The Decision-Making Process in Acute Type A Aortic Dissection: When to Replace the Aortic Arch

Leone, Alessandro; Marco, Luca Di; Murana, Giacomo; Coppola, Giuditta; Fiorentino, Mariafrancesca; Amodio, Ciro; Bartolomeo, Roberto Di; Pacini, Davide

doi:10.1053/j.semtcvs.2019.05.036

Cited by 8 publications

(7 citation statements)

References 31 publications

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“…Donor aortic dissections are more likely to be retained as the retrograde that develops downwards, and aortic insufficiency is a fatal complication of such acute aortic dissections. It may require Bentall and Cabrol procedure or valve protecting procedure such as David (2,3,5,7,(8)(9)(10)(11)(12). The Bentall procedure after HTX was first performed by Schellemans et al (5).…”

Section: Discussionmentioning

confidence: 99%

“…Donor and/or recipient aortic dissection following heart transplantation (HTx) was published in very small numbers of articles (1)(2)(3)(4)(5)(6)(7). As a result of the preparation of recipients, donor care, anesthesia and surgical techniques, improvements in immunosuppressive therapy, the survival of HTx patients are increasing day by day, thus increasing the incidence of late complications (1).…”

Section: Introductionmentioning

confidence: 99%

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Recipient Type A Aortic Dissection After Orthotopic Heart Transplantation

Konukoğlu

Doğan

Sever

et al. 2022

Preprint

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Recipient Type A Aortic Dissection After Orthotopic Heart Transplantation

Konukoğlu

Doğan

Sever

et al. 2022

Preprint

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“…The management of aortic arch disease either in the context of acute type A aortic dissection or in the presence of aneurysmatic disease is quite challenging and still a matter of significant debate [49], [50]. Open repair for aortic arch disease remains the standard of care in high volume centres, although endovascular treatment has become quite an established approach in the presence of significant comorbidities [51].…”

Section: Discussionmentioning

confidence: 99%

Evaluation of Different Cannulation Strategies for Aortic Arch Surgery Using a Cardiovascular Numerical Simulator

Lazzari¹,

Capoccia²,

Badagliacca³

et al. 2022

Preprint

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Aortic disease has a significant impact on quality of life. Involvement of the aortic arch requires preservation of blood supply to the brain during surgery. Deep hypothermic circulatory arrest is an established technique for this purpose although neurological injury remains high. Additional techniques have been used to reduce the risk although controversy still remains. A three-way cannulation approach, including both carotid arteries and the femoral artery or the ascending aorta, has been used successfully for aortic arch replacement and redo procedures. We have de-veloped circuits of the circulation to simulate blood flow during this type of cannulation set up. The aim is to analyse using CARDIOSIM© cardiovascular simulation platform, how the haemodynamic and energetic parameters are affected and the benefit derived with particular reference to the cerebral circulation.

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“…It is well known that the management of aortic arch disease either in the context of acute type A aortic dissection or in the presence of aneurysmatic disease is a challenging task and a subject of conflicting debate [37,38]. Open repair for aortic arch disease is still considered the standard of care in high volume centres, although the advent of endovascular treatment has led to a reset in the "modus operandi", particularly when a lack of fitness and comorbidities may preclude a traditional surgical approach [39].…”

Section: Discussionmentioning

confidence: 99%

Alternative Approach for Cerebral Protection during Complex Aortic Arch and Redo Surgery

Capoccia

Nienaber

Mireskandari

et al. 2021

JCDD

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Total arch replacement remains a very demanding surgical procedure. It can be associated with reasonable long-term outcomes but carries serious perioperative complications. Aortic arch surgery has progressed in recent years to a wider adoption of reproducible and reliable techniques. Conventional open, surgical aortic arch replacement is currently offered to the majority of patients, although hybrid and wholly endovascular techniques are gaining popularity. With regards to open arch replacement, the nuances of surgical technique, the mode of cannulation and the optimal cerebral protection protocols remain a matter of debate. We propose an alternative cannulation approach facilitated by the cooperation between cardiac and vascular surgeons. A three-way arterial cannulation including both carotid arteries and the femoral artery (or ascending aorta) is the key feature of this approach. A case series of complex patients is presented to show both the feasibility and relative safety of a standardised new approach with a 100% technical success rate and a 16% 30-day mortality. The three-way cannulation approach may have a role to play for complex and extensive procedures requiring prolonged cerebral protection. We believe that a shared skill set from cardiac and vascular specialists is essential for the safe management and successful outcomes using this adaptive technique.

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The Decision-Making Process in Acute Type A Aortic Dissection: When to Replace the Aortic Arch

Cited by 8 publications

References 31 publications

Recipient Type A Aortic Dissection After Orthotopic Heart Transplantation

Recipient Type A Aortic Dissection After Orthotopic Heart Transplantation

Evaluation of Different Cannulation Strategies for Aortic Arch Surgery Using a Cardiovascular Numerical Simulator

Alternative Approach for Cerebral Protection during Complex Aortic Arch and Redo Surgery

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