Robotic mitral valve surgery is associated with a high likelihood of valve repair and low operative mortality and morbidity. The combination of algorithm-driven patient selection and increased experience enhanced clinical outcomes and procedural efficiency.
Background
Data regarding the risk of aortic dissection in patients with bicuspid aortic valve and large ascending aortic diameter are limited, and appropriate timing of prophylactic ascending aortic replacement lacks consensus. Thus our objectives were to determine the risk of aortic dissection based on initial cross-sectional imaging data and clinical variables and to isolate predictors of aortic intervention in those initially prescribed serial surveillance imaging.
Methods
From January 1995 to January 2014, 1,181 patients with bicuspid aortic valve underwent cross-sectional computed tomography (CT) or magnetic resonance imaging (MRI) to ascertain sinus or tubular ascending aortic diameter greater than or equal to 4.7 cm. Random Forest classification was used to identify risk factors for aortic dissection, and among patients undergoing surveillance, time-related analysis was used to identify risk factors for aortic intervention.
Results
Prevalence of type A dissection that was detected by imaging or was found at operation or on follow-up was 5.3% (n = 63). Probability of type A dissection increased gradually at a sinus diameter of 5.0 cm—from 4.1% to 13% at 7.2 cm—and then increased steeply at an ascending aortic diameter of 5.3 cm—from 3.8% to 35% at 8.4 cm—corresponding to a cross-sectional area to height ratio of 10 cm2/m for sinuses of Valsalva and 13 cm2/m for the tubular ascending aorta. Cross-sectional area to height ratio was the best predictor of type A dissection (area under the curve [AUC] = 0.73).
Conclusions
Early prophylactic ascending aortic replacement in patients with bicuspid aortic valve should be considered at high-volume aortic centers to reduce the high risk of preventable type A dissection in those with aortas larger than approximately 5.0 cm or with a cross-sectional area to height ratio greater than approximately 10 cm2/m.
SUMMARY
BackgroundOver-the-counter histamine-2 receptor antagonists, antacids and alginate/antacids are commonly used for gastro-oesophageal reflux disease.
Objectives: Consensus regarding initial cannulation site for acute type A dissection repair is lacking. Objectives were to review our experience with systematic initial axillary artery cannulation, characterize patients on the basis of cannulation site, and assess outcomes.Methods: From January 2000 to January 2017, 775 patients underwent emergency acute type A dissection repair. Initial axillary cannulation was performed in 617 (80%), femoral in 93 (12%), and central in 65 (8.4%). In-hospital mortality and stroke risk factors were identified using logistic regression.
Results:Reasons for selecting initial central or femoral instead of axillary cannulation included unsuitable axillary anatomy (n ¼ 67; 42%), surgeon preference (n ¼ 38; 24%), hemodynamic instability (n ¼ 34; 22%), and preexisting cannulation (n ¼ 19; 12%). Cannulation site was shifted or added intraoperatively in 82 (11%), with initial cannulation site being axillary (n ¼ 23 of 617; 3.7%), central (6 of 65; 9.2%), or femoral (n ¼ 53 of 93; 57%), for surgeon preference (n ¼ 60; 73%), high flow resistance (n ¼ 13; 16%), increased aortic false lumen flow (n ¼ 6; 7.3%), and other (n ¼ 3; 3.7%). In-hospital mortality was 8.6% (n ¼ 67; lowest for axillary, 7.3% [P ¼ .02]) and stroke 8.3% (n ¼ 64). Hemodynamic instability (odds ratio [OR], 7.
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