Aortic arch surgery in octogenarians: is it justified?

Size: px
Start display at page:

Download "Aortic arch surgery in octogenarians: is it justified?"

Transcription

1 European Journal of Cardio-Thoracic Surgery 46 (2014) doi: /ejcts/ezu056 Advance Access publication 28 February 2014 ORIGINAL ARTICLE a Aortic arch surgery in octogenarians: is it justified? Hiroshi Kurazumi a, Akihito Mikamo a, *, Tomoaki Kudo a, Ryo Suzuki a, Masaya Takahashi a, Bungo Shirasawa a, Nobuya Zempo b and Kimikazu Hamano a Department of Surgery and Clinical Science, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi, Japan b Division of Vascular Surgery, Yamaguchi Prefecture Grand Medical Center, Hofu, Yamaguchi, Japan * Corresponding author. Department of Surgery and Clinical Science, Yamaguchi University Graduate School of Medicine, Minami-Kogushi, Ube, Yamaguchi , Japan. Tel: ; fax: ; mikamo@yamaguchi-u.ac.jp (A. Mikamo). Received 12 September 2013; received in revised form 31 December 2013; accepted 20 January 2014 Abstract OBJECTIVES: Elderly patients are sometimes denied aortic arch surgery because of the perception of poor outcomes and an unacceptable quality of life (QOL). In this study, we evaluated the early clinical outcomes, long-term survival and QOL following surgical treatment for aortic arch disease in octogenarian patients. METHODS: A total of 47 consecutive patients over the age of 80 years were referred to our institutions. Of these patients, 20 underwent surgical intervention (surgical group) and 27 were treated medically (medical group). Kaplan Meier survival analysis was performed between the two groups, and the results were compared with age-matched population data. The risk factors for mortality were determined using a Cox regression analysis. A QOL assessment was performed using the 36-item Short Form Health Survey. RESULTS: The patient characteristics at baseline were not significantly different between the two groups. In the surgical cases, conventional total aortic arch replacement was performed in 15 patients, debranched thoracic endovascular aortic repair (TEVAR) in 2 and chimney TEVAR in 3. Emergency procedures were performed in 3 patients. No hospital deaths occurred in the surgical groups. Reoperation for bleeding was required in 2 patients, and prolonged mechanical ventilation was required in 4 patients. The 5-year survival was 61.5% in the surgical group and 14.2% in the medical group (P = 0.02). Freedom from aorta-related death at 5 years was 92.3% in the surgical group and 32.3% in the medical group (P = 0.01). There were no differences in the 5-year survival between patients undergoing surgical intervention and the sex- and age-matched population (P = 0.80), whereas the 5-year survival was significantly lower in patients who received medical therapy relative to the sex- and age-matched population (P < 0.001). Medical therapy was the sole risk factor for mortality (hazard ratio: 3.16, P = 0.04). Among the survivors at mid-term, the quality-of-life measures were similar between those in the surgical group and those in the medical group. CONCLUSIONS: Surgical intervention for aortic arch disease in octogenarians can yield satisfactory early clinical outcomes and acceptable mid-term survival with adequate daily activity. This study indicates that among octogenarians, age alone should not disqualify a patient from receiving an aortic arch intervention. Keywords: Octogenarians Aortic arch disease Total arch replacement INTRODUCTION The progress and development of medical therapy have contributed to increasing lifespan all over the world, which has significantly increased the number of people over the age of 80 years [1]. With this aging of the population and the greater use of diagnostic modalities, such as computed tomography (CT), magnetic resonance imaging and echocardiography, the diagnosis of asymptomatic aortic aneurysm is becoming increasingly common. Elderly patients often present with additional comorbid conditions, and past reports have indicated that cardiac surgery in elderly patients is associated with significant operative mortality Presented at the Postgraduate Course of the 27th Annual Meeting of the European Association for Cardio-Thoracic Surgery, Vienna, Austria, 6 October and morbidity, as well as prolonged in-hospital treatment [2 4]. Cardiovascular surgeons often hesitate to perform aortic arch surgery on elderly patients, assuming poor clinical outcomes, because thoracic aortic surgery is thought to be a more invasive procedure relative to other types of cardiac surgery. Consequently, elderly patients might be denied aortic arch surgery despite the risk of sudden death due to the rupture of aneurysm. During the last decade, progress in the perioperative management, advances in the operative technique and the development of less invasive procedures (e.g. thoracic endovascular aortic repair (TEVAR)) have encouraged surgeons to more frequently perform aortic arch surgery on elderly patients. The purpose of this study is to justify surgical intervention for octogenarians suffering from aortic arch disease. The Author Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

2 H. Kurazumi et al. / European Journal of Cardio-Thoracic Surgery 673 PATIENTS AND METHODS All procedures were approved by the Institutional Review Board of Yamaguchi University Hospital, and the study was conducted in accordance with the Declaration of Helsinki. Patients Consecutive 49 octogenarians who were referred to our institution for the treatment of aortic arch disease from August 2003 to August 2012 were enrolled in this study. The inclusion criteria for aortic arch lesion were defined as aneurysm diameter 60 mm, saccular aneurysm or impending rupture/rupture of aneurysm. Only the patients who required surgical reconstruction of their arch vessels were enrolled in this study, and patients who did not need surgical reconstruction of their arch vessels were excluded from this study, i.e. those who suffered from a distal arch aneurysm. Octogenarians who appear clinically frail are excluded from this study. All patients were discussed at a joint meeting of cardiologists and cardiovascular surgeons regarding the indications for intervention for their aortic arch disease. The surgeon met with all patients, both in the medical group and in the surgical group, and the patients provided adequate informed consent for the choice of surgical intervention or medical therapy, and the decisionmaking for the treatment was done under the instruction of patients and their families. Two patients were denied the operation by surgeons, because one had severe dementia and the other suffered from lung cancer on terminal stage, and they were excluded from this study. A total of 20 patients chose surgical intervention as the treatment for their aortic arch disease (the surgical group) and 27 patients underwent medical therapy (the medical group). Details of trial enrolment are shown in Fig. 1. All 27 patients in the medical group independently chose medical therapy despite receiving a recommendation from the surgeons for surgical therapy. In the surgical group, patients who were deemed not suitable for an open operation with full cardiopulmonary bypass and circulatory arrest had a debranching TEVAR or a chimney TEVAR. In the medical group, patients were administered antihypertensive agents, i.e. beta-blockers, angiotensinconverting enzyme inhibitors, angiotensin receptor blockers or calcium blockers, according to the guidelines for the management of aortic aneurysm and aortic dissection patients [5]. Operative procedures Of the 20 patients in the surgical group, 15 received open conventional aortic repair with cardiopulmonary bypass (CPB). Open surgery was performed through a median sternotomy under general anaesthesia. An arterial cannula was directly inserted to the bilateral axillary artery, and bicaval venous drainage with ventricular venting was routinely performed. Cold-blood cardioplegia was administered antegrade via the aortic root with an ascending aortic clamp or coronary perfusion. After inducing hypothermic circulatory arrest (rectal temperature <25 C), antegrade selective cerebral perfusion (ASCP) was initiated. Open distal anastomosis was first performed during hypothermic lower body circulatory arrest (LBCA). The circumferential pledgeted mattress sutures were performed in addition to a running suture for deep distal aortic anastomosis and graft graft anastomosis to reinforce the distal anastomosis and to avoid surgical bleeding from it. A quadrifurcated Dacron arch graft was used to repair the aortic aneurysm. Circulation of the lower body was resumed from a branch of the arch graft. The three arch vessels were reconstructed individually, and the proximal aortic anastomosis was then performed. Five of the 20 patients received TEVAR using a debranching or chimney technique to reconstruct the arch vessels without CPB. Two patients received debranching TEVAR; 1 patient underwent a right subclavian artery to the left carotid artery bypass before TEVAR, and the other patient underwent an ascending aorta to the bilateral subclavian artery and right carotid artery bypass before TEVAR. The other 3 patients received chimney TEVAR; chimney graft was applied to the brachiocephalic artery, left carotid artery or left subclavian artery to restore upper body circulation. In all TEVAR procedures, a GORE TAG thoracic endoprosthesis device (W. L. Gore and Associates, Flagstaff, AZ, USA) was used to avoid thoracic aortic aneurysms. Assessment of early clinical outcomes Operative mortality was defined as any death occurring within 30 days of the operation or any death during hospital stay after the operation. The postoperative course was followed up in terms of ICU stay, postoperative hospital stay, neurological events, renal status, respiratory status, bleeding and deep sternal infection. Prolonged ventilation was identified as intubation time 24 h. Assessment of late clinical outcomes To assess the late clinical outcomes, we investigated the overall survival, freedom from an aorta-related death and freedom from an aortic event. The follow-up rate was 100%. Aortic events were identified as aortic rupture/dissection, sudden death and reoperation/reintervention for aortic disease. The follow-up data were collected by reviewing the hospital charts and telephone questionnaires. The mean follow-up period was 23.2 ± 22.6 months (median: 46.8 months). AORTIC SURGERY Figure 1: Trial enrolment. A total of 49 patients were enrolled between August 2003 and August Assessment of health-related quality of life The mid-term survivor patients of the present study completed the 36-item Short Form Health Survey (SF-36) to assess their health-related quality of life (HRQOL). This instrument is a generic health profile with eight scales measuring the following domains of

3 674 H. Kurazumi et al. / European Journal of Cardio-Thoracic Surgery health: physical functioning, role-physical, bodily pain, general health, vitality, social functioning, role-emotional and mental health. These scales can be aggregated into the physical component summary (PCS) and mental component summary (MCS). The PCS is an overall assessment of physical health that includes functioning and evaluation of one s ability to perform physical tasks. The MCS is an overall measurement of mental health, consisting of an assessment of psychological distress and well-being, social and role functioning and overall vitality. Scoring of the SF-36 is standardized and norm-based, with a mean of 50 (10 standard deviation (SD)) for the PCS and MCS within the Japanese general population. A higher score suggests a better HRQOL. The HRQOL questionnaire was sent in August At that time, 28 patients had survived and 19 patients were already dead. The questionnaire was sent to all 28 surviving patients, and we received 16 answers (response rate 57.1%). The HRQOL was evaluated 31.7 ± 26.1 months after choosing a treatment. Statistical analysis Results of continuous data are expressed as the mean ± SD. For the continuous data, the differences were evaluated using the Student s t-test. For the categorical data, the differences were evaluated using the χ 2 and Fisher exact tests. Time-to-event analyses were performed using Kaplan Meier estimates and then compared between groups using the log-rank test. Independent predictors of overall survival were examined using Cox regression analysis. The multivariable models included covariates with a P-value of <0.10 in the univariate analyses. All statistical analyses, except analysis between the estimated survival curve and the predicted survival curve, were performed using the StatView software (version 5.0). Predicted survival was calculated from sex- and agematched Japanese populations based on the Japanese abridged life tables published by the Ministry of Health, Labour and Welfare in Japan ( Statistical analysis between the estimated survival curve and the predicted survival curve was performed using Greenwood analysis manually. RESULTS Patient population and operative data Patient clinical profiles are given in Table 1. In the surgical group, 3 patients received emergent operations due to ruptured or impending ruptured aneurysm, whereas the medical group did not include any emergent cases. Although the differences were not statistically significant, the surgical group included more urgent/emergent cases, and patients in the medical group were 2 years older than those in the surgical group. Operative procedures and intraoperative parameters are given in Table 2. In the surgical group, 15 of the 20 patients received conventional open aortic graft replacements using CPB. The other 5 patients received TEVAR-related procedures. Almost all patients in the medical group presented with asymptomatic aortic arch aneurysm, which was diagnosed by chance upon CT scan. Early operative outcomes Perioperative complications and in-hospital status in the surgical group are given in Table 3. No hospital deaths occurred in the surgical groups. The duration of ICU stay was 3.4 ± 3.2 days (median: 7, 25th percentile: 4, 75th percentile: 10), and that of the postoperative hospital stay was 20.3 ± 18.1 days (median: 46, 25th percentile: 24, 75th percentile: 68). One patient in the surgical group was transferred to another hospital for rehabilitation because the activity of daily life was severely affected due to perioperative muscle weakness. Stroke, myocardial infarction, newly required haemodialysis and deep sternum infection were not observed. Reoperation for bleeding was required for 2 patients. One was bleeding from the vasa vasorum of residual excluded aneurysmal wall, and the other was bleeding from the free wall of the left ventricular (LV) due to an injury by the venting tube, which was inserted in the vein to LV via the left upper pulmonary artery. Of the 20 patients, 4 required prolonged ventilation for >24 h, and 1 patient required a tracheotomy due to respiratory failure. One patient was transferred to another hospital for rehabilitation because of severely affected activities of daily life due to perioperative muscle weakness. The rate of return to preoperative social activities was 95% (19/20). Late clinical outcomes Overall survival was significantly higher in the surgical group. Five-year survival was 61.5% in the surgical group and 13.6% in the medical group (P = 0.02), which is shown in Fig. 2A. We observed 4 late deaths in the surgical group and 14 in the medical group. In the surgical group, 1 patient died from a rupture of a thoracoabdominal aortic aneurysm 11 months after the total aortic replacement. However, in the medical group, 10 patients died from ruptures of aortic aneurysms. In the surgical group, 1 patient died from pneumonia, 1 from cancer and 1 from pancreatitis. In the medical group, 2 patients died from pneumonia, 1 from heart failure and 1 from aging. In addition, the freedom from aorta-related death and aortic event at 5 years was significantly higher in the surgical group. As Table 1: Patient characteristics Patient characteristics and clinical profiles Surgical group (n = 20) Medical group (n = 27) P-value Age (years) 82.6 ± ± Female (%) 5 (25) 8 (30) Aneurysm diameter (mm) 67.4 ± ± Saccular aneurysm (%) 4 (20) 4 (15) Hypertension (%) 16 (80) 15 ( Diabetes mellitus (%) 1 (5) 2 (7) >0.999 Dyslipidaemia (%) 4 (20) 5 (19) >0.999 Smoking history (%) 7 (35) 9 (33) >0.999 Coronary artery disease (%) 2 (10 5 (19) Peripheral vascular disease (%) 3 (15) 5 (19) >0.999 CVD (%) 2 (10) 3 (11) >0.999 Renal dysfunction (%) 0 (0) 3 (11) HD (%) 0 (0) 1 (4) >0.999 COPD (%) 2 (10) 3 (11) >0.999 Marfan syndrome (%) 0 (0) 0 (0) >0.999 Urgent/emergent (%) 3 (15) 0 ( JapanSCORE (%) 11.9 ± ± Logistic EuroSCORE (%) 21.2 ± ± A P-value less than 0.05 was considered statistically significant. CVD: cerebrovascular disease; HD: haemodialysis; COPD: chronic obstructive pulmonary disease; EuroSCORE: European system for cardiac operative risk evaluation.

4 H. Kurazumi et al. / European Journal of Cardio-Thoracic Surgery 675 Table 2: Operative procedures performed in the surgical group and the intraoperative data Open conventional aortic repair (n = 15) TEVAR-related procedure (n = 5) Total arch replacement 14 Debranching TEVAR 2 Hemiarch replacement 1 Chimney TEVAR 3 Operation time (min) 610 ± 126 Operation time (min) 330 ± 148 Blood loss (g) 982 ± 663 Blood loss (g) 527 ± 451 CPB (min) 311 ± 69 Aorta clamp time (min) 228 ± 69 ASCP (min) 151 ± 54 LBCA (min) 111 ± 40 Lowest rectal temperature ( C) 22.0 ± 1.9 Concomitant AVR 3 Concomitant CABG 4 Proximal landing Zone 0 Zone 1 Zone CPB: cardiopulmonary bypass; ASCP: antegrade selective cerebral perfusion; LBCA: lower body circulatory arrest; AVR: aortic valve replacement; CABG: coronary artery bypass grafting. Table 3: Postoperative early clinical outcomes Outcomes Surgical group (n = 20) Hospital mortality (%) 0 (0) Intensive care unit stay (days) 3.4 ± 3.2 Postoperative hospital stay (days) 20.3 ± 18.1 Stroke (%) 0 (0) Myocardial infarction (%) 0 (0) New requirement of haemodialysis (%) 0 (0) Prolonged ventilation (>24 h) (%) 4 (20) Tracheotomy (%) 1 (5) Bleeding requiring reoperation (%) 2 (10) Deep sternal infection (%) 0 (0) shown in Fig. 2B and C, freedom from aorta-related death and aortic events were 92.3 and 86.3% in the surgical group and 32.3 and 32.3% in the medical group, respectively. Five-year survival of the patients undergoing surgical intervention was similar to that of the sex- and age-matched Japanese population (P = 0.807). However, the 5-year survival was significantly lower in patients who received medical therapy relative to the sex- and agematched Japanese population (P < 0.001), as shown in Fig. 2D. Risk factor assessment for mortality We also analysed the risk factors for mortality using Cox s proportional hazard models, which is given in Table 4. The univariate analysis revealed two risk factors: medical therapy and renal dysfunction. In the multivariate analysis, medical therapy was the sole risk factor for mortality (hazard ratio: 3.169, 95% confidence interval (CI) , P = 0.042). Health-related quality of life assessments We assessed the HRQOL of the survivors of this study using the SF-36 questionnaire. HRQOL was evaluated at 31.7 ± 26.1 months after making the choice of which treatment to receive. None of the HRQOL scores were significantly different between the two groups. The PCS was 50.4 ± 13.8 in the surgical group and 41.9 ± 12.8 in the medical group (P = 0.311). The MCS was 52.0 ± 8.9 in the surgical group and 50.4 ± 14.2 in the medical group (P = 0.798). Both the physical and mental summarized scores were similar between the groups (Table 5). DISCUSSION The number of cardio and thoracic aortic surgical procedures in patients 80 years of age or older is increasing, as lifespan expands across the world. In past decades, investigators reported the clinical outcomes of cardiac surgery for elderly patients, with hospital mortality rates that ranged from 3.2 to 18.9%, which are higher than those for younger patients [2, 3, 6 8]. Prior studies have identified the elderly as an at-risk population during major cardiac operations. However, favourable surgical outcomes were recently reported even in nonagenarians [9, 10]. Abel et al. [11] reported clinical outcomes in octogenarians after cardiac surgery, concluding that age is not an independent risk factor for hospital mortality. Tang et al. reported the excellent surgical outcomes for acute type A aortic dissection in octogenarians (operative mortality rate: 0%), concluding that surgery should be offered for acute type A aortic dissection even in the elderly population [12]. In this study, we failed to observe any hospital mortality or fatal sequelae, and the majority of the patients returned home after thoracic aortic surgery. Although advanced age may be an independent risk factor for operative mortality, we think that the operation should still be performed if the patients will receive obvious benefits from the surgical treatments. The other concern regarding surgical treatment for elderly patients is the postoperative HRQOL. The HRQOL assessment after cardiac surgery in elderly patients has been addressed in a few studies, which have invariably reported favourable results with negative effects in only a small subset of studies [10]. Grady et al. [13] reported the transition of the HRQOL after isolated cardiac operations. They found that the physical and mental components of the SF-36 improved from baseline within 3 6 months postoperatively and remained stable for 3 years. Caceres et al. [10] reported that elderly patients undergoing cardiac surgery AORTIC SURGERY

5 676 H. Kurazumi et al. / European Journal of Cardio-Thoracic Surgery Figure 2: Estimated time to event curve predicted using the Kaplan Meier method in octogenarian patients undergoing surgical and medical therapy. Survival curves of the surgical group are represented by a red solid line, and those of the medical group are represented by a blue solid line. Predicted survival curves of the surgical group and medical group, which were calculated relative to a sex- and age-matched Japanese general population, are represented by a red dashed line and a blue dashed line, respectively. ES: estimated survival; PS: predicted survival. Table 4: Risk factor analysis for mortality Univariate Multivariate Hazard ratio (95% CI) P-value Hazard ratio (95% CI) P-value Age ( ) Female gender ( ) Aneurysm diameter ( ) Saccular aneurysm ( ) Hypertension ( ) Diabetes mellitus ( ) Smoking history ( ) CAD ( ) CVD ( ) Renal dysfunction ( ) ( ) COPD ( ) Urgent/emergent ( ) Medical therapy ( ) ( ) CI: confidence interval; CAD: coronary artery disease; CVD: cerebrovascular disease; COPD: chronic obstructive pulmonary disease. are highly symptomatic and have severely limited preoperative HRQOL; consequently, by easing their cardiac symptoms, surgical treatment is thought to improve their HRQOL despite the higher operative risk. However, most patients with thoracic aortic aneurysm do not present any symptoms, suggesting that invasive therapy, such as total arch replacement, incurs the risk of severely affecting the postoperative activity of daily life compared with the preoperative state. We assessed the HRQOL using the SF-36 questionnaire at 31.7 ± 26.1 months after the choice was made regarding treatment. Although we were only able to evaluate the HRQOL in the survivors of this study, and the pretreated assessment of the HRQOL was lacking, the HRQOL scores were not significantly different between the surgical group and the medical group. As 1 patient in the surgical group was transferred to another hospital for rehabilitation due to severely affected activities of daily life resulting from perioperative muscle weakness, the rate of return to preoperative social activities was 95% (19/20) in this study. These results appear to indicate an acceptable outcome in terms of the postoperative HRQOL. In this study, 15 of 20 patients in the surgical group received open conventional aortic arch repair with CPB. Generally, total arch replacement is thought to be one of the most invasive thoracic aortic surgeries. Previous reports revealed that the early mortality following aortic arch surgery is % [14, 15]. However, the early outcome for thoracic aortic surgery has been greatly

6 H. Kurazumi et al. / European Journal of Cardio-Thoracic Surgery 677 Table 5: HRQOL scores among the survivors who completed the SF-36 questionnaire Quality-of-life score components Surgical group (n = 10) Medical group (n =6) P-value Physical functioning 42.3 ± ± Role-physical 44.6 ± ± Bodily pain 53.7 ± ± Social functioning 49.9 ± ± General health 50.8 ± ± perceptions Vitality 46.7 ± ± Role-emotional 50.9 ± ± Mental health 54.6 ± ± PCS 50.4 ± ± MCS 52.0 ± ± HRQOL: health-related quality of life; SF-36: 36-item Short Form Health Survey; PCS: physical component summary; MCS: mental component summary. improved in recent years [16 18]. Additionally, less invasive procedures, such as debranching TEVAR or chimney TEVAR, can also be indicated for aortic arch aneurysm, although this technique remains under development [19]. The progress of open repair and the introduction of less invasive procedures encourage surgeons to perform surgical intervention for aortic arch disease in high-risk patients. Indeed, predicted survival in the surgical group, calculated according to the logistic European system for cardiac operative risk evaluation, was 21.2 ± 11.8%, suggesting that surgical treatment was worthwhile for the high-risk patients. Further progress of aortic surgery will lead to the widespread application of surgical intervention for high-risk patients in the near future. In our series, the CPB, ASCP and LBCA times were longer than those observed in previous reports, although our operative results were satisfactory. Corvera and Fehrenbacher [20] reported excellent results with no mortality after extensive arch and thoracic aortic surgery that required 5 h of CPB in their selected cohort. We believe that a prolonged CPB due to problems with aortic anastomosis and perfusion may be associated with high postoperative mortality and morbidity. Prolonged CPB in the absence of procedural or perfusion problems might be of little consequence in itself. The durations of CPB and ASCP in our surgery were mainly dependent on the LBCA time. In our practice, reasons for the long LBCA duration might include circumferential pledgeted mattress sutures in addition to a running suture for the deep distal aortic anastomosis and graft graft anastomosis (stepwise method). We believe that the most important goal for thoracic aortic surgery is to avoid surgical bleeding after repair. This study has several limitations. It is a retrospective study from only two hospitals, and the number of patients enrolled was small because our hospital is not a high-volume centre. The renal dysfunction was only observed in the medically treated group; therefore, the hazard ratio may not extrapolate to the surgically treated group. The hazard ratio might be inaccurate because of the insufficient number of patients. Patients in the early phase of this study were not given the option to receive the TEVAR-related procedure because TEVAR devices had not yet become commercially available in our country. In conclusion, surgical intervention for aortic arch disease can yield satisfactory clinical outcomes and mid-term survival with adequate daily activity in octogenarians. This study indicates that age alone should not be a disqualifying factor for aortic arch intervention in octogenarian patients. Conflict of interest: none declared. REFERENCES [1] Salomon JA, Wang H, Freeman MK, Vos T, Flaxman AD, Lopez AD et al. Healthy life expectancy for 187 countries, : a systematic analysis for the Global Burden Disease Study Lancet 2013;380: [2] Asimakopoulos G, Edwards MB, Taylor KM. Aortic valve replacement in patients 80 years of age and older: survival and cause of death based on 1100 cases: collective results from the UK heart valve registry. Circulation 1997;96: [3] Salazar E, Torres J, Barragán R, López M, Lasses LA. Aortic valve replacement in patients 70 years and older. Clin Cardiol 2004;27: [4] Kirsch M, Guesnier L, LeBesnerais P, Hillion ML, Debauchez M, Seguin J et al. Cardiac operations in octogenarians: perioperative risk factors for death and impaired autonomy. Ann Thorac Surg 1998;66:60 7. [5] JCS Joint Working Group. Guidelines for diagnosis and treatment of aortic aneurysm and aortic dissection ( JCS 2011)-digest version. Circ J 2013;77: [6] Nowicki ER, Birkmeyer NJ, Weintraub RW, Leavitt BJ, Sanders JH, Dacey LJ et al. Multivariable prediction of in-hospital mortality associated with aortic and mitral valve surgery in Northern New England. Ann Thorac Surg 2004;77: [7] Nagendran J, Norris C, Maitland A, Koshal A, Ross DB. Is mitral valve surgery safe in octogenarians? Eur J Cardiothorac Surg 2005;28:83 7. [8] Khan D, Mukherjee S, Sarkar S, Kumar V, Charles EV. Cardiac surgery in octogenarians. J Indian Med Assoc 2012;110: [9] Assmann A, Minol JP, Mehdiani A, Akhyari P, Boeken U, Lichtenberg A. Cardiac surgery in nonagenarians: not only feasible, but also reasonable? Interact CardioVasc Thorac Surg 2013;17: [10] Caceres M, Cheng W, De Robertis M, Mirocha JM, Czer L, Esmailian F et al. Survival and quality of life for nonagenarians after cardiac surgery. Ann Thorac Surg 2013;95: [11] Abel NJ, Rogal GJ, Burns P, Saunders CR, Chamberlain RS. Aortic valve replacement with and without coronary artery bypass graft surgery in octogenarians: is it safe and feasible? Cardiology 2013;124: [12] Tang GH, Malekan R, Yu CJ, Kai M, Lansman SL, Spielvogel D. Surgery for acute type A aortic dissection in octogenarians is justified. J Thorac Cardiovasc Surg 2013;145:S [13] Grady KL, Lee R, Subacǐus H, Malaisrie SC, McGee EC Jr, Kruse J et al. Improvements in health-related quality of life before and after isolated cardiac operations. Ann Thorac Surg 2011;91: [14] Kazui T, Washiyama N, Muhammad BA, Terada H, Yamashita K, Takinami M et al. Total arch replacement using aortic arch branched grafts with the aid of antegrade selective cerebralperfusion. Ann Thorac Surg 2000;70:3 8. [15] Okita Y, Takamoto S, Ando M, Morota T, Matsukawa R, Kawashima Y. Mortality and cerebral outcome in patients who underwent aortic arch operations using deep hypothermic circulatory arrest with retrograde cerebral perfusion: no relation of early death, stroke, and delirium to the duration of circulatory arrest. J Thorac Cardiovasc Surg 1998;115: [16] Okita Y, Okada K, Omura A, Kano H, Minami H, Inoue T et al. Total arch replacement using antegrade cerebral perfusion. J Thorac Cardiovasc Surg 2013;145:S [17] Okada K, Omura A, Kano H, Inoue T, Oka T, Minami H et al. Effect of atherothrombotic aorta on outcomes of total aortic arch replacement. J Thorac Cardiovasc Surg 2013;145: [18] Okada K, Omura A, Kano H, Sakamoto T, Tanaka A, Inoue T et al. Recent advancements of total aortic arch replacement. J Thorac Cardiovasc Surg 2012;144: [19] Samura M, Zempo N, Ikeda Y, Hidaka M, Kaneda Y, Suzuki K et al. Endovascular repair of distal arch aneurysm with double-chimney technique. Ann Thorac Surg 2013;95: [20] Corvera JS, Fehrenbacher JW. Total arch and descending thoracic aortic replacement by left thoracotomy. Ann Thorac Surg 2012;93: AORTIC SURGERY

Remodeling of the Remnant Aorta after Acute Type A Aortic Dissection Surgery

Remodeling of the Remnant Aorta after Acute Type A Aortic Dissection Surgery Remodeling of the Remnant Aorta after Acute Type A Aortic Dissection Surgery Are Young Patients More Likely to Develop Adverse Aortic Remodeling of the Remnant Aorta Over Time? Suk Jung Choo¹, Jihoon Kim¹,

More information

Aortic Arch Treatment Open versus Endo Evidence versus Zeitgeist. M. Grabenwoger Dept. of Cardiovascular Surgery Hospital Hietzing Vienna, Austria

Aortic Arch Treatment Open versus Endo Evidence versus Zeitgeist. M. Grabenwoger Dept. of Cardiovascular Surgery Hospital Hietzing Vienna, Austria Aortic Arch Treatment Open versus Endo Evidence versus Zeitgeist M. Grabenwoger Dept. of Cardiovascular Surgery Hospital Hietzing Vienna, Austria Evidence Surgical aortic arch replacement with a Dacron

More information

I-Hui Wu, M.D. Ph.D. Clinical Assistant Professor Cardiovascular Surgical Department National Taiwan University Hospital

I-Hui Wu, M.D. Ph.D. Clinical Assistant Professor Cardiovascular Surgical Department National Taiwan University Hospital Comparisons of Aortic Remodeling and Outcomes after Endovascular Repair of Acute and Chronic Complicated Type B Aortic Dissections I-Hui Wu, M.D. Ph.D. Clinical Assistant Professor Cardiovascular Surgical

More information

Chairman and O. Wayne Isom Professor Department of Cardiothoracic Surgery Weill Cornell Medicine

Chairman and O. Wayne Isom Professor Department of Cardiothoracic Surgery Weill Cornell Medicine Leonard N. Girardi, M.D. Chairman and O. Wayne Isom Professor Department of Cardiothoracic Surgery Weill Cornell Medicine New York, New York Houston Aortic Symposium Houston, Texas February 23, 2017 weill.cornell.edu

More information

Antegrade Thoracic Stent Grafting during Repair of Acute Debakey I Dissection: Promotes Distal Aortic Remodeling and Reduces Late Open Re-operation

Antegrade Thoracic Stent Grafting during Repair of Acute Debakey I Dissection: Promotes Distal Aortic Remodeling and Reduces Late Open Re-operation Antegrade Thoracic Stent Grafting during Repair of Acute Debakey I Dissection: Promotes Distal Aortic Remodeling and Reduces Late Open Re-operation Vallabhajosyula, P: Szeto, W; Desai, N; Pulsipher, A;

More information

Management of Acute Aortic Syndromes. M. Grabenwoger, MD Dept. of Cardiovascular Surgery Hospital Hietzing, Vienna, Austria

Management of Acute Aortic Syndromes. M. Grabenwoger, MD Dept. of Cardiovascular Surgery Hospital Hietzing, Vienna, Austria Management of Acute Aortic Syndromes M. Grabenwoger, MD Dept. of Cardiovascular Surgery Hospital Hietzing, Vienna, Austria I have nothing to disclose. Acute Aortic Syndromes Acute Aortic Dissection Type

More information

Complex Thoracic and Abdominal Aortic Repair Using Hybrid Techniques

Complex Thoracic and Abdominal Aortic Repair Using Hybrid Techniques Complex Thoracic and Abdominal Aortic Repair Using Hybrid Techniques Tariq Almerey MD, January Moore BA, Houssam Farres MD, Richard Agnew MD, W. Andrew Oldenburg MD, Albert Hakaim MD Department of Vascular

More information

Femoral Versus Aortic Cannulation for Surgery of Chronic Ascending Aortic Aneurysm

Femoral Versus Aortic Cannulation for Surgery of Chronic Ascending Aortic Aneurysm Femoral Versus Aortic Cannulation for Surgery of Chronic Ascending Aortic Aneurysm Fitsum Lakew, MD, Piotr Pasek, MD, Michael Zacher, MD, Anno Diegeler, MD, and Paul P. Urbanski, MD Department of Cardiovascular

More information

Total arch replacement with separated graft technique and selective antegrade cerebral perfusion

Total arch replacement with separated graft technique and selective antegrade cerebral perfusion Masters of Cardiothoracic Surgery Total arch replacement with separated graft technique and selective antegrade cerebral perfusion Teruhisa Kazui 1,2 1 Hamamatsu University School of Medicine, Hamamatsu,

More information

Total arch replacement using selective antegrade cerebral perfusion as the neuroprotection strategy

Total arch replacement using selective antegrade cerebral perfusion as the neuroprotection strategy Featured Article Total arch replacement using selective antegrade cerebral perfusion as the neuroprotection strategy Yutaka Okita, Kenji Okada, Atsushi Omura, Hiroya Kano, Hitoshi Minami, Takeshi Inoue,

More information

Aggressive Resection/Reconstruction of the Aortic Arch in Type A Dissection

Aggressive Resection/Reconstruction of the Aortic Arch in Type A Dissection Aggressive Resection/Reconstruction of the Aortic Arch in Type A Dissection M. Grabenwoger Dept. of Cardiovascular Surgery Hospital Hietzing Vienna, Austria Disclosure Statement Consultant of Jotec, Hechingen,

More information

Early- and medium-term results after aortic arch replacement with frozen elephant trunk techniques a single center study

Early- and medium-term results after aortic arch replacement with frozen elephant trunk techniques a single center study Featured Article Early- and medium-term results after aortic arch replacement with frozen elephant trunk techniques a single center study Sergey Leontyev*, Martin Misfeld*, Piroze Daviewala, Michael A.

More information

Modification in aortic arch replacement surgery

Modification in aortic arch replacement surgery Gao et al. Journal of Cardiothoracic Surgery (2018) 13:21 DOI 10.1186/s13019-017-0689-y LETTER TO THE EDITOR Modification in aortic arch replacement surgery Feng Gao 1,2*, Yongjie Ye 2, Yongheng Zhang

More information

Frozen Elephant Trunk procedure in patients with aortic dissection type B and concomitant aortic arch or ascending aortic pathology

Frozen Elephant Trunk procedure in patients with aortic dissection type B and concomitant aortic arch or ascending aortic pathology Frozen Elephant Trunk procedure in patients with aortic dissection type B and concomitant aortic arch or ascending aortic pathology Eduard Charchyan MD, PhD, Yurii Belov MD, PhD, Denis Breshenkov, Alexey

More information

Development of Stent Graft. Kato et al. Development of an expandable intra-aortic prothesis for experimental aortic dissection.

Development of Stent Graft. Kato et al. Development of an expandable intra-aortic prothesis for experimental aortic dissection. Development of Stent Graft Kato et al. Development of an expandable intra-aortic prothesis for experimental aortic dissection. ASAIO J 1993 The New England Journal of Medicine Downloaded from nejm.org

More information

Experience of endovascular procedures on abdominal and thoracic aorta in CA region

Experience of endovascular procedures on abdominal and thoracic aorta in CA region Experience of endovascular procedures on abdominal and thoracic aorta in CA region May 14-15, 2015, Dubai Dr. Viktor Zemlyanskiy National Research Center of Emergency Care Astana, Kazakhstan Region Characteristics

More information

SELECTIVE ANTEGRADE TECHNIQUE OF CHOICE

SELECTIVE ANTEGRADE TECHNIQUE OF CHOICE SELECTIVE ANTEGRADE CEREBRAL PERFUSION IS THE TECHNIQUE OF CHOICE MARKO TURINA University of Zurich Zurich, Switzerland What is so special about the operation on the aortic arch? Disease process is usually

More information

Importance of the third arterial graft in multiple arterial grafting strategies

Importance of the third arterial graft in multiple arterial grafting strategies Research Highlight Importance of the third arterial graft in multiple arterial grafting strategies David Glineur Department of Cardiovascular Surgery, Cliniques St Luc, Bouge and the Department of Cardiovascular

More information

Aggressive Resection/Reconstruction of the Aortic Arch in Type A Dissection: Con

Aggressive Resection/Reconstruction of the Aortic Arch in Type A Dissection: Con Aggressive Resection/Reconstruction of the Aortic Arch in Type A Dissection: Con Thomas G. Gleason, M.D. Ronald V. Pellegrini Professor and Chief Division of Cardiac Surgery University of Pittsburgh Presenter

More information

debris + 3 debris debris debris Tel: ,3

debris + 3 debris debris debris Tel: ,3 13 467 471 2004 debris + 3 13.2 15.47.0 6.5 7.7 0 3 25.012.5 7.0 0 13 467 471 2004 Tel: 075-251-5752 602-8566 463-1 2004 3 7 2004 5 18 30 1 2,3 4 2000 7 debris debris debris 7 13 4 Table 1 Patients profiles

More information

Aortic Arch/ Thoracoabdominal Aortic Replacement

Aortic Arch/ Thoracoabdominal Aortic Replacement Aortic Arch/ Thoracoabdominal Aortic Replacement Joseph S. Coselli, M.D. Vice Chair, Department of Surgery Professor, Chief, and Cullen Foundation Endowed Chair Division of Cardiothoracic Surgery Baylor

More information

Key Words Aneurysms Aortic disease Atherosclerosis Heart surgery Elderly

Key Words Aneurysms Aortic disease Atherosclerosis Heart surgery Elderly 70 : Outcome of Aortic Arch Surgery in Patients Aged 70 Years or Older: Axillary Artery Cannulation and Selective Cerebral Perfusion Supports Yasuhisa Takao Tetsuro Fumihiro Kunihiro Masataka Kazue Kiyoshige

More information

The operative mortality rate after redo valvular operations

The operative mortality rate after redo valvular operations Clinical Outcomes of Redo Valvular Operations: A 20-Year Experience Naoto Fukunaga, MD, Yukikatsu Okada, MD, Yasunobu Konishi, MD, Takashi Murashita, MD, Mitsuru Yuzaki, MD, Yu Shomura, MD, Hiroshi Fujiwara,

More information

Type II arch hybrid debranching procedure

Type II arch hybrid debranching procedure Safeguards and Pitfalls Type II arch hybrid debranching procedure Prashanth Vallabhajosyula, Wilson Y. Szeto, Nimesh Desai, Caroline Komlo, Joseph E. Bavaria Division of Cardiovascular Surgery, University

More information

Is a minimally invasive approach for re-operative aortic valve replacement superior to standard full resternotomy?

Is a minimally invasive approach for re-operative aortic valve replacement superior to standard full resternotomy? Interactive CardioVascular and Thoracic Surgery Advance Access published May 7, 2012 Interactive CardioVascular and Thoracic Surgery 0 (2012) 1 5 doi:10.1093/icvts/ivr141 BEST EVIDENCE TOPIC Is a minimally

More information

Ann Thorac Cardiovasc Surg 2018; 24: Online January 26, 2018 doi: /atcs.oa Original Article

Ann Thorac Cardiovasc Surg 2018; 24: Online January 26, 2018 doi: /atcs.oa Original Article Ann Thorac Cardiovasc Surg 2018; 24: 89 96 Online January 26, 2018 doi: 10.5761/atcs.oa.17-00138 Original Article Selective Cerebral Perfusion with the Open Proximal Technique during Descending Thoracic

More information

Does Patient-Prosthesis Mismatch Affect Long-term Results after Mitral Valve Replacement?

Does Patient-Prosthesis Mismatch Affect Long-term Results after Mitral Valve Replacement? Original Article Does Patient-Prosthesis Mismatch Affect Long-term Results after Mitral Valve Replacement? Hiroaki Sakamoto, MD, PhD, and Yasunori Watanabe, MD, PhD Background: Recently, some articles

More information

Bicuspid aortic root spared during ascending aorta surgery: an update of long-term results

Bicuspid aortic root spared during ascending aorta surgery: an update of long-term results Short Communication Bicuspid aortic root spared during ascending aorta surgery: an update of long-term results Marco Russo, Guglielmo Saitto, Paolo Nardi, Fabio Bertoldo, Carlo Bassano, Antonio Scafuri,

More information

Total Arch Replacement Using Bilateral Axillary Antegrade Selective Cerebral Perfusion

Total Arch Replacement Using Bilateral Axillary Antegrade Selective Cerebral Perfusion Original Article Total Arch Replacement Using Bilateral Axillary Antegrade Selective Cerebral Perfusion Satoshi Yamashiro, MD, PhD, Yukio Kuniyoshi, MD, Katsuya Arakaki, MD, Hitoshi Inafuku, MD, Yuji Morishima,

More information

CORONARY ARTERY BYPASS GRAFT (CABG) MEASURES GROUP OVERVIEW

CORONARY ARTERY BYPASS GRAFT (CABG) MEASURES GROUP OVERVIEW CONARY ARTERY BYPASS GRAFT (CABG) MEASURES GROUP OVERVIEW 2015 PQRS OPTIONS F MEASURES GROUPS: 2015 PQRS MEASURES IN CONARY ARTERY BYPASS GRAFT (CABG) MEASURES GROUP: #43 Coronary Artery Bypass Graft (CABG):

More information

Percutaneous Approaches to Aortic Disease in 2018

Percutaneous Approaches to Aortic Disease in 2018 Percutaneous Approaches to Aortic Disease in 2018 Wendy Tsang, MD, SM Assistant Professor, University of Toronto Toronto General Hospital, University Health Network Case 78 year old F Lower CP and upper

More information

Descending aorta replacement through median sternotomy

Descending aorta replacement through median sternotomy Descending aorta replacement through median sternotomy Mitrev Z, Anguseva T, Belostotckij V, Hristov N. Special hospital for surgery Filip Vtori Skopje - Makedonija June, 2010 Cardiosurgery - Skopje 1

More information

Gelweave TM. Thoracic and Thoracoabdominal Graft Geometries. Ante-Flo TM 4 Branch Plexus. Siena Valsalva TM Trifurcate Arch Graft. Coselli.

Gelweave TM. Thoracic and Thoracoabdominal Graft Geometries. Ante-Flo TM 4 Branch Plexus. Siena Valsalva TM Trifurcate Arch Graft. Coselli. Gelweave TM Thoracic and Thoracoabdominal Graft Geometries Ante-Flo TM 4 Branch Plexus Siena Valsalva TM Trifurcate Arch Graft Coselli Lupiae Product availability subject to local regulatory approval.

More information

Total Arch Replacement Under Flow Monitoring During Selective Cerebral Perfusion Using a Single Pump

Total Arch Replacement Under Flow Monitoring During Selective Cerebral Perfusion Using a Single Pump Total Arch Replacement Under Flow Monitoring During Selective Cerebral Perfusion Using a Single Pump Hideyuki Shimizu, MD, PhD, Toru Matayoshi, CP, Masanori Morita, CP, Toshihiko Ueda, MD, PhD, and Ryohei

More information

Surgical AVR: Are there any contraindications? Pyowon Park Samsung Medical Center Seoul, Korea

Surgical AVR: Are there any contraindications? Pyowon Park Samsung Medical Center Seoul, Korea Surgical AVR: Are there any contraindications? Pyowon Park Samsung Medical Center Seoul, Korea Contents Decision making in surgical AVR in old age Clinical results of AVR with tissue valve Impact of 19mm

More information

Midterm Results of Aortic Arch Replacement in a Stanford Type A Aortic Dissection With an Intimal Tear in the Aortic Arch

Midterm Results of Aortic Arch Replacement in a Stanford Type A Aortic Dissection With an Intimal Tear in the Aortic Arch ORIGINAL ARTICLE DOI 10.4070 / kcj.2009.39.7.270 Print ISSN 1738-5520 / On-line ISSN 1738-5555 Copyright c 2009 The Korean Society of Cardiology Midterm Results of Aortic Arch Replacement in a Stanford

More information

Neurological Complications of TEVAR. Frank J Criado, MD. Union Memorial-MedStar Health Baltimore, MD USA

Neurological Complications of TEVAR. Frank J Criado, MD. Union Memorial-MedStar Health Baltimore, MD USA ISES Online Neurological Complications of Frank J Criado, MD TEVAR Union Memorial-MedStar Health Baltimore, MD USA frank.criado@medstar.net Paraplegia Incidence is 0-4% after surgical Rx of TAAs confined

More information

Neurological outcomes and mortality in patients with type A aortic dissection. Impact of intra-operative management

Neurological outcomes and mortality in patients with type A aortic dissection. Impact of intra-operative management Neurological outcomes and mortality in patients with type A aortic dissection. Impact of intra-operative management P Santé, M. Buonocore L Majello, A Caiazzo, G Petrone, G Nappi Dept. of Cardiothoracic

More information

No Disclosure. Aortic Dissection in Japan. This. The Challenge of Acute and Chronic Type B Aortic Dissections with Endovascular Aortic Repair

No Disclosure. Aortic Dissection in Japan. This. The Challenge of Acute and Chronic Type B Aortic Dissections with Endovascular Aortic Repair No Disclosure The Challenge of Acute and Chronic Type B Aortic Dissections with Endovascular Aortic Repair Toru Kuratani Department of Cardiovascular Surgery Osaka University Graduate School of Medicine,

More information

Lulu Liu, Chaoyi Qin, Jianglong Hou, Da Zhu, Bengui Zhang, Hao Ma, Yingqiang Guo

Lulu Liu, Chaoyi Qin, Jianglong Hou, Da Zhu, Bengui Zhang, Hao Ma, Yingqiang Guo Case Report One-stage hybrid surgery for acute Stanford type A aortic dissection with David operation, aortic arch debranching, and endovascular graft: a case report Lulu Liu, Chaoyi Qin, Jianglong Hou,

More information

SURGICAL INTERVENTION IN AORTOPATHIES ZOHAIR ALHALEES, MD RIYADH, SAUDI ARABIA

SURGICAL INTERVENTION IN AORTOPATHIES ZOHAIR ALHALEES, MD RIYADH, SAUDI ARABIA SURGICAL INTERVENTION IN AORTOPATHIES ZOHAIR ALHALEES, MD RIYADH, SAUDI ARABIA In patients born with CHD, dilatation of the aorta is a frequent feature at presentation and during follow up after surgical

More information

Long-term results (22 years) of the Ross Operation a single institutional experience

Long-term results (22 years) of the Ross Operation a single institutional experience Long-term results (22 years) of the Ross Operation a single institutional experience Authors: Costa FDA, Schnorr GM, Veloso M,Calixto A, Colatusso D, Balbi EM, Torres R, Ferreira ADA, Colatusso C Department

More information

Endovascular therapy for Ischemic versus Nonischemic complicated acute type B aortic dissection (catbad).

Endovascular therapy for Ischemic versus Nonischemic complicated acute type B aortic dissection (catbad). Endovascular therapy for Ischemic versus Nonischemic complicated acute type B aortic dissection (catbad). AS. Eleshra, MD 1, T. Kölbel, MD, PhD 1, F. Rohlffs, MD 1, N. Tsilimparis, MD, PhD 1,2 Ahmed Eleshra

More information

ORIGINAL PAPER. Department of Cardiac Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan ABSTRACT

ORIGINAL PAPER. Department of Cardiac Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan ABSTRACT Nagoya J. Med. Sci. 79. 443 ~ 451, 2017 doi:10.18999/nagjms.79.4.443 ORIGINAL PAPER Clinical outcomes and quality of life after surgery for dilated ascending aorta at the time of aortic valve replacement;

More information

STS/EACTS LatAm CV Conference 2017

STS/EACTS LatAm CV Conference 2017 STS/EACTS LatAm CV Conference 2017 Joseph E. Bavaria, MD Director, Thoracic Aortic Surgery Program Roberts-Measey Professor and Vice Chair of CV Surgery University of Pennsylvania Immediate-Past President

More information

Minimally invasive aortic valve replacement in high risk patient groups

Minimally invasive aortic valve replacement in high risk patient groups Review Article Minimally invasive aortic valve replacement in high risk patient groups Daniel Fudulu, Harriet Lewis, Umberto Benedetto, Massimo Caputo, Gianni Angelini, Hunaid A. Vohra Department of Cardiac

More information

Results of Transapical Valves. A.P. Kappetein Dept Cardio-thoracic surgery

Results of Transapical Valves. A.P. Kappetein Dept Cardio-thoracic surgery Results of Transapical Valves A.P. Kappetein Dept Cardio-thoracic surgery Rotterda am, The Netherlands 2002 FIM 2003 2005 2006 2010 THV THV Cribier-Edwards Edwards Edwards Sapien Sapien XT Bovine pericardium

More information

Publicado : Interactive CardioVascular Thoracic Surgery 2011;12:650.

Publicado : Interactive CardioVascular Thoracic Surgery 2011;12:650. Pulmonary embolism due to biological glue after repair of type A aortic dissection Jose Rubio Alvarez,MD, PhD, 1 Juan Sierra Quiroga, MD, PhD, 1 Anxo Martinez de Alegria MD 2, Jose-Manuel Martinez Comendador,

More information

Early and One-year Outcomes of Aortic Root Surgery in Marfan Syndrome Patients

Early and One-year Outcomes of Aortic Root Surgery in Marfan Syndrome Patients Early and One-year Outcomes of Aortic Root Surgery in Marfan Syndrome Patients A Prospective, Multi-Center, Comparative Study Joseph S. Coselli, Irina V. Volguina, Scott A. LeMaire, Thoralf M. Sundt, Elizabeth

More information

Hybrid Repair of a Complex Thoracoabdominal Aortic Aneurysm

Hybrid Repair of a Complex Thoracoabdominal Aortic Aneurysm Hybrid Repair of a Complex Thoracoabdominal Aortic Aneurysm Virendra I. Patel MD MPH Assistant Professor of Surgery Massachusetts General Hospital Division of Vascular and Endovascular Surgery Disclosure

More information

Aneurysms that arise in the distal aortic arch and

Aneurysms that arise in the distal aortic arch and Surgical Management of Distal Arch Aneurysm: Another Approach With Improved Results Kenji Minatoya, MD, Hitoshi Ogino, MD, Hitoshi Matsuda, MD, Hiroaki Sasaki, MD, Toshikatsu Yagihara, MD, and Soichiro

More information

UC SF An Algorithm to Choose Which Uncomplicated (Asymptomatic) Acute Type B Dissection Patients Should Undergo TEVAR. Disclosures.

UC SF An Algorithm to Choose Which Uncomplicated (Asymptomatic) Acute Type B Dissection Patients Should Undergo TEVAR. Disclosures. An Algorithm to Choose Which Uncomplicated (Asymptomatic) Acute Type B Dissection Patients Should Undergo TEVAR Disclosures Royalties and research grant support from Cook Medical, Inc. Jade S. Hiramoto,

More information

Selective antegrade cerebral perfusion during aortic arch surgery confers survival and neuroprotective advantages

Selective antegrade cerebral perfusion during aortic arch surgery confers survival and neuroprotective advantages Selective antegrade cerebral perfusion during aortic arch surgery confers survival and neuroprotective advantages Mohammad Shihata, MD, a Rohan Mittal, a A. Senthilselvan, hd, b David Ross, MD, a Arvind

More information

Advances in Treatment of Traumatic Aortic Transection

Advances in Treatment of Traumatic Aortic Transection Advances in Treatment of Traumatic Aortic Transection Himanshu J. Patel MD University of Michigan Medical Center Author Disclosures Consulting fees from WL Gore Inc. There is no disease more conducive

More information

separated graft technique 29 II HCA SCP continuous cold blood cardioplegia P<0.05 I cerebrovascular accident CVA II CVA

separated graft technique 29 II HCA SCP continuous cold blood cardioplegia P<0.05 I cerebrovascular accident CVA II CVA 12 115 122 2003 2003 2 43 29 2 12 4 Bentall 4 2 1996en bloc technique14 I 1997 separated graft technique29 II HCA SCP continuous cold blood cardioplegia CCBC HCA I 86.6 37.1 II 74.2 43.4 SCP I 55.6 15.6

More information

Minimally Invasive Aortic Surgery With Emphasis On Technical Aspects, Extracorporeal Circulation Management And Cardioplegic Techniques

Minimally Invasive Aortic Surgery With Emphasis On Technical Aspects, Extracorporeal Circulation Management And Cardioplegic Techniques Minimally Invasive Aortic Surgery With Emphasis On Technical Aspects, Extracorporeal Circulation Management And Cardioplegic Techniques Konstadinos A Plestis, MD System Chief of Cardiothoracic and Vascular

More information

Advances in the Treatment of Acute Type A Dissection: An Integrated Approach

Advances in the Treatment of Acute Type A Dissection: An Integrated Approach Advances in the Treatment of Acute Type A Dissection: An Integrated Approach Joseph E. Bavaria, MD, Derek R. Brinster, MD, Robert C. Gorman, MD, Y. Joseph Woo, MD, Thomas Gleason, MD, and Alberto Pochettino,

More information

University of Florida Department of Surgery. CardioThoracic Surgery VA Learning Objectives

University of Florida Department of Surgery. CardioThoracic Surgery VA Learning Objectives University of Florida Department of Surgery CardioThoracic Surgery VA Learning Objectives This service performs coronary revascularization, valve replacement and lung cancer resections. There are 2 faculty

More information

Registry of Endovascular Aneurysm Registry data report

Registry of Endovascular Aneurysm Registry data report SPECIAL REPORT Lifeline Repair: Registry of Endovascular Aneurysm Registry data report Lifeline Registry of Endovascular Aneurysm Repair Steering Committee Purpose: The goal of the Lifeline Endovascular

More information

Disclosures The PREVENT IV Trial was supported by Corgentech and Bristol-Myers Squibb

Disclosures The PREVENT IV Trial was supported by Corgentech and Bristol-Myers Squibb Saphenous Vein Grafts with Multiple Versus Single Distal Targets in Patients Undergoing Coronary Artery Bypass Surgery: One-Year Graft Failure and Five-Year Outcomes from the Project of Ex-vivo Vein Graft

More information

Elective Surgery for Thoracic Aortic Aneurysms: Late Functional Status and Quality of Life

Elective Surgery for Thoracic Aortic Aneurysms: Late Functional Status and Quality of Life Elective Surgery for Thoracic Aortic Aneurysms: Late Functional Status and Quality of Life Andreas Zierer, MD, Spencer J. Melby, MD, Jordon G. Lubahn, BS, Gregorio A. Sicard, MD, Ralph J. Damiano, Jr,

More information

Emerging Roles for Distal Aortic Interventions in Type A Dissection Surgery

Emerging Roles for Distal Aortic Interventions in Type A Dissection Surgery Emerging Roles for Distal Aortic Interventions in Type A Dissection Surgery Type A Dissection Workshop 2014 CCC Vancouver Oct 26 th, 2014 Jehangir Appoo Libin Cardiovascular Institute University of Calgary

More information

Importance of changes in thoracic and abdominal aortic stiffness following stent graft implantation

Importance of changes in thoracic and abdominal aortic stiffness following stent graft implantation 14/9/2018 Importance of changes in thoracic and abdominal aortic stiffness following stent graft implantation Christos D. Liapis, MD, FACS, FRCS, FEBVS Professor (Em) of Vascular Surgery National & Kapodistrian

More information

Measuring the risk in valve patients Lessons learnt from the TAVI story? Bernard Iung Bichat Hospital, Paris, France

Measuring the risk in valve patients Lessons learnt from the TAVI story? Bernard Iung Bichat Hospital, Paris, France Measuring the risk in valve patients Lessons learnt from the TAVI story? Bernard Iung Bichat Hospital, Paris, France Faculty disclosure Bernard Iung I disclose the following financial relationships: Consultant

More information

Sotiris C. Stamou 1, Laura A. Rausch 1, Nicholas T. Kouchoukos 2, Kevin W. Lobdell 3, Kamal Khabbaz 4, Edward Murphy 5, Robert C.

Sotiris C. Stamou 1, Laura A. Rausch 1, Nicholas T. Kouchoukos 2, Kevin W. Lobdell 3, Kamal Khabbaz 4, Edward Murphy 5, Robert C. Featured Article Comparison between antegrade and retrograde cerebral perfusion or profound hypothermia as brain protection strategies during repair of type A aortic dissection Sotiris C. Stamou 1, Laura

More information

Role of Gender in TEVAR and EVAR results from the GREAT registry

Role of Gender in TEVAR and EVAR results from the GREAT registry Role of Gender in TEVAR and EVAR results from the GREAT registry Mauro Gargiulo Vascular Surgery University of Bologna - DIMES Policlinico S.Orsola-Malpighi Bologna, Italy mauro.gargiulo2@unibo.it Disclosure

More information

Outcome of elderly patients with severe but asymptomatic aortic stenosis

Outcome of elderly patients with severe but asymptomatic aortic stenosis Outcome of elderly patients with severe but asymptomatic aortic stenosis Robert Zilberszac, Harald Gabriel, Gerald Maurer, Raphael Rosenhek Department of Cardiology Medical University of Vienna ESC Congress

More information

Valve Disease in Patients With Heart Failure TAVI or Surgery? Miguel Sousa Uva Hospital Cruz Vermelha Lisbon, Portugal

Valve Disease in Patients With Heart Failure TAVI or Surgery? Miguel Sousa Uva Hospital Cruz Vermelha Lisbon, Portugal Valve Disease in Patients With Heart Failure TAVI or Surgery? Miguel Sousa Uva Hospital Cruz Vermelha Lisbon, Portugal I have nothing to disclose. Wide Spectrum Stable vs Decompensated NYHA II IV? Ejection

More information

Increasing life expectancy in industrialized countries

Increasing life expectancy in industrialized countries ADULT CARDIAC Analysis of Ascending and Transverse Aortic Arch Repair in Octogenarians Pallav J. Shah, MD, Anthony L. Estrera, MD, Charles C. Miller III, PhD, Taek-Yeon Lee, MD, Adel D. Irani, MD, Riad

More information

Policy Specific Section: March 30, 2012 March 7, 2013

Policy Specific Section: March 30, 2012 March 7, 2013 Medical Policy Transcatheter Aortic Valve Replacement for Aortic Stenosis Type: Medical Necessity and Investigational / Experimental Policy Specific Section: Surgery Original Policy Date: Effective Date:

More information

What Determines Aortic False Lumen Growth Post Dissection?

What Determines Aortic False Lumen Growth Post Dissection? Aortic Dissections What Determines Aortic False Lumen Growth Post Dissection? UCSF Vascular Symposium April 26, 2012 Most common aortic emergency Incidence of aortic dissections are 2/100,000 person-years

More information

Introduction. Study Design. Background. Operative Procedure-I

Introduction. Study Design. Background. Operative Procedure-I Risk Factors for Mortality After the Norwood Procedure Using Right Ventricle to Pulmonary Artery Shunt Ann Thorac Surg 2009;87:178 86 86 Addressor: R1 胡祐寧 2009/3/4 AM7:30 SICU 討論室 Introduction Hypoplastic

More information

Clinical trial and real-world outcomes of an endovascular iliac aneurysm repair with the GORE Iliac Branch Endoprosthesis (IBE)

Clinical trial and real-world outcomes of an endovascular iliac aneurysm repair with the GORE Iliac Branch Endoprosthesis (IBE) Clinical trial and real-world outcomes of an endovascular iliac aneurysm repair with the GORE Iliac Branch Endoprosthesis (IBE) Jan MM Heyligers, PhD, FEBVS Consultant Vascular Surgeon The Netherlands

More information

Brain Protection Using Antegrade Selective Cerebral Perfusion: A Multicenter Study

Brain Protection Using Antegrade Selective Cerebral Perfusion: A Multicenter Study Brain Protection Using Antegrade Selective Cerebral Perfusion: A Multicenter Study Marco Di Eusanio, MD, Marc A. A. M. Schepens, MD, PhD, Wim J. Morshuis, MD, PhD, Karl M. Dossche, MD, PhD, Roberto Di

More information

Arch Repair with the Bolton Medical RelayBranch Thoracic Stent-graft system: Multicenter experience

Arch Repair with the Bolton Medical RelayBranch Thoracic Stent-graft system: Multicenter experience Arch Repair with the Bolton Medical RelayBranch Thoracic Stent-graft system: Multicenter experience Joost van Herwaarden, MD, PhD University Medical Center, Utrecht Disclosure I have the following potential

More information

Ischemic Heart Disease Interventional Treatment

Ischemic Heart Disease Interventional Treatment Ischemic Heart Disease Interventional Treatment Cardiac Catheterization Laboratory Procedures (N = 89) is a regional and national referral center for percutaneous coronary intervention (PCI). A total of

More information

Minimally Invasive Mitral Valve Repair: Indications and Approach

Minimally Invasive Mitral Valve Repair: Indications and Approach Minimally Invasive Mitral Valve Repair: Indications and Approach Juan P. Umaña, M.D. Chief Medical Officer Director, Cardiovascular Medicine FCI - Institute of Cardiology Bogota Colombia 1 Mitral Valve

More information

Less Invasive Aortic Valve Surgery

Less Invasive Aortic Valve Surgery Less Invasive Aortic Valve Surgery SCTS Brighton 19th March 2013 Andrew Chukwuemeka MD FRCS Consultant Cardiothoracic Surgeon Hammersmith Hospital Imperial College Healthcare NHS Trust Less Invasive Aortic

More information

Total aortic arch replacement with a novel four-branched frozen elephant trunk graft: first-in-man results

Total aortic arch replacement with a novel four-branched frozen elephant trunk graft: first-in-man results European Journal of Cardio-Thoracic Surgery 43 (2013) 406 410 doi:10.1093/ejcts/ezs296 Advance Access publication 31 May 2012 ORIGINAL ARTICLE Total aortic arch replacement with a novel four-branched frozen

More information

The Ross Procedure: Outcomes at 20 Years

The Ross Procedure: Outcomes at 20 Years The Ross Procedure: Outcomes at 20 Years Tirone David Carolyn David Anna Woo Cedric Manlhiot University of Toronto Conflict of Interest None The Ross Procedure 1990 to 2004 212 patients: 66% 34% Mean age:

More information

Impaired Chronotropic Response to Exercise Stress Testing in Patients with Diabetes Predicts Future Cardiovascular Events

Impaired Chronotropic Response to Exercise Stress Testing in Patients with Diabetes Predicts Future Cardiovascular Events Diabetes Care Publish Ahead of Print, published online May 28, 2008 Chronotropic response in patients with diabetes Impaired Chronotropic Response to Exercise Stress Testing in Patients with Diabetes Predicts

More information

Aortic Arch pathology options: Open,Hybrid, fenestration, Chimney or branched stent-graft?

Aortic Arch pathology options: Open,Hybrid, fenestration, Chimney or branched stent-graft? Aortic Arch pathology options: Open,Hybrid, fenestration, Chimney or branched stent-graft? Chang Shu, M.D., Ph.D Vascular Surgery Center National Center for Cardiovascular Diseases. Fuwai Hospital, CAMS

More information

Repair of the initial tear is the most crucial step in the

Repair of the initial tear is the most crucial step in the Total Aortic Arch Grafting for Acute Type A Dissection: Analysis of Residual False Lumen Yoshiharu Takahara, MD, Yoshio Sudo, MD, Kenzi Mogi, MD, Mituyuki Nakayama, MD, and Manabu Sakurai, MD Division

More information

Jean M Panneton, MD Professor of Surgery Program Director Vascular Surgery Chief EVMS. Arch Pathology: The Endovascular Era is here

Jean M Panneton, MD Professor of Surgery Program Director Vascular Surgery Chief EVMS. Arch Pathology: The Endovascular Era is here Jean M Panneton, MD Professor of Surgery Program Director Vascular Surgery Chief EVMS Arch Pathology: The Endovascular Era is here Disclosures Consultant: Cook Medical, Bolton Medical, Medtronic Inc, Volcano,

More information

Currently, aortic dissection is associated with a high mortality

Currently, aortic dissection is associated with a high mortality Efficacy and Pitfalls of Transapical Cannulation for the Repair of Acute Type A Aortic Dissection Akihito Matsushita, MD, Susumu Manabe, MD, Minoru Tabata, MD, MPH, Toshihiro Fukui, MD, Tomoki Shimokawa,

More information

Presenter Disclosure. Patrick O. Myers, M.D. No Relationships to Disclose

Presenter Disclosure. Patrick O. Myers, M.D. No Relationships to Disclose Presenter Disclosure Patrick O. Myers, M.D. No Relationships to Disclose Aortic Valve Repair by Cusp Extension for Rheumatic Aortic Insufficiency in Children Long term Results and Impact of Extension Material

More information

TAVI- Is Stroke Risk the Achilles Heel of Percutaneous Aortic Valve Repair?

TAVI- Is Stroke Risk the Achilles Heel of Percutaneous Aortic Valve Repair? TAVI- Is Stroke Risk the Achilles Heel of Percutaneous Aortic Valve Repair? Elaine E. Tseng, MD and Marlene Grenon, MD Department of Surgery Divisions of Adult Cardiothoracic and Vascular and Endovascular

More information

Cost-effectiveness of minimally invasive coronary artery bypass surgery Arom K V, Emery R W, Flavin T F, Petersen R J

Cost-effectiveness of minimally invasive coronary artery bypass surgery Arom K V, Emery R W, Flavin T F, Petersen R J Cost-effectiveness of minimally invasive coronary artery bypass surgery Arom K V, Emery R W, Flavin T F, Petersen R J Record Status This is a critical abstract of an economic evaluation that meets the

More information

Distal Arch and Descending Aorta: What Is the Optimal Therapy in 2017?

Distal Arch and Descending Aorta: What Is the Optimal Therapy in 2017? Distal Arch and Descending Aorta: What Is the Optimal Therapy in 2017? Eric E. Roselli, MD Chief, Adult Cardiac Surgery Director, Aorta Center Heart and Vascular Institute, Cleveland Clinic Disclosures

More information

FEV1 predicts length of stay and in-hospital mortality in patients undergoing cardiac surgery

FEV1 predicts length of stay and in-hospital mortality in patients undergoing cardiac surgery EUROPEAN SOCIETY OF CARDIOLOGY CONGRESS 2010 FEV1 predicts length of stay and in-hospital mortality in patients undergoing cardiac surgery Nicholas L Mills, David A McAllister, Sarah Wild, John D MacLay,

More information

A Loeys-Dietz Patient with a Trans-Atlantic Odyssey. Repeated Aortic Root Surgery ending with a Huge Left Main Coronary Aneurysm 4

A Loeys-Dietz Patient with a Trans-Atlantic Odyssey. Repeated Aortic Root Surgery ending with a Huge Left Main Coronary Aneurysm 4 1 2 3 A Loeys-Dietz Patient with a Trans-Atlantic Odyssey Repeated Aortic Root Surgery ending with a Huge Left Main Coronary Aneurysm 4 5 6 7 8 9 Thierry Carrel 1, Florian Schoenhoff 1 and Duke Cameron

More information

Incidence of Postoperative Atrial Fibrillation after minimally invasive mitral valve surgery

Incidence of Postoperative Atrial Fibrillation after minimally invasive mitral valve surgery Incidence of Postoperative Atrial Fibrillation after minimally invasive mitral valve surgery JUAN S. JARAMILLO, MD Cardiovascular Surgery Clinica CardioVID Medellin Colombia DISCLOSURE INFORMATION Consultant

More information

TSDA ACGME Milestones

TSDA ACGME Milestones TSDA ACGME Milestones Short MW and Edwards JA. Assessing resident milestones using a CASPE March 2012 Short MW and Edwards JA. Assessing resident milestones using a CASPE March 2012 Short

More information

Acute type A aortic dissection (Type I, proximal, ascending)

Acute type A aortic dissection (Type I, proximal, ascending) Acute Type A Aortic Dissection R. Morton Bolman, III, MD Acute type A aortic dissection (Type I, proximal, ascending) is a true surgical emergency. It is estimated that patients suffering this calamity

More information

Combined Endovascular and Surgical Repair of Thoracoabdominal Aortic Pathology: Hybrid TEVAR

Combined Endovascular and Surgical Repair of Thoracoabdominal Aortic Pathology: Hybrid TEVAR Combined Endovascular and Surgical Repair of Thoracoabdominal Aortic Pathology: Hybrid TEVAR William J. Quinones-Baldrich MD Professor of Surgery Director UCLA Aortic Center UCLA Medical Center Los Angeles,

More information

THORACOABDOMINAL AORTIC ANEURYSMS HYBRID REPAIR

THORACOABDOMINAL AORTIC ANEURYSMS HYBRID REPAIR Update on Open and Endovascular Therapeutic Option for Aortic Repair CENTRE CARDIO-TORACIQUE DE MONACO Friday November 7 th, 2014 THORACOABDOMINAL AORTIC ANEURYSMS HYBRID REPAIR Roberto Chiesa Vascular

More information

ABERRANT RIGHT SUBCLAVIAN ARTERY AND CALCIFIED ANEURYSM OF. Jose Rubio-Alvarez, Juan Sierra-Quiroga, Belen Adrio Nazar and Javier Garcia Carro.

ABERRANT RIGHT SUBCLAVIAN ARTERY AND CALCIFIED ANEURYSM OF. Jose Rubio-Alvarez, Juan Sierra-Quiroga, Belen Adrio Nazar and Javier Garcia Carro. ABERRANT RIGHT SUBCLAVIAN ARTERY AND CALCIFIED ANEURYSM OF KOMMERELL S DIVERTICULUM : AN ALTERNATIVE APPROACH. Jose Rubio-Alvarez, Juan Sierra-Quiroga, Belen Adrio Nazar and Javier Garcia Carro. Department

More information

Use of carotid subclavian arterial bypass and thoracic endovascular aortic repair to minimize cerebral ischemia in total aortic arch reconstruction

Use of carotid subclavian arterial bypass and thoracic endovascular aortic repair to minimize cerebral ischemia in total aortic arch reconstruction Xydas et al Evolving Technology/Basic Science Use of carotid subclavian arterial bypass and thoracic endovascular aortic repair to minimize cerebral ischemia in total aortic arch reconstruction Steve Xydas,

More information

Follow-up of Aortic Dissection: How, How Often, Which Consequences Euro Echo 2011

Follow-up of Aortic Dissection: How, How Often, Which Consequences Euro Echo 2011 Follow-up of Aortic Dissection: How, How Often, Which Consequences Euro Echo 2011 Susan E. Wiegers, MD, FASE Director of Clinical Echocardiography Hospital of the University of Pennsylvania Disclosure

More information

Diagnostic, Technical and Medical

Diagnostic, Technical and Medical Diagnostic, Technical and Medical Approaches to Reduce CABG Related Stroke Pieter Kappetein, Michael Mack, M.D. Dept Thoracic Surgery, Rotterdam, The Netherlands Baylor Healthcare System Dallas, TX Background

More information