A most educative cross-Atlantic retrospective study on an always important question. The short accompanying video is also valuable!
This site is not optimized for Internet Explorer 8 (or older).
Please upgrade to a newer version of Internet Explorer or use an alternate browser such as Chrome or Firefox.
Colleagues from Italy and Germany compared the short- and mid-term outcomes of the straight tube graft (David-I) and the Valsalva graft in 232 patients undergoing an isolated David procedure. The two groups did not differ significantly in 30-day mortality (1% vs 2%), late survival (p = 0.799), or valve-related reoperation (p = 0.241). Although with more cusp repairs (22% vs 4%), patients with Valsalva graft showed a higher incidence of aortic insufficiency ≥ II° after surgery (17% vs 0%) and at follow-up (39% vs 22%).
In this brief review, the authors elaborate on status quo of the use of endovascular stent grafts in the management of patients with connective tissue disorders. Because the radial force and circumferential stress on the native aorta remains a signficant issue that leads to stent graft failure, open surgical repair remains the gold standard in most of such patients.
Hansson and colleagues analyzed the effect of preoperative dual antiplatelet therapy on outcomes for patients undergoing surgery for acute aortic dissection type A. Among 1,141 patients with acute type A dissection, 108 had aspirin and clopidogrel, and 11 had aspirin and ticagrelor. Dual antiplatelet therapy led to more bleeding and more transfusions but not to more deaths. However, major bleeding was associated with higher mortality.
This article addresses the controversy surrounding the optimal annular stabilization technique following valve sparing root reconstruction (VSRR) and the lack of comprehensive imaging data in the evaluation of the natural history of aortic root graft geometry, valve competency, and prognosis postreconstruction. Seventy consecutive patients were prospectively enrolled between 2008 and 2017 (mean age 56.4 ± 16.4 years, 19.7% women) for VSRR. Dacron aortic annuloplasty reconstruction was found to be stable over time, without the need for external or internal stabilization.
In this experimental study on segmental artery coil embolization, the authors examined the optimal occlusion pattern to reduce the risk of spinal cord ischemia during thoracoabdominal aortic repair. Von Aspern and colleagues found that staged regional occlusion, with coiling of lumbar arteries first, leads to better perfusion recovery, no neurological deficits, and no cord tissue damage.
Shah V, Orlov O, Orlov C, Plestis K. Type A Dissection Repair Using the Florida Sleeve Technique. July 2019. doi:10.25373/ctsnet.8940038.
A 56-year-old man status post repair of a descending thoracic aortic aneurysm after type B aortic dissection presented with acute type A dissection. The patient had a long history of drug abuse and disclosed using cocaine two days prior to presentation.
A median sternotomy was performed. The right subclavian artery was cannulated using the graft technique. The right atrium was cannulated to establish cardiopulmonary bypass. Epiaortic scanning showed significant clot in the area proximal to the innominate artery.
Deep hypothermic circulatory arrest was initiated at 20˚C. The aorta was then opened and significant clot was removed. The innominate artery was clamped. A balloon-tipped catheter was advanced into the left carotid artery and antegrade cerebral perfusion was started. A 26 mm graft was directly anastomosed to the aorta 1 cm proximal to the innominate artery. The graft was clamped and deaired and rewarming begun. Aortotomy was performed 1 cm above the sinotubular junction. The dissection at the noncoronary and right coronary sinuses was repaired with Teflon felt inserted between the intima and adventitia and secured with BioGlue.
Two openings were created on a 38 mm graft to accommodate the coronary arteries. The 38 mm graft was then cut to the height of the sinotubular junction and anastomosed to the ascending aorta in a continuous fashion. Next, the 26 mm graft was anastomosed to the sleeve graft placed over the aortic root. The patient was weaned off cardiopulmonary bypass and the chest was closed in standard fashion. The patient had an uneventful hospital course and was discharged on the fifth postoperative day. Six months later the patient underwent successful extent III thoracoabdominal aneurysm repair. Two-year follow-up echocardiogram demonstrated trace aortic insufficiency.
The Florida sleeve procedure allows for preservation of the native aortic valve and sinuses in appropriately selected patents. Long-term studies are necessary to assess its durability.
Hess PJ Jr, Klodell CT, Beaver TM, Martin TD. The Florida sleeve: a new technique for aortic root remodeling with preservation of the aortic valve and sinuses. Ann Thorac Surg. 2005;80(2):748-750.
Investigators reported the distribution of thoracic aortic growth in smokers based on longitudinal data of current and ex-smokers aged 50-70 years from the Danish Lung Cancer Screening Trial. Mean and 95th percentile of annual aortic growth of the ascending aortic and descending aortic diameters were calculated with the first and last noncontrast computed tomography scans during follow-up.
Tirone David's experience on his operation, with interesting data on the durability of the re-implantation.
Thoracic stentgrafts are stiffer than the aorta. To understand how this mismatch might affect the left ventricle, van Bakel and colleagues quantified the left ventricular remodeling after thoracic endovascular aortic repair (TEVAR) in 8 patients. They estimated an increase in left ventricular stroke work and found an increase in left ventricular mass after TEVAR. The authors conclude that compliant endografts should be developed to prevent adverse left ventricular remodeling after TEVAR.