Hemiarch Reconstruction Versus Clamped Aortic Anastomosis for Concomitant Ascending Aortic Aneurysm

Abstract

Propensity score matching yielded 116 pairs of non-hemiarch patients versus 116 hemiarch patients. Within the propensity score-matched cohort, there were no differences in postoperative stroke (1.7% versus 3.4%; p = 0.41), new postoperative dialysis (6.0% versus 5.2%; p = 0.78), postoperative renal insufficiency (27.6% versus 19.8%; p = 0.16), 30-day mortality (2.6% versus 3.4%; p = 0.701), or 1-year mortality (4.3% versus 4.3%; p = 1.00) CONCLUSIONS: Hemiarch replacement using DHCA with RCP does not increase the risk of operative complications compared with a normothermic, clamped-distal aortic anastomosis, and therefore its use should not be limited when planning complex multiprocedural reconstructions during elective ascending thoracic aortic replacement with concomitant cardiac surgery.

Time of day does not influence outcomes in acute type A aortic dissection: Results from the IRAD

“…Compared with the general surgical population, cardiac and aortic surgery is high risk and has a high rate of associated preventable adverse events. [20][21][22][23] Moreover, emergent surgery for TAAAD represents a high operative risk population that demands specialized care from dedicated and knowledgeable staff.…”

Trans-carotid endovascular repair of ascending aortic pseudoaneurysms

“…One of the most concerning complications with a transcarotid approach is a stroke. Although we did not use neurocerebral monitoring such as EEG, motor evoked potentials, and somatosensory evoked potentials, these can be utilized for intraoperative monitoring and may help identify a stroke expeditiously . Subclavian artery approaches have been reported as well and success with subclavian TAVR have encouraged surgeons to use the subclavian artery for deployment in select patients .…”

“…Although we did not use neurocerebral monitoring such as EEG, motor evoked potentials, and somatosensory evoked potentials, these can be utilized for intraoperative monitoring and may help identify a stroke expeditiously. 8 Subclavian artery approaches have been reported as well and success with subclavian TAVR have encouraged surgeons to use the subclavian artery for deployment in select patients. 9,10 However, deployment via the carotid artery may confer an advantage as the delivery system is relatively coaxial with the ascending aorta compared to the subclavian artery.…”

Ascending aortic aneurysm: propensity score matching analysis of hemiarch and non-hemiarch replacement

“…Sultan I, et al [18], проведя сравнительный анализ результатов изолированного протезирования восходящей аорты и протезирования восходящей аорты по типу "полудуги", не выявили увеличения риска развития инсульта при более радикальной операции по сравнению с изолированным протезированием восходящей аорты. Kilic A, et al [19] показали, что результаты Hemiarch даже у пациентов старше 75 лет не имеют существенных различий по частоте и структуре послеоперационных осложнений и летальности в сравнении с менее возрастной когортой больных.…”