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

Save this PDF as:
 WORD  PNG  TXT  JPG

Size: px
Start display at page:

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

Transcription

1 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, MD Division of Cardiothoracic Surgery, University of Pennsylvania Medical Center, Philadelphia, Pennsylvania Background. Acute type A dissections require surgery to prevent death from proximal aortic rupture or malperfusion. Most series over the past decade have reported a death rate in the range of 15% to 30%. The objective of this study is to examine the effect of an integrated surgical approach on the treatment of acute type A dissections. Methods. From January 1994 to April 2002, 163 consecutive patients underwent repair of acute type A dissection. All had an integrated operative management as follows: intraoperative transesophageal echocardiography; hypothermic circulatory arrest (HCA) with retrograde cerebral perfusion to replace the aortic arch; HCA established after 3 minutes of electroencephalographic silence in neuromonitored patients (60%) or after 45 minutes of cooling in patients who were not neuromonitored (40%); reinforcement of the residual arch tissue with a Teflon felt neo-media; cannulation of the arch graft to reestablish cardiopulmonary bypass at the completion of HCA (antegrade graft perfusion); and remodeling of the sinus of Valsalva segments with Teflon felt neo-media and aortic valve resuspension or replacement with a biological or mechanical valved conduit. When HCA times were greater than 50 minutes, antegrade cerebral perfusion is used. Since Februay 1999, Acute type A dissection remains a difficult and catastrophic disease to treat. Surgical treatment has been guided by established principles, which include: (1) resection and replacement of the aortic tear site, usually the ascending aorta or arch; (2) repair or replacement of the aortic sinus segments with false lumen obliteration to treat potential coronary malperfusion and late aortic root abnormalities; (3) resuspension or replacement of the aortic valve; and (4) obliteration of the false lumen at the distal anastomosis and reestablishment of primary flow into the true lumen. There have been many therapeutic and diagnostic advances over the past few years to improve treatment outcomes based on these principles. These include hypothermic circulatory arrest (HCA), open distal anastomosis, native aortic root reconstructive techniques, and advances in circulation management. Presented at the Aortic Surgery Symposium VIII, May 2 3, 2002, New York, NY. Address reprint requests to Dr Bavaria, Division of Cardiothoracic Surgery, Hospital of the University of Pennsylvania, 3400 Spruce St, Philadelphia, PA ; BioGlue has been used as an anastomotic adjunct in the repair of type A dissections. Results. Mean age was years, with 68% men and 15% with previous cardiac surgery. Seven percent of patients presented with a preoperative neurologic deficit, and 3% developed a new cerebrovascular accident after dissection repair. The in-hospital death rate was 9.8%. Excluding the patients with preoperative strokes (7%) and those with postoperative stroke (3%), the in-hospital death rate was 6.6%. In 6 patients, prompt changes in circulatory management consisting of switching cannulation sites or cross-clamp release with direct temporary aortic arch fenestration occurred when there were sudden changes in electroencephalogram during cooling. Conclusions. A standardized approach to the treatment of acute type A dissections has improved outcomes. Our 55% mortality in patients with preoperative cerebral vascular accident (CVA) suggests that this group may be candidates for medical or delayed surgical treatment. Conversely, our 6.6% mortality rate for neurologically intact patients warrants aggressive and expeditious surgical intervention. (Ann Thorac Surg ) 2002 by The Society of Thoracic Surgeons Despite many potential therapeutic and diagnostic advances, many large series, including recent ones, reveal a 25% perioperative mortality rate [1 3]. Our own results during the period of 1988 to 1994 showed the same outcome. Our team felt that no single therapeutic advance would significantly impact outcome, but that an integrated approach may reduce morbidity and mortality. In 1994, our institution established a standard perioperative management algorithm for this extremely complex surgical disease (see Table 1). This report examines our outcomes over an 8-year period managing patients with acute type A dissection. Material and Methods A retrospective study was performed on 163 consecutive patients from January 1994 to April 2002 undergoing surgical repair of type A dissections using the aortic Dr Bavaria discloses that he has a financial relationship with Cryolife, Inc by The Society of Thoracic Surgeons /02/$22.00 Published by Elsevier Science Inc PII S (02)

2 Ann Thorac Surg AORTIC SURGERY SYMPOSIUM VIII BAVARIA ET AL S1849 Table 1. Integrated Approach to Operative Management 1. Rapid admission to the operation room for both diagnosis and therapy (bypass the intensive care unit) 2. Intraoperative transesophageal echocardiogram 3. Neurocerebral monitoring (60%) 4. Routine open aortic arch reconstruction with retrograde or antegrade cerebral perfusion (hemi-arch preferred) 5. Routine antegrade arch graft perfusion after completion of arch repair 6. Aortic valve resuspension in most patients when preexisting leaflet or root pathology is absent 7. Creation of an aortic neo-media using either felt or Bioglue to strengthen the aortic and sinus walls and obliterate the false lumen surgery team s standardized perioperative protocol. Follow-up data were obtained from review of the patient charts and from our long-term aortic surgery clinic, where we direct the care of these patients for their entire life. Demographics and Operative Data Mean age was years. There were 111 men (68%) and 52 women (32%) (Table 2). Bicuspid valvular disease was present in 15 patients (9%). All patients with an obtainable blood pressure were included in the study regardless of preoperative malperfusion neurologic deficit or ongoing cardiopulmonary resuscitation. 60% of patients were able to have neurocerebral monitoring (NCM). Operative data are summarized in Table 3. Table 2. Demographics Patients 163 Mean Age (SD) Male 111 (68%) Bicuspid aortic valve 15 (9%) Marfan s/ehlers Danlos 12 (7.3%) Preoperative shock/unstable 24 (15%) Table 3. Operative Data No. Time (minutes) SD CPB time Myocardial ischemic time HCA (with RCP or ACP) time Previous cardiac surgery 24 (15%) Full root replacement 27 (17%) Composite mechanical graft 23 Biological root 4 Extensive/total arch replacement 8 (5%) (elephant trunk) BioGlue used 58 (36%) Neurocerebral monitoring used 97 (60%) ACP antegrade cerebral perfusion; HCA hypothermic circulatory arrest; RCP retrograde cerebral perfusion. Surgical Technique The general surgical approach consisted of rapid transfer to the operating room directly from the helipad or the emergency room without stopping over in the intensive care unit. Transesophageal echocardiogram (TEE) monitoring was used throughout the case for both diagnostic confirmation and therapeutic evaluation. Standard antegrade and retrograde cold blood cardioplegia was used for cardiac protection. Briefly, venous cannulation consisted of standard double-stage right atrial venous cannula connected by a Y connector to a small right-angle, single-stage superior vena cava cannula. In most patients, the femoral artery was utilized for arterial cannulation. Occasionally, the right axillary/ subclavian artery was used for primary arterial cannulation. In 97 (60%) patients, neurocerebral monitoring (NCM) was performed with the use of electroencephalogram (EEG) and somatosensory-evoked potential (SEP) monitoring during the entire operation. Neuromonitored patients were cooled for 3 minutes beyond EEG silence and 3 C below EEG silence, which usually occurred at a nasopharyngeal temperature between 15 C and 20 C [4]. Details of our neurocerebral protocols have been previously described [5, 6]. When NCM was not available, patients were cooled for a total of 45 minutes. The time of 45 minutes was chosen secondary to data from NCM in open aortic arch operations, demonstrating that most patients achieved EEG silence after 45 minutes of active cooling [7]. Additional pharmacological management consists of1gofsolumedrol,1gofmagnesium, and 2.5 mg/kg of lidocaine after initiation of cardiopulmonary bypass (CPB). The ascending aorta was not clamped during the cooling period except when aortic valve insufficiency mandated ascending aortic clamping to prevent left ventricular dilatation. All patients had a left ventricular vent inserted through the right superior pulmonary vein. Once profound hypothermia was achieved, antegrade CPB was interrupted and oxygenated blood at 12 C was infused into the superior vena cava cannula, which was snared between the azygos vein and the right atrial junction. With the patient in slight Trendelenburg position, a retrograde cerebral perfusion RCP pressure of 25 mm Hg was maintained, yielding a flow between 200 and 300 ml/min. The innominate vein was inspected to confirm bilateral jugular venous system inflow. Throughout the RCP period, dark blood emanated from the brachiocephalic arterial orifices, including the left common carotid, implying oxygen extraction. Generally, RCP was used when arch reconstructive time was less than 50 minutes and antegrade cerebral perfusion (ACP) was used when an open aortic arch time was more than 50 minutes. Primary ACP was used in 4% of patients. Using ACP, flow was directed through the innominate and left carotid artery with balloon-tipped catheters to maintain a right radial artery pressure of at least 40 mm Hg. The left subclavian artery was clamped. After completion of ACP or RCP, the entire circulation was then deaired using a brief period of RCP, and the arch graft was cannulated with a standard antegrade graft perfusion technique.

3 S1850 AORTIC SURGERY SYMPOSIUM VIII BAVARIA ET AL Ann Thorac Surg Fig 3. Reconstruction of sinus segments using geometric felt strips as neo-media. (A) Noncoronary sinus. (B) Right coronary sinus. Fig 1. Felt neo-media placed at distal anastomosis during hemiarch reconstruction. Resection of the aortic arch and ascending aorta was undertaken, and a Dacron tube graft was used as a replacement conduit. Felt, BioGlue, or a combination of both were placed between the intima and adventitia to obliterate the false lumen and recreate a neomedia (Figs 1, 2). Hemiarch repair was used in 155 patients (95%) and an extensive or total aortic arch replacement (elephant trunk procedure) was utilized in 8 patients (5%). The primary tear site was resected in all patients. The aortic root was replaced or repaired depending on the pathology present. When repair was deemed possible, the aortic valve leaflets were resuspended utilizing three pledgeted supracommisural sutures. The sinus of valsalva segments were then reinforced with Teflon felt as a neomedia (Fig 3) and more recently, since February 1999, BioGlue was used as an adjunct (Figs 4, 5). In 136 of 163 (83%) patients, the aortic root was repaired, and in 27 of 163 (17%) patients, the aortic root was replaced with either a biological or a mechanical valved conduit (Table 3). Recently, we have used the full-root stentless valve at the aortic root when replacement is necessary. Indications for the replacement of the aortic root included bicuspid aortic valve (n 15), Marfan s syndrome (n 11), Ehlers-Danlos syndrome (n 1), primary abnormalities of the aortic valve leaflets, obvious sinus of valsalva aneurysm, and extension of both the tear and dissection to the aortic valve annulus (Table 4). TEE was utilized in all patients to assess the adequacy of the aortic root repair. Neurocerebral Monitoring NCM was used in 60% of patients. Forty percent of patients without NCM were done at night or at times when the dedicated neurology team was unavailable. Six (3.7%) patients underwent immediate therapeutic changes in the operation secondary to EEG changes after initiation of CPB. These EEG changes were due to malperfusion of arch branches leading to lack of adequate Fig 2. Using BioGlue instead of felt at the distal anastomosis (3-mm thick neo-media ). Fig 4. BioGlue is used to reinforce the sinus segment and obliterate the false lumen. Note the very careful application at the aortic root. Gauze is used inside the aorta to protect the valve leaflets and coronary ostia from any inadvertent spill.

4 Ann Thorac Surg AORTIC SURGERY SYMPOSIUM VIII BAVARIA ET AL S1851 Table 5. Neurocerebral Data Neurocerebral monitored patients 60% Changes in operating room due to EEG changes 3.7% Preoperative stroke 11 (7%) Postoperative stroke 5 (3%) Transient neurological deficit 9.8% so although the diagnosis was incorrect, the therapeutic procedure was necessary and similar. Fig 5. Completed dissection repair with resuspension and anastomotic application of BioGlue. cerebral blood flow. Prompt changes in circulatory management consisted of switching cannulation sites or cross-clamp release with direct temporary aortic arch fenestration. Results Neurologic Outcomes Of the 163 patients undergoing repair, 11 (7%) had sustained a preoperative CVA. Of note, 6 of 11 (55%) of these patients died in the hospital after successful repair of the dissection. Five patients out of the remaining 152 neurologically intact preoperative patients (3.3%) developed focal strokes postoperatively (Table 5). Diagnostic Intraoperative TEE was extremely useful and converted the diagnosis of four prior type A dissections to type B dissections, thereby avoiding median sternotomy. However, one case was misdiagnosed as a type A and was really a ruptured type B. This patient did poorly and died. Two cases were actually ruptured ascending aneurysms, Table 4. Reasons for Not Performing a Valve Resuspension 1. Marfan s syndrome 2. Sinus of valsalva aneurysm 3. Bicuspid valve or primary valve leaflet abnormality 4. Tear into sinus segment (not simply a dissection down to the annulus) Mortality Overall 30-day mortality was 14 of 163 (8.6%). The mortality for all those patients who died while in the hospital from their original surgery including 30-day mortality was 16 of 163 (9.8%). The relationship of patient CVA to mortality is demonstrated by the high mortality of those patients (6/11 [55%]) who presented with a focal stroke before successful repair of their type A dissections. Mortality in those patients who presented neurologically intact, but developed a perioperative stroke, was high as well (20%) (Table 6). In contrast, the mortality rate for patients who presented without focal neurologic deficits was only 10 of 152 (6.6%). Thus, an early, aggressive surgical intervention to attempt to prevent neurologic complications is warranted. Comment We have presented our results of a recent consecutive series of acute type A dissection presentations. Our earlier experiences with this disease, similar to other groups, revealed significant morbidity and mortality with the previous surgical approach to type A dissection. We felt that an integrated and standardized approach to this complicated disease could unify the entire surgical team towards accomplishing the goal of an alive, wellfunctioning patient postoperatively. We borrowed additional systems approaches from other surgical disciplines, especially our Level I Trauma service, and concentrated all expertise necessary for the successful outcome of this type of surgery with the surgical team. This includes intraoperative TEE performed by cardiovascular anesthesia and intraoperative EEG/SEP performed by dedicated operating room noninvasive, neurocerebral monitoring personnel accustomed to the Table 6. Mortality No. Overall 30-day mortality 14/163 (8.6%) In-hospital mortality (30-day mortality all 16/163 (9.8%) in-hospital deaths) In-hospital mortality with Preoperative CVA 6/11 (55%) New postoperative CVA 1/5 (20%) In-hospital mortality without preoperative 10/152 (6.6%) stroke

5 S1852 AORTIC SURGERY SYMPOSIUM VIII BAVARIA ET AL Ann Thorac Surg unpredictability and intensity of the operating room environment. We utilize rapid helicopter transport directly to the operating room whenever possible, bypassing the intensive care unit (ICU) entirely. The operating room then assumed the role of both the diagnostic and the therapeutic suite. Intraoperative TEE is utilized extensively for confirmation of the diagnosis as well as verification of proper circulation management and adequacy of preand postoperative valvular function. NCM is utilized whenever possible, as we believe this provides valuable information regarding dynamic brachiocephalic circulation changes that can occur after initiation of CPB, aortic cross-clamping, or ventricular fibrillation. Additionally, we use flatline EEG as the hard end point for termination of CPB before HCA,regardless of specific cooling time and absolute nasopharyngeal temperature. An open distal anastomosis allows for a more controlled reconstruction of the acutely dissected aorta. We prefer to perform a hemi-arch anastomosis routinely, but will complete a full arch (elephant trunk) if required (eg, significant arch tear), especially in a Marfan s or younger patient. During open arch dissection surgery, our circulation management protocol is to use RCP if arch reconstructive times are expected to be less than 40 to 50 minutes, and to use ACP if times are expected to be more than 40 to 50 minutes. Although focal stroke rates are reportedly equal when comparing ACP with RCP, temporary neurologic dysfunction has been shown to be significantly increased with RCP times more than 50 minutes [7]. We rarely use HCA alone. Aortic valve resuspension is generally preferred, as long as there is no antecedent aortic root pathology. However, we do not hesitate to perform an aortic root replacement if indicated. Recently, we have preferred to use the porcine stentless aortic root bioprosthesis (full root) as our aortic root conduit of choice, as this eliminates the need for coumadin. In addition, the 20-year life expectancy with a DeBakey type I dissection is poor. Meticulous reconstruction of the native aortic root and distally dissected aorta is extremely important to ensure a long-term repair that minimizes later reoperations on the residual aorta. To achieve this, we place geometrically fashioned strips of felt or BioGlue (or both) between the dissected layers of the aorta (Figs 1, 3). This creates an approximately 3-mm neo-media, which is strong and can accept sutures. We avoid felt strips placed on the intimal side or adventitial side of the aortic anastomosis. We have added BioGlue as an anastomotic adjunct during the repair of acute type A dissections since February At a mean of 14 months of follow-up (range, 1 to 38 months), we have no reoperations at the aortic root and two late distal aortic reoperations in the BioGlue subgroup (n 58). In summary, we believe that our standardized approach to the treatment of acute type A dissection has decreased our perioperative morbidity and mortality significantly compared with our previous experience between 1988 and 1994 [1]. Our present data, with a 55% mortality rate in those patients who present with a focal stroke, suggest that this subgroup may be candidates for aggressive medical therapy and possibly delayed surgery. This treatment algorithm could also be supported by recent data documenting a 42% 30-day survival in medically treated acute type A dissections [2]. Conversely, our 6.6% mortality for neurologically intact patients suggests aggressive and expeditious surgical intervention is warranted. This is evident in our protocol, as we bypass the ICU and radiology suites entirely, and directly admit acute type A dissections for the operating room. Finally, the treatment of acute type A dissections, a complex disease process, may benefit from a standardized surgical algorithm in regionally designated centers. References 1. Bavaria JE, Woo YJ, Hall RA, Wahl PM, Acker MA, Gardner TJ. Circulatory management with retrograde cerebral perfusion for acute type A aortic dissection. Circulation 1996; 94(Suppl 9):II Hagan PG, Nienaber CA, Isselbacher EM, et al. The International Registry of Acute Aortic Dissection (IRAD). New insights into an old disease. JAMA 2000;283: Fann JI, Smith JA, Miller DC, et al. Surgical management of aortic dissection during a 30-year period. Circulation 1995; 92(Suppl 9):II Coselli JS, Crawford ES, Beall AC Jr, Mizrahi EM, Hess KR, Patel VM. Determination of brain temperatures for safe circulatory arrest during cardiovascular operation. Ann Thorac Surg 1988;45: Bavaria JE, Woo YJ, Hall RA, Carpenter JP, Gardner TJ. Retrograde cerebral and distal aortic perfusion during ascending and thoracoabdominal aortic operations. Ann Thorac Surg 1995;60: Stecker MM, Cheung AT, Pochettino A, et al. Deep hypothermic circulatory arrest: I. Effects of cooling on electroencephalogram and evoked potentials. Ann Thorac Surg 2001;71: Bavaria JE, Pochettino A, Brinster DR, et al. New paradigms and improved results for the surgical treatment of acute type A dissection. Ann Surg 2001;234:

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

Disease of the aortic valve is frequently associated with

Disease of the aortic valve is frequently associated with Stentless Aortic Bioprosthesis for Disease of the Aortic Valve, Root and Ascending Aorta John R. Doty, MD, and Donald B. Doty, MD Disease of the aortic valve is frequently associated with morphologic abnormalities

More information

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

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

Anatomy determines the close vicinity of the sinuses of

Anatomy determines the close vicinity of the sinuses of Aortic Valve Reimplantation According to the David Type I Technique Matthias Karck, MD, and Axel Haverich, MD Department of Thoracic and Cardiovascular Surgery, Hannover Medical School, Hannover, Germany.

More information

Frozen elephant trunk for DeBakey type 1 dissection: the Cleveland Clinic technique

Frozen elephant trunk for DeBakey type 1 dissection: the Cleveland Clinic technique Masters of Cardiothoracic Surgery Frozen elephant trunk for DeBakey type 1 dissection: the Cleveland Clinic technique Eric E. Roselli, Michael Z. Tong, Faisal G. Bakaeen Aorta Center, Department of Thoracic

More information

An anterior aortoventriculoplasty, known as the Konno-

An anterior aortoventriculoplasty, known as the Konno- The Konno-Rastan Procedure for Anterior Aortic Annular Enlargement Mark E. Roeser, MD An anterior aortoventriculoplasty, known as the Konno-Rastan procedure, is a useful tool for the cardiac surgeon. Originally,

More information

Aortic Replacement in Bicuspid Disease: How to Match the Procedure to the Patient

Aortic Replacement in Bicuspid Disease: How to Match the Procedure to the Patient Aortic Replacement in Bicuspid Disease: How to Match the Procedure to the Patient John S. Ikonomidis MD, PhD Horace G. Smithy Professor and Chief Division of Cardiothoracic Surgery Medical University of

More information

Therapeutic Pathway In Acute Aortic Dissection. Speaker: Cesare Quarto Consultant Cardiac Surgeon Royal Brompton Hospital, London UK

Therapeutic Pathway In Acute Aortic Dissection. Speaker: Cesare Quarto Consultant Cardiac Surgeon Royal Brompton Hospital, London UK Therapeutic Pathway In Acute Aortic Dissection Speaker: Cesare Quarto Consultant Cardiac Surgeon Royal Brompton Hospital, London UK Disclosure of Interest Speaker name: Cesare Quarto I do not have any

More information

Aortic root false aneurysm from gelatin-resorcinolformaldehyde GRF glue following surgical treatment for type A dissection

Aortic root false aneurysm from gelatin-resorcinolformaldehyde GRF glue following surgical treatment for type A dissection Jichi Medical University Journal Aortic root false aneurysm from gelatin-resorcinolformaldehyde GRF glue following surgical treatment for type A dissection Yasuhito Sakano, Tsutomu Saito, Yoshio Misawa

More information

Open fenestration for complicated acute aortic B dissection

Open fenestration for complicated acute aortic B dissection Art of Operative Techniques Open fenestration for complicated acute aortic B dissection Santi Trimarchi 1, Sara Segreti 1, Viviana Grassi 1, Chiara Lomazzi 1, Marta Cova 1, Gabriele Piffaretti 2, Vincenzo

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

Thoracoabdominal aortic aneurysms by definition traverse

Thoracoabdominal aortic aneurysms by definition traverse Thoracoabdominal Aortic Aneurysm Repair: Open Technique Joseph Huh, MD, Scott A. LeMaire, MD, Scott A. Weldon, MA, CMI, and Joseph S. Coselli, MD Thoracoabdominal aortic aneurysms by definition traverse

More information

Frozen Elephant Trunk in Acute Aortic Dissection

Frozen Elephant Trunk in Acute Aortic Dissection Frozen Elephant Trunk in Acute Aortic Dissection Derek R. Brinster, M.D. Professor of Cardiovascular and Thoracic Surgery Hofstra North Shore-LIJ School of Medicine Director of Aortic Surgery for the North

More information

The management of chronic thromboembolic pulmonary

The management of chronic thromboembolic pulmonary Technique of Pulmonary Thromboendarterectomy Isabelle Opitz, MD, and Marc de Perrot, MD, MSc, FRCSC Toronto Pulmonary Endarterectomy Program, Toronto General Hospital, Ontario, Canada. Address reprint

More information

The first report of the Society of Thoracic Surgeons

The first report of the Society of Thoracic Surgeons REPORT The Society of Thoracic Surgeons National Congenital Heart Surgery Database Report: Analysis of the First Harvest (1994 1997) Constantine Mavroudis, MD, Melanie Gevitz, BA, W. Steves Ring, MD, Charles

More information

Acute Aortic Regurgitation Secondary to Aortic Dissection

Acute Aortic Regurgitation Secondary to Aortic Dissection Acute Aortic Regurgitation Secondary to Aortic Dissection Surgical Management Without Valve Replacement Hassan Najafi, M.D., William S. Dye, M.D., Hushang Javid, M.D., James A. Hunter, M.D., Marshall D.

More information

Surgical Procedures and Complications

Surgical Procedures and Complications Radiological Society of North America, RSNA 2013 Refresher Course Program: Vascular Track Surgical Procedures and Complications Learning objectives Outline RC 112 : Key Concepts: Surgical Procedures and

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

Stentless root bioprosthesis for repair of acute type A aortic dissection

Stentless root bioprosthesis for repair of acute type A aortic dissection ACQUIRED CARDIOVASCULAR DISEASE Stentless root bioprosthesis for repair of acute type A aortic dissection Craig R. Smith, MS, Sotiris C. Stamou, MD, PhD, Robert L. Hooker, MD, Charles C. Willekes, MD,

More information

Index. Note: Page numbers of article titles are in boldface type.

Index. Note: Page numbers of article titles are in boldface type. Index Note: Page numbers of article titles are in boldface type. A Ablation, radiofrequency, anesthetic considerations for, 479 489 Acute aortic syndrome, thoracic endovascular repair of, 457 462 aortic

More information

Acute myocardial infarction (MI) due to extension of

Acute myocardial infarction (MI) due to extension of Coronary Malperfusion Due to Type A Aortic Dissection: Mechanism and Surgical Management Koji Kawahito, MD, Hideo Adachi, MD, Sei-ichiro Murata, MD, Atsushi Yamaguchi, MD, and Takashi Ino, MD Department

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

Since the first resection of the aortic arch performed by

Since the first resection of the aortic arch performed by Antegrade Cerebral Perfusion With Cold Blood: A 13-Year Experience Jean Bachet, MD, David Guilmet, MD, Bertrand Goudot, MD, Gilles D. Dreyfus, MD, Philippe Delentdecker, MD, Denis Brodaty, MD, and Claude

More information

Selective Heart, Brain and Body Perfusion in Open Aortic Arch Replacement

Selective Heart, Brain and Body Perfusion in Open Aortic Arch Replacement The Journal of ExtraCorporeal Technology Selective Heart, Brain and Body Perfusion in Open Aortic Arch Replacement Sven Maier, MSc; Fabian Kari, MD; Bartosz Rylski, MD; Matthias Siepe, MD; Christoph Benk,

More information

Hybrid treatment of the ascending aorta and arch in acute Type I dissection

Hybrid treatment of the ascending aorta and arch in acute Type I dissection West German Heart and Vascular Center University Hospital Essen, Germany Hybrid treatment of the ascending aorta and arch in acute Type I dissection Heinz Jakob, MD, PhD Department of Thoracic and Cardiovascular

More information

Aortic Valve Resuspension in Ascending Aortic Aneurysm Repair With Aortic Insufficiency

Aortic Valve Resuspension in Ascending Aortic Aneurysm Repair With Aortic Insufficiency Aortic Valve Resuspension in Ascending Aortic Aneurysm Repair With Aortic Insufficiency Paul Simon, MD, Anton Mortiz, MD, Reinhard Moidl, MD, Natascha Kupilik, MD, Martin Grabenwoeger, MD, Marek Ehrlich,

More information

Edward P. Chen MD. Director Thoracic Aortic Surgery Division of Cardiothoracic Surgery Emory University School of Medicine Atlanta, Georgia

Edward P. Chen MD. Director Thoracic Aortic Surgery Division of Cardiothoracic Surgery Emory University School of Medicine Atlanta, Georgia David Procedure in Acute Type A Dissection Edward P. Chen MD Director Thoracic Aortic Surgery Division of Cardiothoracic Surgery Emory University School of Medicine Atlanta, Georgia The Houston Aortic

More information

Quality ID #166 (NQF 0131): Coronary Artery Bypass Graft (CABG): Stroke- National Quality Strategy Domain: Effective Clinical Care

Quality ID #166 (NQF 0131): Coronary Artery Bypass Graft (CABG): Stroke- National Quality Strategy Domain: Effective Clinical Care Quality ID #166 (NQF 0131): Coronary Artery Bypass Graft (CABG): Stroke- National Quality Strategy Domain: Effective Clinical Care 2018 OPTIONS FOR INDIVIDUAL MEASURES: REGISTRY ONLY MEASURE TYPE: Outcome

More information

The morbidity and mortality rates associated with the. Outcome of Surgical Treatment in Patients With Acute Type B Aortic Dissection

The morbidity and mortality rates associated with the. Outcome of Surgical Treatment in Patients With Acute Type B Aortic Dissection Outcome of Surgical Treatment in Patients With Acute Type B Aortic Dissection Tomoki Shimokawa, MD, Kazutaka Horiuchi, MD, Naomi Ozawa, MD, Kenu Fumimoto, MD, Susumu Manabe, MD, Tetsuya Tobaru, MD, and

More information

Although the overall mortality rate after surgical repair

Although the overall mortality rate after surgical repair Ascending Aorta Replacement and Local Repair of Tear Site in Type A Aortic Dissection With Arch Tear Kay-Hyun Park, MD, Kiick Sung, MD, Kwhanmien Kim, MD, Tae-Gook Jun, MD, Young Tak Lee, MD, and Pyo Won

More information

Femoral artery cannulation has been used for cardiopulmonary

Femoral artery cannulation has been used for cardiopulmonary Femoral Cannulation is Safe for Type A Dissection Repair Daniel S. Fusco, MD, Richard K. Shaw, MD, Maryann Tranquilli, RN, Gary S. Kopf, MD, and John A. Elefteriades, MD Section of Cardiothoracic Surgery,

More information

In 1980, Bex and associates 1 first introduced the initial

In 1980, Bex and associates 1 first introduced the initial Technique of Aortic Translocation for the Management of Transposition of the Great Arteries with a Ventricular Septal Defect and Pulmonary Stenosis Victor O. Morell, MD, and Peter D. Wearden, MD, PhD In

More information

Ascending Thoracic Aorta: Postsurgical CT Evaluation

Ascending Thoracic Aorta: Postsurgical CT Evaluation Ascending Thoracic Aorta: Postsurgical CT Evaluation Santiago Martinez Jimenez, MD GOALS Ascending Thoracic Aorta: Postsurgical CT Evaluation Santiago Martínez MD smartinez-jimenez@saint-lukes.org Saint

More information

Tetralogy of Fallot (TOF) with absent pulmonary valve

Tetralogy of Fallot (TOF) with absent pulmonary valve Repair of Tetralogy of Fallot with Absent Pulmonary Valve Syndrome Karl F. Welke, MD, and Ross M. Ungerleider, MD, MBA Tetralogy of Fallot (TOF) with absent pulmonary valve syndrome (APVS) occurs in 5%

More information

Durability of Aortic Valve Preservation and Root Reconstruction in Acute Type A Aortic Dissection

Durability of Aortic Valve Preservation and Root Reconstruction in Acute Type A Aortic Dissection Durability of Aortic Valve Preservation and Root Reconstruction in Acute Type A Aortic Dissection Filip P. Casselman, MD, M. Erwin S. H. Tan, MD, Freddy E. E. Vermeulen, MD, Johannes C. Kelder, MD, Wim

More information

Cardiac tumors are unusual and cardiac malignancy, usually

Cardiac tumors are unusual and cardiac malignancy, usually Cardiac Autotransplantation Shanda H. Blackmon, MD,* and Michael J. Reardon, MD Cardiac tumors are unusual and cardiac malignancy, usually sarcoma, is a very small subset of these. The literature on cardiac

More information

Heart transplantation is the gold standard treatment for

Heart transplantation is the gold standard treatment for Organ Care System for Heart Procurement and Strategies to Reduce Primary Graft Failure After Heart Transplant Masaki Tsukashita, MD, PhD, and Yoshifumi Naka, MD, PhD Primary graft failure is a rare, but

More information

Understanding the Cardiopulmonary Bypass Machine and Its Tubing

Understanding the Cardiopulmonary Bypass Machine and Its Tubing Understanding the Cardiopulmonary Bypass Machine and Its Tubing Robert S. Leckie, MD Division of Cardiac Anesthesia, Beth Israel Deaconess Medical Center ABL 1/09 Reservoir Bucket This is a cartoon of

More information

Native aortic valve replacement is the procedure of choice

Native aortic valve replacement is the procedure of choice Left Ventricle Apical Aortic Conduit for Aortic Stenosis Giovanni Speziali, MD, and Kenton J. Zehr, MD Native aortic valve replacement is the procedure of choice for pure aortic valve stenosis. Occasionally,

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

Techniques to preserve the native aortic valve during aortic

Techniques to preserve the native aortic valve during aortic Valve-Sparing Aortic Root Replacement with the Valsalva Graft Duke Cameron, MD, and Luca Vricella, MD Techniques to preserve the native aortic valve during aortic root replacement have evolved considerably

More information

Steph ani eph ani Mi M ck i MD Cleveland Clinic

Steph ani eph ani Mi M ck i MD Cleveland Clinic Stephanie Mick MD Stephanie Mick MD Cleveland Clinic Upper hemisternotomy AVR Ascending Aorta MVr Thoracotomy Based Anterior AVR Lateral Thoracotomy Mitral/Tricuspid surgery Robotically assisted surgery

More information

Cardiothoracic Fellow Expectations Division of Cardiac Anesthesia, Beth Israel Deaconess Medical Center

Cardiothoracic Fellow Expectations Division of Cardiac Anesthesia, Beth Israel Deaconess Medical Center The fellowship in Cardiothoracic Anesthesia at the Beth Israel Deaconess Medical Center is intended to provide the foundation for a career as either an academic cardiothoracic anesthesiologist or clinical

More information

Chapter 13 Worksheet Code It

Chapter 13 Worksheet Code It Class: Date: Chapter 13 Worksheet 3 2 1 Code It True/False Indicate whether the statement is true or false. 1. A cardiac catheterization diverts blood from the heart to the aorta. 2. Selective vascular

More information

Panel Discussion: Session II Aortic Arch

Panel Discussion: Session II Aortic Arch Panel Discussion: Session II Aortic Arch Moderator: Randall B. Griepp, MD Panelists: Robert Bonser, FRCS, FRCP, Axel Haverich, MD, PhD, Teruhisa Kazui, MD, Nicholas T. Kouchoukos, MD, Hazim J. Safi, MD,

More information

Improving Results of Open Arch Replacement

Improving Results of Open Arch Replacement Improving Results of Open Arch Replacement Thoralf M. Sundt III, MD, Thomas A. Orszulak, MD, David J. Cook, MD, and Hartzell V. Schaff, MD Divisions of Cardiovascular Surgery and Anesthesiology, Mayo Clinic

More information

Fate of Aneurysms of the Distal Arch and Proximal Descending Thoracic Aorta After Transaortic Endovascular Stent-Grafting

Fate of Aneurysms of the Distal Arch and Proximal Descending Thoracic Aorta After Transaortic Endovascular Stent-Grafting CARDIOVASCULAR Fate of Aneurysms of the Distal Arch and Proximal Descending Thoracic Aorta After Transaortic Endovascular Stent-Grafting Taijiro Sueda, MD, Kazumasa Orihashi, MD, Kenji Okada, MD, Yuji

More information

The clinical applications for periods of hypothermic

The clinical applications for periods of hypothermic SESSION 4: AORTIC ARCH II Cerebral Metabolic Suppression During Hypothermic Circulatory Arrest in Humans Jock N. McCullough, MD, Ning Zhang, MD, David L. Reich, MD, Tatu S. Juvonen, MD, PhD, James J. Klein,

More information

Echocardiographic Evaluation of the Aorta

Echocardiographic Evaluation of the Aorta Echocardiographic Evaluation of the Aorta William F. Armstrong M.D. Director Echocardiography Laboratory Professor of Medicine University of Michigan The Aorta: What to Evaluate Dimensions / shape Atherosclerotic

More information

Case 9799 Stanford type A aortic dissection: US and CT findings

Case 9799 Stanford type A aortic dissection: US and CT findings Case 9799 Stanford type A aortic dissection: US and CT findings Accogli S, Aringhieri G, Scalise P, Angelini G, Pancrazi F, Bemi P, Bartolozzi C Department of Diagnostic and Interventional Radiology, University

More information

Aortic valve repair is an accepted option for aortic valve

Aortic valve repair is an accepted option for aortic valve Complex Aortic Valve Disease in Children Christopher W. Baird, MD,* and Pedro J. del Nido, MD Aortic valve repair is an accepted option for aortic valve pathologic conditions in children and young adults.

More information

Hybrid Aortic Arch Debranching With Staged Endovascular Completion in DeBakey Type I Aortic Dissection

Hybrid Aortic Arch Debranching With Staged Endovascular Completion in DeBakey Type I Aortic Dissection Hybrid Aortic Arch Debranching With Staged Endovascular Completion in DeBakey Type I Aortic Dissection Antonino G.M. Marullo, MD, PhD, Samuele Bichi, MD, Rocco A. Pennetta, MD, Gerardo Di Matteo, MD, Antonio

More information

Neonatal Aortic Arch Reconstruction Avoiding Circulatory Arrest and Direct Arch Vessel Cannulation

Neonatal Aortic Arch Reconstruction Avoiding Circulatory Arrest and Direct Arch Vessel Cannulation Neonatal Aortic Arch Reconstruction Avoiding Circulatory Arrest and Direct Arch Vessel Cannulation Christo I. Tchervenkov, MD, Stephen J. Korkola, MD, Dominique Shum-Tim, MD, Christos Calaritis, BS, Eric

More information

Diversion of the inferior vena cava following repair of atrial septal defect causing hypoxemia

Diversion of the inferior vena cava following repair of atrial septal defect causing hypoxemia Marshall University Marshall Digital Scholar Internal Medicine Faculty Research Spring 5-2004 Diversion of the inferior vena cava following repair of atrial septal defect causing hypoxemia Ellen A. Thompson

More information

Bicuspid Aortic Valve Repair in the Setting of Severe Aortic Insufficiency

Bicuspid Aortic Valve Repair in the Setting of Severe Aortic Insufficiency Bicuspid Aortic Valve Repair in the Setting of Severe Aortic Insufficiency Edward P. Chen MD Director Thoracic Aortic Surgery Division of Cardiothoracic Surgery Emory University School of Medicine Atlanta,

More information

Redacement of the AsGending Aorta and Aortic Valve with a Composite Graft: Results in 25 Patients

Redacement of the AsGending Aorta and Aortic Valve with a Composite Graft: Results in 25 Patients Redacement of the AsGending Aorta and Aortic Valve with a Composite Graft: Results in 25 Patients Nicholas T. Kouchoukos, M.D., Robert B. Karp, M.D., and William A. Lell, M.D. ABSTRACT Our experience with

More information

Marfan s S drome: Combined Composite Valve GrAeplacement of the Aortic Root and Transaortic Mihal Valve Replacement

Marfan s S drome: Combined Composite Valve GrAeplacement of the Aortic Root and Transaortic Mihal Valve Replacement Marfan s S drome: Combined Composite Valve GrAeplacement of the Aortic Root and Transaortic Mihal Valve Replacement E. Stanley Crawford, M.D., and Joseph S. Coselli, M.D. ABSTRACT Echocardiographic studies

More information

Descending endograft for DeBakey type 1 aortic dissection: pro

Descending endograft for DeBakey type 1 aortic dissection: pro Perspective Descending endograft for DeBakey type 1 aortic dissection: pro Paolo Berretta, Marco Di Eusanio Division of Cardiac Surgery, G. Mazzini Hospital, Teramo, Italy Correspondence to: Marco Di Eusanio.

More information

Strategies in the surgical treatment of type A aortic arch dissection

Strategies in the surgical treatment of type A aortic arch dissection Perspective Strategies in the surgical treatment of type A aortic arch dissection Jehangir J. Appoo 1*, Zlatko Pozeg 2* 1 Libin Cardiovascular Institute of Alberta, Division of Cardiac Surgery, Department

More information

SPINAL CORD ISCHEMIA AFTER THORACIC ANEURYSM REPAIR: RISK STRATIFICATION & PREVENTION DISCLOSURES. INDIVIDUAL None

SPINAL CORD ISCHEMIA AFTER THORACIC ANEURYSM REPAIR: RISK STRATIFICATION & PREVENTION DISCLOSURES. INDIVIDUAL None DISCLOSURES AFTER THORACIC ANEURYSM REPAIR: INDIVIDUAL None RISK STRATIFICATION & PREVENTION INSTITUTIONAL Cook, Inc W. L. Gore, Inc Conrad, J Vasc Surg, 2008 1 Intraoperative Adjuncts Oversew intercostals

More information

Extra Anatomic Bypass For Congenital And Acquired Disorders Of The Thoracic Aorta

Extra Anatomic Bypass For Congenital And Acquired Disorders Of The Thoracic Aorta Extra Anatomic Bypass For Congenital And Acquired Disorders Of The Thoracic Aorta V. Arakelyan Bakoulev Scientific Center for Cardiovascular Surgery The Institute of Coronary and Vascular Surgery Moscow,

More information

Frozen Elephant Trunk: A technique which can be offered in complex pathology to fix the whole aorta in one setting

Frozen Elephant Trunk: A technique which can be offered in complex pathology to fix the whole aorta in one setting CASE REPORT Open Access Frozen Elephant Trunk: A technique which can be offered in complex pathology to fix the whole aorta in one setting John Kokotsakis 1, Vania Anagnostakou 2, Theodoros Kratimenos

More information

Chapter 14. The Cardiovascular System

Chapter 14. The Cardiovascular System Chapter 14 The Cardiovascular System Introduction Cardiovascular system - heart, blood and blood vessels Cardiac muscle makes up bulk of heart provides force to pump blood Function - transports blood 2

More information

Thinking outside of the box Perfusion management and myocardial protection strategy for a patient with sickle cell disease

Thinking outside of the box Perfusion management and myocardial protection strategy for a patient with sickle cell disease Thinking outside of the box Perfusion management and myocardial protection strategy for a patient with sickle cell disease Shane Buel MS, RRT 1 Nicole Michaud MS CCP PBMT 1 Rashid Ahmad MD 2 1 Vanderbilt

More information

ROLE OF VASCULAR SURGERY, CARDIAC SURGERY AND RADIOLOGY IN THE TREATMENT OF THORACIC AORTIC ANEURYSMS

ROLE OF VASCULAR SURGERY, CARDIAC SURGERY AND RADIOLOGY IN THE TREATMENT OF THORACIC AORTIC ANEURYSMS ROLE OF VASCULAR SURGERY, CARDIAC SURGERY AND RADIOLOGY IN THE TREATMENT OF THORACIC AORTIC ANEURYSMS Armando Mansilha MD, PhD, FEBVS Joel Sousa MD 16 th National Congress of the Italian Society of Vascular

More information

Special considerations in mitral valve repair during aortic root surgery

Special considerations in mitral valve repair during aortic root surgery Safeguards and Pitfalls Special considerations in mitral valve repair during aortic root surgery Friedhelm Beyersdorf Department of Cardiovascular Surgery, University Heart Center Freiburg, Freiburg im

More information

Lab Activity 25. Blood Vessels & Circulation. Portland Community College BI 232

Lab Activity 25. Blood Vessels & Circulation. Portland Community College BI 232 Lab Activity 25 Blood Vessels & Circulation Portland Community College BI 232 Artery and Vein Histology Walls have 3 layers: Tunica intima Tunica media Tunica externa 2 Tunica Intima Is the innermost layer

More information

Operations on the aortic arch involve sophisticated

Operations on the aortic arch involve sophisticated Surgical Management of Hemorrhage From Rupture of the Aortic Arch René Prêtre, MD, Nicolas Murith, MD, Dominique Delay, MD, and Tshibambula Kalonji, MD Cardiovascular Surgery, Department of Surgery, University

More information

Influence of Perioperative Hemodynamics on Spinal Cord Ischemia in Thoracoabdominal Aortic Repair

Influence of Perioperative Hemodynamics on Spinal Cord Ischemia in Thoracoabdominal Aortic Repair Influence of Perioperative Hemodynamics on Spinal Cord Ischemia in Thoracoabdominal Aortic Repair Yujiro Kawanishi, MD, Kenji Okada, MD, Masamichi Matsumori, MD, Hiroshi Tanaka, MD, Teruo Yamashita, MD,

More information

The recent interest in minimal access surgery throughout

The recent interest in minimal access surgery throughout Partial Versus Full Sternotomy for Aortic Valve Replacement Michael F. Szwerc, MD, Daniel H. Benckart, MD, Robert J. Wiechmann, MD, Edward B. Savage, MD, Gary W. Szydlowski, MD, George J. Magovern, Jr,

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

In operations involving the transverse aortic arch, acute

In operations involving the transverse aortic arch, acute Antegrade Cerebral Perfusion With a Simplified Technique: Unilateral Versus Bilateral Perfusion Christian Olsson, MD, and Stefan Thelin, MD, PhD Department of Surgical Sciences, Division of Cardiothoracic

More information

HOW TO DO IT. Intraluminal Graft for Acute Dissection of the Ascending Aorta

HOW TO DO IT. Intraluminal Graft for Acute Dissection of the Ascending Aorta HOW TO DO IT Intraluminal Graft for Acute Dissection of the Ascending Aorta Hendrick B. Barner, M.D., and Vallee L. Willman, M.D. ABSTRACT A technique of intraluminal graft placement for the management

More information

Perioperative Management of DORV Case

Perioperative Management of DORV Case Perioperative Management of DORV Case James P. Spaeth, MD Department of Anesthesia Cincinnati Children s Hospital Medical Center University of Cincinnati Objectives: 1. Discuss considerations regarding

More information

Parasternal Approach for Minimally Invasive Aortic Valve Surgery

Parasternal Approach for Minimally Invasive Aortic Valve Surgery Parasternal Approach for Minimally Invasive Aortic Valve Surgery Lawrence H. Cohn Aortic valve replacement for the stenotic or regurgitant aortic valve has been one of the major advances of medical science

More information

Distal Coronary Artery Dissection Following Percutaneous Transluminal Coronary Angioplasty

Distal Coronary Artery Dissection Following Percutaneous Transluminal Coronary Angioplasty Distal Coronary rtery Dissection Following Percutaneous Transluminal Coronary ngioplasty Douglas. Murphy, M.D., Joseph M. Craver, M.D., and Spencer. King 111, M.D. STRCT The most common cause of acute

More information

Total aortic repair: the new paradigm in the treatment of acute type A aortic dissection

Total aortic repair: the new paradigm in the treatment of acute type A aortic dissection Perspective Total aortic repair: the new paradigm in the treatment of acute type A aortic dissection George Matalanis 1, Nisal K. Perera 1, Sean D. Galvin 2 1 Department of Cardiac Surgery, The Austin

More information

Aortic Center of Excellence at Sentara

Aortic Center of Excellence at Sentara Gordon K. Stokes, MD, FACS Eastern Virginia Medical School Sentara Vascular Specialists Norfolk, VA Aortic Center of Excellence at Sentara April 25, 2014 Disclosures I have no disclosures relevant to this

More information

2015 Facility and Physician Billing Guide Heart Valve Technologies

2015 Facility and Physician Billing Guide Heart Valve Technologies 2015 Facility and Physician Billing Guide Heart Valve Technologies PHYSICIAN BILLING CODES Clinicians use Current Procedural Terminology (CPT 1 ) codes to bill for procedures and services. Each CPT code

More information

Thoracic aortic aneurysms are life threatening and

Thoracic aortic aneurysms are life threatening and Thoracic Aortic Aneurysms: Treatment With Endovascular Self-Expandable Stent Grafts Martin Grabenwöger, MD, Doris Hutschala, MD, Marek P. Ehrlich, MD, Fabiola Cartes-Zumelzu, MD, Siegfried Thurnher, MD,

More information

Early and Midterm Outcomes of the VSSR procedure with De Paulis valsalva graft: A Chinese single-center Experience in 38 patients

Early and Midterm Outcomes of the VSSR procedure with De Paulis valsalva graft: A Chinese single-center Experience in 38 patients Xu et al. Journal of Cardiothoracic Surgery (2015) 10:167 DOI 10.1186/s13019-015-0347-1 RESEARCH ARTICLE Open Access Early and Midterm Outcomes of the VSSR procedure with De Paulis valsalva graft: A Chinese

More information

Management of the vertebral artery during thoracic endovascular aortic repair with coverage of the left subclavian artery

Management of the vertebral artery during thoracic endovascular aortic repair with coverage of the left subclavian artery Original Article Management of the vertebral artery during thoracic endovascular aortic repair with coverage of the left subclavian artery Jian Zhu*, Er-Ping Xi*, Shui-Bo Zhu, Gui-Lin Yin, Rong-Ping Wang,

More information

Repair or Replacement

Repair or Replacement Surgical intervention post MitraClip Device: Repair or Replacement Saudi Heart Association, February 21-24 Rüdiger Lange, MD, PhD Nicolo Piazza, MD, FRCPC, FESC German Heart Center, Munich, Germany Division

More information

Clinical outcomes of aortic root replacement after previous aortic root replacement

Clinical outcomes of aortic root replacement after previous aortic root replacement Clinical outcomes of aortic root replacement after previous aortic root replacement Luis Garrido-Olivares, MD, MSc, Manjula Maganti, MSc, Susan Armstrong, MSc, and Tirone E. David, MD Objective: The study

More information

Clinical material and methods. Department of Cardiovascular Surgery, Hôpital Bon-Secours, Metz, France

Clinical material and methods. Department of Cardiovascular Surgery, Hôpital Bon-Secours, Metz, France Surgical Options for Beating-Heart Aortic Valve Replacement in Patients with Patent Coronary Artery Bypass Daniel Grandmougin, Maria-Christina Delolme, David Derouck, Nabil Yammine, Christophe Minetti,

More information

Endovascular Ascending Repair: Is This the Next Frontier?

Endovascular Ascending Repair: Is This the Next Frontier? Endovascular Ascending Repair: Is This the Next Frontier? The 11 th Houston Aortic Symposium Session II: Ascending Aorta/Aortic Dissection (Proximal) February 15, 2018 Michael D. Dake, M.D. Thelma and

More information

Ischemic mitral regurgitation (IMR) is an insufficiency of

Ischemic mitral regurgitation (IMR) is an insufficiency of Repair Techniques for Ischemic Mitral Regurgitation Damien J. LaPar, MD, MSc, and Irving L. Kron, MD Ischemic mitral regurgitation (IMR) is an insufficiency of the mitral valve (MV) secondary to myocardial

More information