Endovascular Aortic Clamping for Pseudoaneurysms of the Aortic Root With Aortic Regurgitation

Maselli, Daniele; Santise, Gianluca; Montalto, Andrea; Musumeci, Francesco

doi:10.1016/j.athoracsur.2005.02.090

Cited by 11 publications

(11 citation statements)

References 10 publications

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“…Selective cannulation of the coronary ostia should be carried out with care if detachment, dissection, or infection of the ostia have been documented previously. Retrograde or percutaneous infusion of cardioplegia 15 through the coronary sinus may represent a valid alternative. If difficulties in delivering cardioplegia are anticipated with all routes, a lower core temperature will provide some extra time for myocardial protection to address the complex situation more effectively.…”

Section: Discussionmentioning

confidence: 99%

Reoperative surgery on the thoracic aorta

Bartolomeo

Berretta

Petridis

et al. 2013

The Journal of Thoracic and Cardiovascular Surgery

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The objective of our study was to report our hospital and long-term results after reinterventions on the thoracic aorta. Methods: Between 1986 and 2011, 224 reoperations on the proximal thoracic aorta after previous aortic surgery were performed in our institution. The number of reinterventions quadrupled during the course of the study period. Mean patient age was 58.1 years, and 174 patients (77.7%) were male. An urgent/emergency operation was performed in 39 patients (17.4%). Indications for surgery included degenerative and chronic postdissection aneurysm (n ¼ 166), false aneurysm (n ¼ 31), active prosthetic infection (n ¼ 16), acute dissection (n ¼ 10), and other (n ¼ 1). Surgical procedures involved the aortic root in 40.6% of patients, the ascending aorta in 9.4%, the aortic arch in 24.6%, and the entire proximal thoracic aorta in 25.4%. Results: Hospital mortality was 12.1%. On multivariate analysis, cardiopulmonary bypass time (odds ratio, 1.1023/minute; P<.001), and urgent/emergency status (odds ratio, 5.6; P<.001) emerged as independent predictors of hospital mortality. The follow-up was 98.7% complete. Estimated 1-, 5-, and 10-year survival rates were 84.4%, 72.5%, and 48.5%, respectively. Eighteen reinterventions were performed during follow-up-16 because of the progression of aortic disease at the proximal aorta (n ¼ 2) and downstream aorta (n ¼ 14). Freedom from reoperation at 1, 5, and 10 years was 95.6%, 90.2%, and 81.5%, respectively. Conclusions: Reoperative aortic surgery was associated with satisfactory short-and long-term results, especially if carried out on an elective basis. The extent of the aortic replacement did not impact survival and was associated with a reduced need for reintervention. The progressive nature of aortic disease and the favorable results of elective primary aortic interventions suggest favoring aggressive aortic resections at initial surgery.

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Section: Discussionmentioning

confidence: 99%

Reoperative surgery on the thoracic aorta

Bartolomeo

Berretta

Petridis

et al. 2013

The Journal of Thoracic and Cardiovascular Surgery

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“…Several different techniques with a varying degree of complexity of performing resternotomy if AR is present have been described. Maselli and colleagues 7 used intraaortic endoclamping prior to circulatory arrest in order to prevent the left ventricle from dilating in six patients with pseudoaneurysm and AR with good results. A similar technique was described by Pettersson and colleagues 6 using a transfemoral balloon aortic occlusion catheter, with percutaneous placement of a retrograde cardioplegic catheter in the jugular vein to achieve myocardial protection.…”

Section: Discussionmentioning

confidence: 99%

“…This is particularly relevant in the presence of aortic regurgitation (AR). Several approaches and maneuvers to decompress the ventricle under such conditions have been suggested 6‐9 …”

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confidence: 99%

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Resternotomy Using Hypothermic Arrest

Möller

Líška

Lockowandt

et al. 2010

Journal of Cardiac Surgery

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“…The use of the right axillary artery as the inflow vessel for CPB has been described for pseudoaneurysms of the ascending aorta and arch. 2 When there is dissection of the descending aorta, axillary artery cannulation-which enables antegrade pump flow into the aorta-is associated with a lower risk of malperfusion and brain embolization. Circulatory arrest, however, can be very dangerous in the presence of severe aortic regurgitation, because overstretching myocardial fibers in the unvented and arrested heart can result in fatal myocardial damage.…”

Section: Discussionmentioning

confidence: 99%

Modified Port-Access Technique for the Treatment of Aortic Dissection after Previous Cardiac Surgery

Prifti¹,

Demiraj²,

Xhaxho³

2017

Texas Heart Institute Journal

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One of the most challenging conditions to manage after previous cardiac surgery is chronic S urgical treatment of acute ascending aortic dissection is challenging in patients who have a history of cardiac surgery.1 In such cases, a repeat sternotomy might cause catastrophic bleeding because of existing injury to the ascending aorta. The objective is to achieve profound hypothermia and circulatory arrest before opening the chest under cardiopulmonary bypass (CPB) via femofemoral cannulation. If aortic valve insufficiency is present, ventricular fibrillation might develop as the temperature decreases, leading to ventricular distention and myocardial damage. This phenomenon is not resolved by femofemoral bypass.The aim of this brief report is to describe a technique that uses the port-access approach in treating chronic ascending aortic dissection after previous cardiac surgery. Case ReportIn November 2009, a 52-year-old man underwent mitral valve repair because of severe regurgitation. Two years later, he was readmitted to our hospital with severe dyspnea. Echocardiograms revealed severe aortic valve regurgitation and an intimal flap in the ascending aorta. A contrast-enhanced computed tomographic angiogram showed a 6.5-cm segment of the ascending aorta very close to the sternum; an aortic dissection started above the coronary sinuses and extended to the descending aorta. The true lumen of the aorta was 3.8 to 4.2 cm in diameter, and the false lumen was partly filled with thrombus. The patient had reported an episode of severe chest pain 3 months earlier. We thereupon made a diagnosis of chronic aortic dissection and scheduled the patient for surgery.Modif ied Technique. An EndoPlege ® catheter (Edwards Lifesciences LLC; Irvine, Calif ) was advanced into the coronary sinus with transesophageal echocardiographic (TEE) assistance. The patient was draped, with the right clavicle and right shoulder exposed. After heparin administration, a 22F QuickDraw ® venous cannula (Edwards Lifesciences) was percutaneously inserted into the right femoral vein and advanced into the right atrium under TEE guidance. The right axillary artery was approached by blunt dissection through the deltopectoral groove. A 10-mm Dacron graft, trimmed at a 45° angle, was anastomosed to the anterior aspect of the axillary artery (Fig. 1). Then, a 21F EndoReturn ® arterial cannula (Edwards Lifesciences) was inserted into the Dacron graft, secured with 3 ties, and connected to the arterial

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Endovascular Aortic Clamping for Pseudoaneurysms of the Aortic Root With Aortic Regurgitation

Cited by 11 publications

References 10 publications

Reoperative surgery on the thoracic aorta

Reoperative surgery on the thoracic aorta

Resternotomy Using Hypothermic Arrest

Modified Port-Access Technique for the Treatment of Aortic Dissection after Previous Cardiac Surgery

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