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Aim: The present study aimed to analyze early and late outcomes after open repair of chronic type B aortic dissection.
Methods: We retrospectively reviewed our cases of open descending thoracic aortic aneurysm (DTAA) with chronic dissection from 1991-2013. Long-term survival and aortic reinterventions were analyzed and patient comorbidities were e...
Contexts in source publication
Context 1
... distal anastomosis was then performed and established, typically using a 3-0 running polyprolene suture. After completion, distal aortic perfusion was initiated via the side arch graft (Figure 6), An aortic clamp was then placed proximally, either proximal or distal to the left subclavian artery (Figure 7). Subsequently, the remaining descending thoracic aorta was opened (Figure 8). ...
Context 2
... distal anastomosis was then performed and established, typically using a 3-0 running polyprolene suture. After completion, distal aortic perfusion was initiated via the side arch graft (Figure 6), An aortic clamp was then placed proximally, either proximal or distal to the left subclavian artery (Figure 7). Subsequently, the remaining descending thoracic aorta was opened (Figure 8). ...
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Objective
This study used data from the Japanese Committee for Stentgraft Management’s national registry, which contained unique surgical data including the surgical timing, anatomical factors, and pathological factors, to reveal the generalized community experience of thoracic endovascular aortic repair (TEVAR).
Methods
The medical background and...
Purpose
Heterozygous pathogenic/likely pathogenic (P/LP) variants in the ACTA2 gene confer a high risk for thoracic aortic aneurysms and aortic dissections. This retrospective multicenter study elucidates the clinical outcome of ACTA2-related vasculopathies.
Methods
Index patients and relatives with a P/LP variant in ACTA2 were included. Data were...
Background
Avoiding various complications is a challenge during re-do thoracoabdominal aneurysm surgery.
Case presentation
A 56-year-old man had undergone surgery for type I aortic dissection four times. The residual thoracoabdominal aortic aneurysm that had severe adhesions to lung parenchyma was resected. Since the proximal anastomotic site was...
Thoracic aortic aneurysms, with an estimated prevalence in the general population of 1%, are potentially lethal, via rupture or dissection. Over the prior two decades, there has been an exponential increase in our understanding of the genetics of thoracic aortic aneurysm and/or dissection (TAAD). To date, 30 genes have been shown to be associated w...
We report a case of intimal injury caused by the occluder device in the false lumen (FL) after treatment of refractory chronic aortic dissection with FL embolization. We speculate that the intimal injury was due to the disproportionate stress from the FL. We covered the new entry by an additional stent graft in the true lumen. The deployment of a s...
Citations
... If the distal tears are located above the abdominal trunk, there is no doubt that it can be repaired in one stage. If the distal tears of the visceral vascular area of abdominal aorta is involved, it is considered that the primary repair of all the tears is too radical and the surgical risk is too high [10,11]. According to previous studies, strict follow-up management can effectively reduce the risk; if there are changes in the disease (rapid dilation of the aorta and organ ischemia) can be timely intervention [9]. ...
Currently, there have been very few reports within the literature which specifically address using fenestrated and branched stent grafts to completely isolate and repair distal entry tears of chronic DeBakey IIIb aortic dissection. This study aimed to evaluate the clinical outcomes of a 3-dimensional (3D) printed aortic model-guided fenestrated stent in the treatment of distal tears of chronic DeBakey IIIb aortic dissection after thoracic endovascular aortic repair (TEVAR). The study was a one-center retrospective study comprising 36 patients who underwent TEVAR and fenestrated endovascular abdominal aortic repair (F-EVAR) between April 2014 and December 2022. Patient data was compiled and analysed for preoperative, intraoperative, and perioperative characteristics. In total, 36 patients (12 females and 24 males) were incorporated into this study. All of the patients included in this study had hypertension, and among them, the leading cause for undergoing II-stage F-EVAR was the progression of a false lumen, accounting for 24 cases (66.7% of the total). The technical success rate was 97.2% and there were no cases of 30-day mortality, myocardial infarction, permanent paraparesis, or organ failure. One year post-F-EVAR treatment, surviving patients showed significant false and true lumen remodelling with 100% complete false-lumen thrombosis. A total of five patients died during the follow-up, two patients died related to aorta complications and three patients died of heart failure, multiple organ failure, or septic shock. II-stage F-EVAR was safe and feasible operation to repair all distal tears of chronic DeBakey IIIb aortic dissection.
... Bicuspid aortic value is the most common congenital lesion in TS (15-30%) while aortic coarctation is the second-most common lesion (7-18%) (3,(19)(20)(21). Acute aortic dissections are up to 100 times more frequent in young individuals with TS compared to population controls and are associated with very high morbidity and mortality (2,(22)(23)(24)(25)(26). TS patients also acquire adult-onset cardiovascular diseases, including coronary artery disease and valvular heart disease, at higherthan-expected rates. ...
Background
To describe short- and mid-term surgical outcomes of patients with Turner syndrome (TS) after cardiovascular interventions.
Methods
All individuals >12 years of age at the time of surgical repair for cardiovascular disease (valve or coarctation repairs, aortic disease, aortic dissection) from 2002 to 2022 were eligible. The primary endpoint was complications or death within 30 days of intervention. Secondary outcomes included late complications and reinterventions within six months. Combined data from the University of Texas Health Science Center at Houston and the Turner Syndrome Society of the United States were included in the analysis.
Results
We identified 22 patients who met the inclusion criterion. The median age was 46 years (range, 21–75 years), with 86% having estrogen replacement therapy. The most common medical condition was hypertension (77%), followed by hypothyroidism (59%). The most frequent indication for surgery was aortic root or ascending aortic aneurysms (68%), followed by symptomatic aortic stenosis in patients with bicuspid aortic valve (64%), coarctation of aorta (45%), and acute aortic dissection (18%). Respiratory complications were the most common (68%). Pleural effusions were the most frequent found sign on imaging studies (68%). Thoracentesis, or chest tube placement, was required in 33% (5/15). Respiratory failure requiring specific support with high flow oxygen and/or thoracentesis occurred in 36% (8/22).
Conclusions
Patients with TS may be at an increased risk for postoperative complications after aortic surgery. Bicuspid aortic valve (59%) and coarctation of the aorta (45%) were the most common congenital malformations among our study group. Our study showed that respiratory complications were the most common, with pleural effusions being the most common post-surgery complication.
... For many years, open surgical repair has been the only therapeutic option for surgical intervention in patients with complicated TBAD. Although it has been used worldwide for decades, there still are some serious postoperative problems, such as renal failure, spinal cord ischemia, blood transfusion, and death [6,7]. Currently, in the treatment of complicated TBAD, thoracic endovascular aortic repair (TEVAR) is considered an attractive alternative because it is less invasive than open surgical repair [8]. ...
Background:
Thoracic endovascular aortic repair is a relatively new technique relative to open surgery, and our aim was to assess whether there is a difference in the risk of common postoperative complications between thoracic endovascular aortic repair and open surgery.
Methods:
The PubMed, Web of Science, and Cochrane library were systematically searched for trials comparing thoracic endovascular aortic repair and open surgical repair from January 2000 to September 2022. Primary outcome was death, other outcomes included common associated complications. Data were combined using risk ratio or standardized mean difference with 95% confidence interval. Funnel plot and egger's test were used for assessing publication bias. The study protocol was registered prospectively with PROSPERO (CRD42022372324).
Results:
This trial included 11 controlled clinical studies with 3667 patients. Thoracic endovascular aortic repair had lower risk of death (risk ratio [RR], 0.59; 95% CI, 0.49 to 0.73; p < 0.00001; I2 = 0), dialysis (RR, 0.55; 95% CI, 0.47 to 0.65; p < 0.00001; I2 = 37%), stroke (RR, 0.71; 95% CI, 0.51 to 0.98; p = 0.03; I2 = 40%), bleeding (RR, 0.44; 95% CI, 0.23 to 0.83; p = 0.01; I2 = 56%), and respiratory complications (RR, 0.67; 95% CI, 0.60 to 0.76; p < 0.00001; I2 = 37%) compared with open surgical repair. In addition, the length of hospital stay was shorter in the thoracic endovascular aortic repair group (SMD, -0.84; 95% CI, -1.30 to -0.38; p = 0.0003; I2 = 80%).
Conclusions:
Thoracic endovascular aortic repair has significant advantages over open surgical repair, in terms of postoperative complications and survival in Stanford type B aortic dissection patients.
... Minimizing ischemic injury during thoracoabdominal aortic aneurysm (TAAA) repair is essential. [1][2][3][4] Here, we describe a new method of open TAAA repair developed and implemented at our center (Federal Center for Cardiovascular Surgery, Perm, Russian Federation) that minimizes visceral organ ischemia. Unlike typical Crawford extent II TAAA open repair, which begins with aortic clamping and proceeds from the proximal to the distal anastomoses, our method reverses the anastomosis order and minimizes aortic clamping. ...
Minimizing ischemic injury during surgical repair of thoracoabdominal aortic aneurysms (TAAAs) is vital for preventing complications such as paraplegia and acute renal failure. In this report, we describe a new technique for TAAA open repair that aims to minimize visceral organ ischemia times. Unlike typical Crawford extent II TAAA open repair, which begins with aortic clamping and proceeds from the proximal to the distal anastomoses, our method reverses the anastomosis order and minimizes aortic clamping.
Between January 2016 and December 2020, we used this approach in 29 patients undergoing TAAA repair. We present one of these cases, a 29‐year‐old patient with progressive aneurysmal dilatation of a DeBakey type III chronic aortic dissection that extended beyond the aortic bifurcation. Our technique reduced aortic cross‐clamping, left heart bypass, and internal organ and spinal cord ischemia times and appears to be safe and effective.
... The "distal first" open surgical repair has been very well described by Estrera et al. [47]. In summary, after exposure of the aorta, this includes the institution of a left heart bypass with distal perfusion of the aorta, opening the distal aorta and creating a fenestration in the dissecting membrane to perfuse both true and false lumina distally. ...
... In the past, high mortality rates and complications were quite frequent [48]. However, with the advent of new techniques, these rates have diminished, but still remain significant: mortality rates of <10% in elective cases; renal failure rates of 8.1%; reintervention for bleeding of 8.1% and spinal cord ischemia of 4.9% [47][48][49]. ...
... On the other hand, there is the notion that recurrent aortic disease may only be managed with surgical resection of the diseased segment, as it obliterates the possibility of aneurysm formation. This opinion has, indeed, a stable background, as freedom from re-intervention in the surgically resected segment reaches 94% in 20 years [47]. Thus, the durability of surgical repair is undisputed. ...
Thoracic aortic dissection (AD) is associated with increased morbidity and mortality. Acute aortic syndrome is the first presentation of the disease in most cases. While acute AD management follows concrete guidelines because of its urgent and life-threatening nature, chronic AD is usually overlooked, although it concerns a wide spectrum of patients surviving an acute event. Acute AD survivors ultimately enter a chronic aortic disease course. Patients with chronic thoracic AD (CTAD) require lifelong surveillance and a proportion of them may present with symptoms and late complications demanding further surgical or endovascular treatment. However, the available data concerning the management of CTAD is sparse in the literature. The management of patients with CTAD is challenging as far as determining the best medical therapy and deciding on intervention are concerned. Until recently, there were no guidelines or recommendations for imaging surveillance in patients with chronic AD. The diagnostic methods for imaging aortic diseases have been improved, while the data on new endovascular and surgical approaches has increased significantly. In this review, we summarize the current evidence in the diagnosis and management of CTAD and the latest recommendations for the surgical/endovascular aortic repair of CTAD.
... Persistent neurological disorders occur in 1.3%, strokes 2.9%, the need for dialysis in 6%. 5-, 10-, 15-, and 20-year survival rates are 72%, 60%, 45%, and 39%, respectively [41]. At the same time, the technique of complete shutdown of the descending aorta from the systemic circulation using the methods of deep hypothermia without applying clamps to it has not lost its relevance [42]. ...
The modern approach to the correction of aortic dissection involves the most complete reconstruction of the entire pathologically altered segment of the vessel, which is often impossible due to the vastness of the lesion and the associated severity of surgery. Reduction of intraoperative trauma can improve survival in the immediate postoperative period, and the completeness of reconstruction to reduce the number of complications and relapses in the long term. In this chapter, the methods of reconstruction of the aorta in case of distal dissection from a conventional open surgery to endovascular techniques, or usage of their combination for minimization of surgical trauma, are reviewed.
... Although open surgery is still the first-choice treatment for post-dissection aortic aneurysm (PDAA), it still requires high technical demands and is also associated with increased mortality and morbidity [5]. Endovascular strategies regarded as less invasive treatment with good early outcomes are suitable for patients unable to tolerate open surgery. ...
Residual patent false lumen (FL) after type B aortic dissection (TBAD) repair is independently associated with poor long-term survival. Open surgery and endovascular repair result in good clinical outcomes in patients with AD. However, both treatments focus on proximal dissection but not distal dissection. About 13.4-62.5% of these patients present with different degrees of distal aneurysmal dilatation after primary repair. Although open surgery is the first-choice treatment for post-dissection aortic aneurysm (PDAA), there is a need for high technical demand since open surgery is associated with high mortality and morbidity. As a treatment strategy with minimal invasion, endovascular repair shows early benefits and low morbidity. For PDAA, the narrow true lumen (TL), rigid initial flap and branch arteries originating from FL have increased difficulties in operation. The aim of endovascular treatment is to promote FL thrombosis and aortic remodeling. Endovascular repair includes intervention from FL and TL sides. TL intervention techniques (parallel stent-graft, branched and fenestrated stent-graft among others) have been proven to be safe and effective in PDAA. Other FL intervention techniques that have been used in selected patients include FL embolization and candy-plug techniques. This article introduces available endovascular techniques and their outcomes for the treatment of PDAA.
... Of note, however, freedom from reoperation on the operated segment was 96.5% at 20 years. 31 Both studies demonstrated the excellent durability of OSR, which to date is unmatched by any form of endovascular treatment. Consistent with these reports, the 30-day mortality rate in the present study was 9%, whereas the overall 1-, 3-,and 5-year survival rates were 83%, 80.9%,and 76.1%, respectively. ...
Background
Patients presenting with descending aortic aneurysms developing after aortic dissection often undergo continued aortic expansion which may require operative interventions to address the risk of aortic rupture. In light of the current advances in various treatment options, including endovascular approaches, we analyzed our experience with open surgical repair (OSR) of aneurysms of the descending aorta following aortic dissection.
Methods
Patients who underwent open repair for aneurysmal changes of the descending aorta after chronic dissection were retrospectively studied. The 30-day operative mortality rate, midterm survival, and major complications were analyzed. Patients were divided into two categories; primary chronic type B aortic dissection and remnant repaired type A aortic dissection (RTAAD).
Results
There were 149 patients with enlargement of the descending thoracic aorta developing after aortic dissection. Of these, 49 patients had medical management, while the remaining 100 patients received OSR. These patients were included in the present analysis. The 30-day mortality and permanent paraplegia rates were 9% and 4%, respectively. The 1-, 3-, and 5-year survival rates were 83%, 80.9%, and 76.1%, respectively. The 1- and 5-year survival rates between the primary chronic type B aortic dissection and remnant RTAAD groups showed no significant between-group differences at 86.7% and 84.3%, and 80% and 71.3%, respectively (P = .289). The overall outcomes of other complications such as renal injury, bleeding reoperation, and extracorporeal membrane oxygenation support showed no significant between-group differences, including an insignificantly higher neurologic complication rate in the remnant RTAAD group. The survival rate in patients with Marfan syndrome was significantly higher than in the patients without Marfan syndrome (P = .033).
Conclusions
OSR for descending aortic aneurysms developing after chronic aortic dissection showed good early and mid- to long-term outcomes, with acceptably low complication rates. OSR for descending aortic aneurysm after chronic aortic dissection associated with Marfan syndrome also showed good early and mid- to long-term outcomes.
... On the contrary, thrombosed false lumen in acute AD shows curvilinear intramural clots, often missing a well-defined outer wall because of mediastinal hematoma and pleural effusions (14). As for aortic diameters, no clear differences were found between patients with IMH or AD, with an average of 5 cm for the ascending aorta and 4 cm in the descending aorta (6,21). ...
... While it was formerly thought that IMH would be less dangerous, several clinical studies have underlined that early and long-term mortality of IMH do not differ from AD (6,11,13). In-hospital mortality varies between 12-26% for type A IMH and AD, and from 5% to 11% for TBIMH and AD (6,11,21). Similar to TAAD, IMH involving the ascending aorta is a lethal condition and is an indication for expeditious surgery because of the risk of cardiac tamponade, rupture or compression of the coronary ostia (6,8,10,11). In particular, IMH concomitant with PAU is associated with an increased risk of expansion and rupture ...
The incidence of intramural hematomas (IMH) in acute dissection (AD) patients varies between 6% and 30% in the literature, most frequently involving only the descending aorta (58%) than the arch or ascending aorta (42%). In this setting, IMH that initiate in the descending aorta, but extend into the arch or ascending aorta have been described, and referred to as a retrograde type A IMH. In these patients the risk of neurological or cardiac complications are high, and therefore an open surgical or hybrid approach has been proposed as the most appropriate. Nevertheless, the endovascular management of such lesions in surgically unfit patients for open surgery have been offered with acceptable outcomes, although the risk of landing in an unsuitable proximal landing zone is evident. In conclusion, retro-TAIMH is an acute aortic syndrome and should be managed as such. The recommended treatment strategy is open surgery for treating ascending or arch involvement, and TEVAR/medical, based on a complication-specific approach, for those with only descending localization. In those patients in whom retro-TAIMH is associated with an acute B dissection presenting with a proximal entry tear located into the descending aorta, a TEVAR represents an option treatment.
... Open surgical repair, on the other hand, can eliminate the risk of aneurysm-related deaths in treated segments [4]. While historical surgical series have demonstrated high mortality rates, contemporary series show more acceptable patient outcomes by improvement in operative technique and surgical modification [4,[20][21][22][23][24][25]. However, paraplegia and paraparesis are still disastrous complications. ...
OBJECTIVES
Aortic repair with aortic tailoring of the false lumen can preserve the true lumen and intercostal arteries naturally. It is a useful surgical strategy to prevent paraplegia. However, aortic remodelling of tailored segments in a late phase after surgery is another concern. This study investigates the destiny of aortic remodelling of tailored aorta.
METHODS
From June 2004 to April 2013, 21 consecutive patients underwent aortic tailoring operation for chronic type B aortic dissecting aneurysm. The mean age at operation was 60 ± 10 years (range, 43–77). The tailored aortic segments were followed by serial CT scanning with the mean follow-up period of 46 ± 32 months (range, 2–103).
RESULTS
There were no operative deaths but paraplegia in 1, stroke in 1 and reversible renal failure in 2 patients. There were two late deaths: one due to pneumonia and the other due to aneurysmal rupture of the abdominal aorta. Eighteen patients revealed a completely thrombosed false lumen and no expansion of the tailored aorta, with it remaining less than 40 mm in diameter during follow-up. However, 3 cases were associated with a patent false lumen and 2 cases revealed aortic events. The aortic event-free rate at 5 years was 95 ± 5.1% in all patients and 66 ± 27% in patients in the patent false lumen group.
CONCLUSIONS
Aortic tailoring is a useful surgical technique for chronic type B aortic dissection. Paraplegia and ischaemia of other visceral organs could less likely occur. Patients with a completely thrombosed false lumen revealed no aortic events; however, a patent false lumen was associated with a high risk of aortic events.
