scholarly journals A Case of Ascending Aorta Replacement for Chronic Aortic Dissection by Minimally Invasive Cardiac Surgery

2015 ◽  
Vol 44 (5) ◽  
pp. 266-270
Author(s):  
Yoshiki Endo ◽  
Keita Kikuchi ◽  
Kotaro Suzuki ◽  
Takayoshi Matsuyama ◽  
Dai Une ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Aortic Dissection ◽  
Minimally Invasive ◽  
Ascending Aorta ◽  
Minimally Invasive Cardiac Surgery ◽  
Chronic Aortic Dissection ◽  
Aorta Replacement ◽  
Ascending Aorta Replacement

scholarly journals Type A aortic dissection in aneurysms having modelled pre-dissection maximum diameter below 45 mm: should we implement current guidelines to improve the survival benefit of prophylactic surgery?

2020 ◽  
Author(s):  
Piergiorgio Tozzi ◽  
Ziyad Gunga ◽  
Lars Niclauss ◽  
Dominique Delay ◽  
Aurelian Roumy ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Survival Benefit ◽  
Type A ◽  
Ascending Aorta ◽  
Aortic Diameter ◽  
Maximum Diameter ◽  
Type A Aortic Dissection ◽  
Aorta Replacement ◽  
Current Guidelines ◽  
Ascending Aorta Replacement

Abstract OBJECTIVES Current guidelines recommend prophylactic replacement of the ascending aorta at an aneurysmal diameter of >55 mm to prevent acute Type A aortic dissection (TAAD) in non-Marfan patients. Several publications have challenged this threshold, suggesting that surgery should be performed in smaller aneurysms to prevent this devastating disease. We reviewed our experience with measuring aortic size at the time of TAAD to validate the existing recommendation for prophylactic ascending aorta replacement. METHODS All patients who had been admitted for TAAD to our emergency department from 2014 to 2019 and underwent ascending aorta replacement were included. Marfan patients were excluded. The maximum diameter of the dissected aorta was measured preoperatively using CT scan. We estimated the aortic diameter at the time of dissection to be 7 mm smaller than the measured maximum diameter of the dissected aorta (modelled pre-dissection diameter). RESULTS Overall, 102 patients were included. Of these, 67 were male (65.6%) and 35 were female (34.4%), and the cohort’s mean age was 65 ± 12.1 years. In addition, 66% were treated for arterial hypertension. The mean maximum modelled pre-dissection diameter was 39.6 ± 4.8 mm: 39.1 ± 5.1 mm in men and 40.7 ± 2.8 mm in women (P = 0.1). The cumulative 30-day mortality rate was 19.6% (20/102). CONCLUSIONS TAAD occurred at a modelled aortic diameter below 45 mm in 87.7% of our patients. Therefore, the current aortic diameter threshold of 55 mm excludes ∼99% of patients with TAAD from prophylactic replacement of the ascending aorta. The maximum diameter of the ascending aorta warrants reappraisal and this parameter should be a distinct part of a personalized decision-making process that also takes into account age, gender and body surface area to establish the surgical indication for preventive aorta replacement aimed to improve the survival benefit of this procedure.

Comparison of the Efficacy of Transthoracic Cannulation into the Ascending Aorta Versus Femoral Artery Cannulation in Minimally Invasive Cardiac Surgery

2019 ◽  
Vol 14 (6) ◽  
pp. 537-544
Author(s):  
Hiroyuki Nakajima ◽  
Akitoshi Takazawa ◽  
Chiho Tounaga ◽  
Akihiro Yoshitake ◽  
Masato Tochii ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Aortic Valve ◽  
Minimally Invasive ◽  
Femoral Artery ◽  
Skin Incision ◽  
Ascending Aorta ◽  
Minimally Invasive Cardiac Surgery ◽  
Atrial Septal Defect Closure ◽  
Artery Cannulation ◽  
Artificial Graft

Objective To delineate the efficacy and safety of transthoracic cannulation to the ascending aorta through a right pleural cavity during minimally invasive cardiac surgery (MICS). Methods We retrospectively assessed the records of 104 patients who underwent MICS in our institution between December 2011 and December 2018. Procedures included mitral valve repair (88 patients), aortic valve replacement (8 patients), atrial septal defect closure (6 patients), and myxoma resection (2 patients). Aortic valve replacements were performed through the third intercostal space (ICS), whereas the other procedures were mainly performed through the fourth ICS. The femoral group comprised 60 patients in whom an artificial graft was anastomosed to the femoral artery and 4 who underwent cannulation into the femoral artery. The aorta group comprised 40 patients in whom transthoracic cannulation was performed through the second or third ICS, separate from the main skin incision. Results No mortality or critical complications were associated with cardiopulmonary bypass. Perfusion pressure measured at outflow of the artificial lung (224 ± 43 vs. 190 ± 42; P < 0.001) and pump pressure measured at the outflow of the pump (293 ± 50 vs. 255 ± 57; P < 0.001) were significantly higher in the femoral group than in the aorta group. The skin incision lengths were similar (56.9 ± 6.9 vs. 55.1 ± 6.0 mm; P = 0.107). Conclusions Transthoracic cannulation into the ascending aorta is reliable and can be safely performed. The possible risks associated with peripheral cannulation and retrograde perfusion can be avoided thereafter.

Subcapsular hepatic hematoma as a complicating cardiac surgery

2021 ◽  
pp. 021849232110691
Author(s):  
Shintaro Takago ◽  
Satoru Nishida ◽  
Yukihiro Noda ◽  
Toru Yamamoto
Keyword(s):  
Atrial Fibrillation ◽  
Cardiac Surgery ◽  
Aortic Valve ◽  
Ascending Aorta ◽  
Aortic Valve Insufficiency ◽  
Ascending Aortic Aneurysm ◽  
Hepatic Hematoma ◽  
Valve Insufficiency ◽  
Aorta Replacement ◽  
Ascending Aorta Replacement

An 80-year-old woman was hospitalized for aortic valve insufficiency, paroxysmal atrial fibrillation, and ascending aortic aneurysm. She underwent aortic valve replacement, pulmonary vein isolation, left atrium appendectomy, and ascending aorta replacement. She developed a subcapsular hepatic hematoma during the surgery. The patient was managed conservatively and discharged successfully.

Ascending aorta replacement and local repair of tear site in type a aortic dissection with arch tear

2003 ◽  
Vol 75 (6) ◽  
pp. 1785-1790 ◽  
Author(s):  
Kay-Hyun Park ◽  
Kiick Sung ◽  
Kwhanmien Kim ◽  
Tae-Gook Jun ◽  
Young Tak Lee ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Type A ◽  
Ascending Aorta ◽  
Local Repair ◽  
Type A Aortic Dissection ◽  
Aorta Replacement ◽  
Ascending Aorta Replacement

scholarly journals Intimal Flap Vegetation Following Aortic Root Re-dissection

Aorta ◽  
2016 ◽  
Vol 04 (01) ◽  
pp. 22-24
Author(s):  
Hiroaki Osada ◽  
Hiroyuki Nakajima ◽  
Katsuaki Meshii ◽  
Motoaki Ohnaka
Keyword(s):  
Infective Endocarditis ◽  
Aortic Dissection ◽  
Ascending Aorta ◽  
Acute Type ◽  
Sinus Of Valsalva ◽  
Type A Aortic Dissection ◽  
Intimal Flap ◽  
Prophylactic Measures ◽  
Aorta Replacement ◽  
Ascending Aorta Replacement

AbstractA 75-year-old man who had undergone ascending aorta replacement for acute Type A aortic dissection presented with a recurring high fever. Transesophageal echocardiography revealed that a vegetation had formed on the re-dissected intimal flap of the noncoronary sinus of Valsalva. This didactic case suggests that antibiotic prophylactic measures be considered for aortic dissection flaps as for irregular valves susceptible to infective endocarditis.

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