BackgroundThe introduction of the frozen elephant trunk (FET) technique for total arch replacement (TAR) has revolutionized the field of aortivascular surgery by allowing hybrid repair of complex aortic pathologies in a single step through combining an open surgical approach with an endovascular one. FET has been associated with favorable aortic remodeling, however, its is also associated with development of distal stent graft induced new entry (dSINE) tears postoperatively. The rate of aortic remodeling and the incidence of dSINE have been linked together, in addition, there seems to be a relationship between these two variables and FET insetion length as well as graft size.AimsThe scope of this review is to highlight the rate of aortic remodeling as well the incidence of dSINE associated with different FET devices available commercially. This review also aimed to investigate the relationship between aortic remodeling, dSINE, FET insertion length and FET graft size.MethodsWe conducted a comprehensive literature search using multiple electronic databases including PubMed, Ovid, Scopus and Embase in order to collate all research evidence on the above mentioned variables.ResultsThoraflex™ Hybrid Plexus seems to yield optimum aortic remodeling by promoting maximum false thrombosis as well true lumen expansion. Thoraflex Hybrid™ is also associated with the lowest incidence of dSINE post-FET relative to the other FET devices on the market. Aortic remodeling and dSINE do influence each other and are both linked with FET graft length and size.ConclusionThe FET technique for TAR shows excellent aortic remodeling but is associated with a considerable risk of dSINE development. However, Thoraflex™ Hybrid has demonstrated itself to be the superior FET device on the aortic arch prostheses market. Since aortic remodeling, dSINE, FET insertion length and stent graft size are all interconnect, the choice of FET device length and size must be made with great care for optimum results.
Background
The treatment of complex thoracic aorta pathologies remains a challenge for cardiovascular surgeons. After introducing Frozen Elephant Trunk (FET), a significant evolution of surgical techniques has been achieved. The present meta‐analysis aimed to assess the efficacy of FET in acute type A aortic dissection (ATAAD) and the effect of circulatory arrest time on post‐operative neurologic outcomes.
Methods
A standard Preferred Reporting Items for Systematic Reviews and Meta‐Analyses search was conducted for all observational studies of patients diagnosed with ATAAD undergoing total arch replacement with FET reporting in‐hospital mortality, bleeding, and neurological outcomes. A random‐effect meta‐analysis was performed using STATA software (StataCorp, TX, USA).
Results
Thirty‐five studies were eligible for the present meta‐analysis, including 3211 patients with ATAAD who underwent total arch replacement with FET. The pooled estimate for in‐hospital mortality, postoperative stroke, and spinal cord injury were 7% (95% CI 5 – 9; I2 = 68.65%), 5% (95% CI 4 – 7; I2 = 63.93%), and 3% (95% CI 2 – 4; I2 = 19.56%), respectively. Univariate meta‐regression revealed that with increasing the duration of hypothermic circulatory arrest time, the effect sizes for postoperative stroke and SCI enhances.
Conclusions
It seems that employing the FET procedure for acute type A dissection is associated with acceptable neurologic outcomes and a similar mortality rate comparing with other aorta pathologies. Besides, increasing hypothermic circulation arrest time appears to be a significant predictor of adverse neurologic outcomes after FET.
The effects of recent Covid-19 pandemic on this planet must be viewed with a wise eye and we should learn that human beings are interconnected chains, and that ignoring the laws of existence will undoubtedly continue with reflections similar to the way we are today. Although the community of heart surgeons is not at the forefront of the treatment of this epidemic, they are ready to rush to the aid of other colleagues if necessary. The aim of preparing this protocol is to prioritize cardiac surgery procedures, maintain blood and blood product reserves and provide the appropriate care for patients while taking precautions for the safety of medical staff. The general recommendation in this first version of protocol is to postpone all elective cardiac surgeries and perform emergent and urgent cases according to suggested personal protection strategies for Covid-19.
Background: The treatment of complex thoracic aorta pathologies remains
a challenge for cardiovascular surgeons. After introducing Frozen
Elephant Trunk (FET), a significant evolution of surgical techniques has
been achieved. The present meta-analysis aimed to assess the efficacy of
FET in acute type A aortic dissection (ATAAD) and the effect of
circulatory arrest time on post-operative neurologic outcomes. Methods:
A standard Preferred Reporting Items for Systematic Reviews and
Meta-Analyses search was conducted for all observational studies of
patients diagnosed with ATAAD undergoing total arch replacement with FET
reporting in-hospital mortality, bleeding, and neurological outcomes. A
random-effect meta-analysis was performed using STATA software
(StataCorp, TX, USA). Results: Thirty-five studies were eligible for the
present meta-analysis, including 3211 patients with ATAAD who underwent
total arch replacement with FET. The pooled estimate for in-hospital
mortality, postoperative stroke, and spinal cord injury were 7% (95%
CI 5 – 9; I2 = 68.65%), 5% (95% CI 4 – 7; I2 = 63.93%), and 3%
(95% CI 2 – 4; I2 = 19.56%), respectively. Univariate meta-regression
revealed that with increasing the duration of hypothermic circulatory
arrest time, the effect sizes for postoperative stroke and SCI enhances.
Conclusions: It seems that employing the FET procedure for acute type A
dissection is associated with acceptable neurologic outcomes and a
similar mortality rate comparing with other aorta pathologies. Besides,
increasing hypothermic circulation arrest time appears to be a
significant predictor of adverse neurologic outcomes after FET.
Coarctation complicated with mycotic pseudo-aneurysm is very rare. We are reporting a case of a 26-year-old man suffered from this pathology. As the incidence of mycotic pseudo-aneurysm is very rare in patients with aortic coarctation, the choice of this pathology for a patient presenting with unexplained fever is the only way to reduce the mortality risk.
Introduction: The use of pericardium has been expanded into different surgical modalities; however, there are scarce data regarding the feasibility of the pericardium in reconstructive urologic surgeries. We systematically reviewed the literature on the effectiveness of the pericardial tissue for reconstructive urologic surgeries. Materials and Methods: PubMed and Scopus were searched online for evidence on the use of the pericardium in urologic surgeries. Through the methodology recommended by the Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines, 38 of 4,071 studies were identified. Results: A total of 715 patients and 139 animals underwent reconstructive urologic surgeries using the pericardium. Bladder, urethral, and renal reconstructions were successful in 100% of the human cases. The rates of dissatisfaction, glans hypoesthesia, and penile shortening were comparable between the pericardial graft surgeries and the other operations during penile straightening, but there was a trend among the patients with pericardial grafts toward having a more penile curvature at follow-up (risk ratio [RR] 2.03, 95% CI 0.90–4.61, p = 0.09; I2 = 0%). Among the animal studies, there were 4 reports of penile reconstruction, 7 studies of bladder reconstruction, and 1 study of urethroplasty. Bladder reconstruction and urethroplasty were successful in 83 and 20% of the animals, respectively. The pooled result of the stimulated intracorporeal pressure 5 V significantly favored pericardial grafts during penile reconstruction (RR 2.61, 95% CI 1.26–3.97, p = 0.0002; I2 = 0%). Conclusions: Our systematic review demonstrates the feasibility of the pericardium, regardless of its type, in urologic surgeries. It, however, seems that urethral substitution needs further investigation. Given the lower cost, easier handling, and less immunogenicity of the pericardium, further studies are required to examine its pros and cons.
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