Cite

show abstract

Section: Methodsmentioning

confidence: 99%

Section: Commentmentioning

confidence: 96%

Section: Surgical Techniquementioning

confidence: 99%

Section: Surgical Techniquementioning

confidence: 99%

See 2 more Smart Citations

Hemiarch and Total Arch Surgery in Patients With Previous Repair of Acute Type I Aortic Dissection

Preventza

Price

Simpson

et al. 2015

The Annals of Thoracic Surgery

Self Cite

View full text Add to dashboard Cite

show abstract

“…These include: a higher surgical risk, the availability, in the acute phase, of surgeons specialized in arch surgery, the real clinical advantage of an immediate radical correction compared to an elective re-operation of selected patients requiring a treatment of the residual thoracic aorta (13)(14)(15).…”

Section: Introductionmentioning

confidence: 99%

Intimal re-layering technique for type A acute aortic dissection—reconstructing the intimal layer continuity to induce remodeling of the false channel

et al. 2018

View full text Add to dashboard Cite

Background: Residual false channel is common after repair of type A acute aortic dissection (TAAAD).Starting from our recent series of TAAAD patients we carried out a retrospective analysis, regarding the failure of primary exclusion at the time of the initial operation. We classified the location of the principal entry tears perfusing the residual false channel. The proposed technique represents our attempt to correct the mechanism of false channel perfusion during primary repair. We describe a new technique designed to address some limitations of standard hemiarch aortic replacement. Its goal are: (I) to reinforce the intimal layer at the arch level; (II) to eliminate inter-luminal communications at the arch level using suture lines around the arch vessels; (III) to provide an elephant trunk configuration for further interventions.Methods: Between August 2016 and January 2018, 11 patients underwent emergency surgery using this technique; 7 were men; the median age was 74 years. All patients were treated using systemic circulatory arrest under moderate hypothermia (26 ℃) and selective cerebral perfusion. All patients had supra-coronary repair; 1 patient had aortic valve replacement + CABG. In the first two patients a manual suture around supra-aortic trunks was used; the subsequent seven patients were treated with a mechanical suture bladeless device. CT scan follow up was performed in all survivors with controls before discharge 3 months and 1 year after operation.Results: No patient died in the operating room and no neurologic deficit was observed in this initial experience. One patient died in POD 5th for low cardiac output syndrome. Median ICU stay was 3 days (IQR, 2-6 days). Hospital mean length of stay was 15.2±8 days. Median cardiopulmonary bypass time was 130 min (IQR, 110-141 min); median arrest time for re-layering was 17 min (IQR, 16-20 min); median total arrest was 36 min (IQR, 29-39 min). Distal aortic anastomosis was performed in zone 0 in 4 patients, zone 1, with innominate replacement, in 5 patients, in zone 2, with branches to innominate and left common carotid arteries, in 2 patients. Median follow up (closing date 06/01/2018) was 443 days (IQR, 262-557 days); no late deaths occurred. No dehiscence at the level of stapler or manual sutures was observed. Proximal 1/3 of the thoracic aorta false channel was obliterated in all cases but one; in 3 cases complete exclusion of the false channel was obtained after operation. In one case stent graft completion was required. Conclusions:This technique combines the advantages of arch replacement to the simplicity of anterior hemiarch repair. This study demonstrates the safety of the procedure and the possibility to induce aortic remodeling without complex arch replacement.

show abstract

Operative Strategien bei Typ-A-Dissektion

Pichlmaier

Reichelt

Günther

et al. 2015

Z Herz- Thorax- Gefäßchir

View full text Add to dashboard Cite

Reoperations on the total aortic arch in 119 patients: Short- and mid-term outcomes, focusing on composite adverse outcomes and survival analysis

Cited by 23 publications

References 13 publications

Hemiarch and Total Arch Surgery in Patients With Previous Repair of Acute Type I Aortic Dissection

Hemiarch and Total Arch Surgery in Patients With Previous Repair of Acute Type I Aortic Dissection

Intimal re-layering technique for type A acute aortic dissection—reconstructing the intimal layer continuity to induce remodeling of the false channel

Operative Strategien bei Typ-A-Dissektion

Contact Info

Product

Resources

About