著者

Tadahisa Sugiura Chitaru Kurihara Masashi Kawabori Andre C. Critsinelis Andrew B. Civitello Jeffrey A. Morgan O. H. Frazier

出版者

The Editorial Committee of Annals of Thoracic and Cardiovascular Surgery

雑誌

Annals of Thoracic and Cardiovascular Surgery (ISSN:13411098)

巻号頁・発行日

vol.27, no.1, pp.64-67, 2021 (Released:2021-02-20)

参考文献数

5

被引用文献数

1 3

---

An increasing number of children with congenital heart disease are surviving into adulthood and subsequently developing end-stage heart failure. Two example populations are adults who have been previously operated on for congenitally corrected transposition of the great arteries (CCTGA) and transposition of the great arteries (TGA). Implantation of a continuous flow left ventricular assist device (CF-LVAD) in these patients can present unusual anatomical and physiologic challenges. In this report, we describe outcomes of CF-LVAD implantation in three such patients. These cases demonstrate the feasibility of implanting a CF-LVAD in patients who have undergone surgery for CCTGA and/or TGA.

著者

Akihiko Usui Masato Mutsuga

出版者

The Editorial Committee of Annals of Thoracic and Cardiovascular Surgery

雑誌

Annals of Thoracic and Cardiovascular Surgery (ISSN:13411098)

巻号頁・発行日

pp.ra.22-00103, (Released:2022-07-15)

参考文献数

49

被引用文献数

3

---

In patients with obstructive hypertrophic cardiomyopathy, left ventricular outflow tract (LVOT) obstruction can be created by the hypertrophic interventricular septum (IVS) as well as systolic anterior motion (SAM) of the anterior mitral leaflet (AML). Sufficient septal myectomy is a fundamental surgical technique to treat LVOT obstruction, however, direct surgical management for SAM is another key aspect. Besides the hypertrophic IVS, mitral valve, subvalvular apparatus, and papillary muscle may play important role for SAM and several surgical techniques have been proposed to treat SAM in literature. In this review, each surgical technique is classified by the anatomical structure on which the surgical procedure is applied. The AML is the main surgical site and is applied with plication (vertical plication, resection–plication–release strategy), extension (the AML extension, transverse incision of the AML), sutured (edge-to-edge repair, anterior leaflet retention plasty), or traction (floating stitch, papillary muscle-to-anterior annulus stitches, paradoxical stitches, transposition of a directed chorda tendinea to the AML). Height reduction of the posterior mitral valve leaflet and papillary muscle reorientation are other techniques. We should understand theoretical aspects of each technique on correction of anatomical and functional abnormalities of the structure and should apply them under proper indication.

著者

Yuhua Jiang Xun Wang Lixia Teng Yanguo Liu Jun Wang Zuolong Zheng

出版者

The Editorial Committee of Annals of Thoracic and Cardiovascular Surgery

雑誌

Annals of Thoracic and Cardiovascular Surgery (ISSN:13411098)

巻号頁・発行日

pp.oa.18-00295, (Released:2019-05-08)

参考文献数

17

被引用文献数

13

---

Objective: To compare the effectiveness of surgical versus nonsurgical treatment for multiple rib fractures accompanied with pulmonary contusion.Methods: The clinical records of consecutive 167 patients with multiple rib fractures accompanied with pulmonary contusion, who were treated from June 2014 to June 2017, were retrospectively analyzed. Of them, 75 and 92 underwent surgery (surgery group) and non-surgical treatment (non-surgery group), respectively. Patient pain score, complications, length of hospital stay, cost of hospitalization, and post-treatment 3-month follow-up results were compared.Results: The mean number of days and moderate pain in the surgery group was significantly lower than that of the non-surgery group (p <0.01). The incidence of post-treatment complications was significantly lower in the surgery group than in the non-surgery group. The length of hospital stay of the surgery group was also significantly shorter than that of the non-surgery group (p <0.01). The cost of hospitalization was significantly higher in the surgery group than in the non-surgery group (p <0.01). The chest computed tomography (CT) scan which was performed 3 months after the treatment revealed that the surgery group had a better recovery than the non-surgery group. Physical recovery of the surgery group was also significantly better than that of the non-surgery group.Conclusion: Surgery to treat multiple rib fractures (≥ 4 fractures) accompanied with pulmonary contusion is safe and effective.

著者

Francis P. Cheung Cheng He Philippa R. Eaton Jim Dimitriou Andrew E. Newcomb

出版者

The Editorial Committee of Annals of Thoracic and Cardiovascular Surgery

雑誌

Annals of Thoracic and Cardiovascular Surgery (ISSN:13411098)

巻号頁・発行日

pp.oa.21-00170, (Released:2022-02-09)

参考文献数

29

---

Background: Concomitant mitral regurgitation (MR) is frequently seen in patients undergoing surgical aortic valve replacement (AVR) for severe aortic stenosis (AS). When the severity of MR is moderate or less, the decision to undertake simultaneous mitral valve intervention can be challenging.Methods: A systematic search of Medline, PubMed (NCBI), Embase and Cochrane Library was conducted to qualitatively assess the current evidence for concomitant mitral valve intervention for MR in patients with AS undergoing AVR. The primary outcome for this systematic review was the postoperative change in the severity of MR and other outcomes of interest included factors that predict improvement or persistence of MR and long-term impacts of residual MR.Results: A total of 17 studies were included. The percentage of patients demonstrating improvement in MR severity following AVR ranged from 17.2% to 72%; the studies that exclusively included patients with moderate functional MR and reported longer term echocardiographic follow-up of greater than 12 months demonstrated an improvement in MR severity of 45% to 72%.Conclusion: This systematic review demonstrates that a proportion of patients can exhibit an improvement in MR following isolated surgical AVR, but whether this confers any long-term morbidity and mortality benefit remains unclear.

著者

Thilo Noack Mateo Marin Cuartas Philipp Kiefer Jens Garbade Bettina Pfannmueller Joerg Seeburger Michael A. Borger

出版者

The Editorial Committee of Annals of Thoracic and Cardiovascular Surgery

雑誌

Annals of Thoracic and Cardiovascular Surgery (ISSN:13411098)

巻号頁・発行日

vol.25, no.6, pp.326-335, 2019 (Released:2019-12-20)

参考文献数

27

被引用文献数

2 4

---

Purpose: This study aims to analyze the clinical outcomes after isolated mitral valve (MV) repair in patients with reduced left ventricular ejection fraction (LVEF <50%) with focus on perioperative characteristics, survival, and freedom from reoperations.Methods: Between 1997 and 2015, 557 patients with reduced LVEF (age: 62.8 ± 11.7 years, male: 320) underwent MV repair for symptomatic mitral regurgitation (MR). Etiologies were dilated non-ischemic cardiomyopathy and ischemic cardiomyopathy in 487 (87.4%) and 70 (12.6%) patients, respectively; these were classified into three different subgroups: LVEF 40%–49% (group 1), 30%–39% (group 2), and <30% (group 3).Results: Overall, 294, 145, and 118 patients had an LVEF of 40%–49%, 30%–39%, and <30%, respectively. Logistic EuroSCORE was significantly higher (P <0.001) as the LVEF worsened. The survival analysis for groups 1–3, respectively, revealed the following: 30-day mortality: 1.4%, 3.4%, and 7.6% (P <0.001); 1-year survival: 93.9%, 89.4%, and 82% (P <0.001); 5-year survival: 81.2%, 75.2%, and 58% (P <0.001).Conclusion: MV repair in patients with impaired LVEF could be performed safely with good clinical short- and mid-term outcome. Nevertheless, reduced preoperative LVEF correlates with worse perioperative and long-term survival.

著者

Takanori Kono Takeshi Oda Keiichi Akaiwa Katsuhiko Nakamura Kenya Sasaoka Hiroyuki Tanaka

出版者

The Editorial Committee of Annals of Thoracic and Cardiovascular Surgery

雑誌

Annals of Thoracic and Cardiovascular Surgery (ISSN:13411098)

巻号頁・発行日

pp.cr.18-00031, (Released:2018-04-20)

参考文献数

16

被引用文献数

2

---

Metal allergy is an uncommon problem during surgery. Among them, titanium allergy is said to be rare, but can lead to serious complications, such as palmoplantar pustulosis (PPP). A 69-year-old woman was admitted to our hospital with a chief complaint of chest pain. Coronary angiography showed severe coronary artery disease that required coronary artery bypass grafting (CABG). The patient had a history of orthopedic surgery for left distal radius fracture 2 years previously, which resulted in inflammation on the left arm and PPP. We suspected titanium allergy based on results of skin patch tests and use of titanium alloy in the previous orthopedic operation. The patient underwent CABG without use of permanent metallic material. As a result, her PPP disappeared. In this rare case, it is difficult to identify the exact cause of the improvement in PPP; thus, further studies are required to clarify the mechanism of remission.

著者

Andre Critsinelis Chitaru Kurihara Masashi Kawabori Tadahisa Sugiura Andrew B. Civitello Jeffrey A. Morgan

出版者

The Editorial Committee of Annals of Thoracic and Cardiovascular Surgery

雑誌

Annals of Thoracic and Cardiovascular Surgery (ISSN:13411098)

巻号頁・発行日

vol.27, no.3, pp.211-214, 2021 (Released:2021-06-20)

参考文献数

8

被引用文献数

1

---

Mechanical circulatory support may result in sufficient myocardial recovery to allow for explantation of the left ventricular assist device (LVAD). The duration of support associated with left ventricular recovery has generally been 6–12 months. In this report, we present a patient in whom the left ventricle recovered after 5 years of support with a LVAD. Our report demonstrates that long-term monitoring for left ventricular recovery is prudent and may allow for late device explantation.

著者

Takuma Tsukioka Kiyotoshi Inoue Hiroko Oka Shinjiro Mizuguchi Ryuhei Morita Noritoshi Nishiyama

出版者

The Editorial Committee of Annals of Thoracic and Cardiovascular Surgery

雑誌

Annals of Thoracic and Cardiovascular Surgery (ISSN:13411098)

巻号頁・発行日

pp.oa.12.01986, (Released:2012-12-26)

参考文献数

12

被引用文献数

7 12

---

Purpose: Pleurodesis continues to play a central role in the management of pneumothorax. In our institute, a 50% glucose solution is used for pleurodesis. We retrospectively analysed the treatment effects of pleurodesis in patients with spontaneous pneumothorax in whom an operation was contraindicated because of underlying disease.Methods: 13 patients (18 cases) with spontaneous pneumothorax were treated with pleurodesis with a 50% glucose solution. After local anesthesia of parietal pleura, 200 to500 mL of a 50% glucose solution was instilled into the pleural space. Pleurodesis was repeated two or three times, until the air leakage stopped.Results: Air leakage stopped in all cases and there were no treatment-related deaths.Overall survival rates at 1, 2, and 3 years after treatment were 83%, 74%, and 49%, respectively. Post-treatment recurrence was observed in six cases. Four cases of recurrence were treated with pleurodesis with a 50% glucose solution. All cases of recurrence occurred within 3 months after pleurodesis.Conclusion: Pleurodesis with a 50% glucose solution is effective and safe in patients with pneumothorax. This procedure can be performed in patients with recurrent pneumothorax as well as patients with a first episode of pneumothorax in whom prolonged air leakage is predicted.

著者

Alexander Weymann Christian Sebening

出版者

The Editorial Committee of Annals of Thoracic and Cardiovascular Surgery

雑誌

Annals of Thoracic and Cardiovascular Surgery (ISSN:13411098)

巻号頁・発行日

vol.20, no.Supplement, pp.813-815, 2014 (Released:2014-12-19)

参考文献数

9

被引用文献数

5 8

---

A 32-year-old man presented to our hospital after a failed suicide attempt using a crossbow. The patient had shot himself in close range with a double-barreled crossbow, simultaneously two arrows, in the chest. In spite of his life-threatening injuries, the man survived. The lodged arrows helped to avoid tremendous loss of blood. After his arrival in the hospital, the surgical removal of the arrows proceeded under direct visualization with corresponding sutures on the heart and liver. The patient's postoperative course was uneventful.

著者

Masahide Komagamine Kan Nawata Shota Kita Kiyoshi Chiba Shingo Kuwata Yoshihiro Akashi Takeshi Miyairi

出版者

The Editorial Committee of Annals of Thoracic and Cardiovascular Surgery

雑誌

Annals of Thoracic and Cardiovascular Surgery (ISSN:13411098)

巻号頁・発行日

pp.cr.22-00002, (Released:2022-03-26)

参考文献数

8

---

From April 2018 to February 2021, 150 patients underwent MitraClip implantation for severe functional mitral regurgitation (MR) at our hospital. Two of our patients, an 85-year-old man and an 84-year-old woman, developed a single leaflet device attachment in the acute phase after the implantation and had severe residual MR requiring surgical correction. The recurrent MR was first pointed out on day 5 and day 4, and the duration between MitraClip implantation and surgery was 13 and 55 days, respectively. Due to strong adhesions with the clips and severe valve damage after MitraClip implantation, both cases underwent mitral valve replacement with a good postoperative course. In patients with a high-risk baseline profile, surgical mitral valve replacement after failed MitraClip implantation should be considered at an optimal timing, and a detailed echocardiographic follow-up is required.

著者

Yichen Zhao Cheng Zhao Qing Ye Fei Li Kemin Liu Shihua Zhao Jiangang Wang

出版者

The Editorial Committee of Annals of Thoracic and Cardiovascular Surgery

雑誌

Annals of Thoracic and Cardiovascular Surgery (ISSN:13411098)

巻号頁・発行日

pp.oa.22-00213, (Released:2023-03-03)

参考文献数

30

---

Purpose: This study aimed to illustrate how percutaneous balloon mitral valvuloplasty (PBMV) and mitral valve (MV) surgeries influence women of childbearing age with rheumatic mitral valve diseases (RMVDs) from two aspects, including clinical outcomes and their postoperative childbearing performances.Methods: Female patients with RMVD who were of childbearing age and underwent MV interventions between 2007 and 2019 at Beijing Anzhen Hospital were identified. Outcomes included all-cause deaths, repeated MV interventions, and atrial fibrillation. A survey about childbearing attempts and complications during pregnancy was also performed during follow-up.Results: A total of 379 patients were involved in this study, consisting of 226 cases of mitral valve replacements, 107 cases of mitral valve repairs (MVrs), and 46 cases of PBMVs. PBMV was associated with higher possibilities of repeated MV interventions (P <0.05). Postoperative childbearing attempts were more frequently observed among bioprosthesis, MVr, and PBMV (P <0.05). However, PBMV and MVr showed a higher incidence of cardiac complications during pregnancy as compared to prosthesis replacement (P <0.05).Conclusions: MVr and PBMV are not recommended to young female patients for higher incidences of postoperative complications. Safe pregnancy is more likely to be present among patients with biological prosthesis.

著者

Akihiko Usui Masato Mutsuga

出版者

The Editorial Committee of Annals of Thoracic and Cardiovascular Surgery

雑誌

Annals of Thoracic and Cardiovascular Surgery (ISSN:13411098)

巻号頁・発行日

vol.28, no.4, pp.239-248, 2022 (Released:2022-08-20)

参考文献数

49

被引用文献数

3

---

In patients with obstructive hypertrophic cardiomyopathy, left ventricular outflow tract (LVOT) obstruction can be created by the hypertrophic interventricular septum (IVS) as well as systolic anterior motion (SAM) of the anterior mitral leaflet (AML). Sufficient septal myectomy is a fundamental surgical technique to treat LVOT obstruction, however, direct surgical management for SAM is another key aspect. Besides the hypertrophic IVS, mitral valve, subvalvular apparatus, and papillary muscle may play important role for SAM and several surgical techniques have been proposed to treat SAM in literature. In this review, each surgical technique is classified by the anatomical structure on which the surgical procedure is applied. The AML is the main surgical site and is applied with plication (vertical plication, resection–plication–release strategy), extension (the AML extension, transverse incision of the AML), sutured (edge-to-edge repair, anterior leaflet retention plasty), or traction (floating stitch, papillary muscle-to-anterior annulus stitches, paradoxical stitches, transposition of a directed chorda tendinea to the AML). Height reduction of the posterior mitral valve leaflet and papillary muscle reorientation are other techniques. We should understand theoretical aspects of each technique on correction of anatomical and functional abnormalities of the structure and should apply them under proper indication.

著者

Kemin Liu Qing Ye Yichen Zhao Cheng Zhao Li Song Jiangang Wang

出版者

The Editorial Committee of Annals of Thoracic and Cardiovascular Surgery

雑誌

Annals of Thoracic and Cardiovascular Surgery (ISSN:13411098)

巻号頁・発行日

pp.oa.22-00210, (Released:2023-03-10)

参考文献数

17

被引用文献数

1

---

Purpose: This study explored the sex differences in the outcomes of degenerative mitral valve repair (MVr).Methods: From 2010 to 2019, 1069 patients who underwent MVr due to degenerative mitral disease at Beijing Anzhen Hospital were analyzed. The average patient follow-up was 5.1 years (interquartile range: 5–7 years). The primary endpoint was overall survival. Secondary endpoints were freedom from reoperation and recurrent mitral regurgitation. A propensity-matched analysis was used to compare the outcomes of males and females.Results: Females were older, had a higher prevalence of atrial fibrillation and moderate-to-severe tricuspid regurgitation, and had smaller left atrial, left ventricular end-diastolic, and left ventricular end-systolic diameters. Males were more likely to undergo concomitant coronary artery bypass grafting and had longer cardiopulmonary bypass and aortic cross-clamp times. The in-hospital mortality was <1% (10/1,069). After propensity score matching of 331 pairs of patients, most variables were well balanced. Before and after propensity score matching, the long-term survival and freedom from reoperation rates were similar. Males had higher durability after surgery compared with females.Conclusions: Females were referred to surgery later and had more complications than males. Long-term survival and freedom from reoperation rates were not significantly different between the sexes.

著者

Tadashi Omoto Atsushi Aoki Kazuto Maruta Tomoaki Masuda

出版者

The Editorial Committee of Annals of Thoracic and Cardiovascular Surgery

雑誌

Annals of Thoracic and Cardiovascular Surgery (ISSN:13411098)

巻号頁・発行日

pp.oa.22-00135, (Released:2022-11-03)

参考文献数

12

---

Purpose: We studied the association between operative timing and the feasibility of mitral valve (MV) repair in active infective endocarditis (IE).Methods: Forty-nine active IE patients who underwent MV operation were classified according to operative timing: within 48 hours (Term I: n = 7), between 3 and 14 days (Term II: n = 22), and ≥15 days (Term III: n = 20). Patient profiles, operative outcomes, and feasibility of MV repair were evaluated. Complexity score and severity score were used to define the feasibility of MV repair depending on the extent of infected lesion and technical difficulties.Results: There were no differences in basic profile in the three groups. Rate of major complications was higher in Term I (86%) than II (41%, p = 0.031) and III (25%, p = 0.005). In-hospital mortality was also higher in Term I (43%) than II (9%, p = 0.039) and III (5%, p = 0.015). The three groups did not differ by feasibility of MV repair calculated by the two-score system or by frequency of MV repair (I: 57%, II: 59%, and III: 55%).Conclusions: Morbidity and mortality were high in urgent cases. Feasibility of MV repair is associated with the extent of infected lesion and technical difficulties, and not with operative timing.

著者

Akira Iyoda Yoko Azuma Takashi Sakai Satoshi Koezuka Hajime Otsuka Atsushi Sano

出版者

The Editorial Committee of Annals of Thoracic and Cardiovascular Surgery

雑誌

Annals of Thoracic and Cardiovascular Surgery (ISSN:13411098)

巻号頁・発行日

vol.28, no.5, pp.329-333, 2022 (Released:2022-10-20)

参考文献数

14

---

Purpose: A pneumothorax occurs in 3%–8% of patients with idiopathic pulmonary fibrosis. A pneumothorax may predict a poor outcome in patients with interstitial lung disease (ILD), and it is difficult to treat patients with ILD and a pneumothorax.Patients and Methods: We retrospectively studied data from all 12 patients with ILD and a pneumothorax who underwent surgical treatment at Toho University Omori Medical Center Hospital between 2009 and 2021.Results: Of the 12 patients, 2 had home oxygen therapy preoperatively and were classified with grade IV interstitial pneumonia (IP). Six patients had preoperative pleurodesis and two had postoperative one using auto-blood. Three patients (25%) had multi-step surgery ≥2, and 5 patients had surgical resection of bullae. No patients had postoperative acute exacerbations and all were discharged from the hospital in a stable condition. The 5-year overall survival rate for all patients was 70.0%. The median survival time was not reached. One patient with unclassified IP was doing well 116 months after surgery.Conclusion: Patients with ILD and a pneumothorax were shown to require multi-step surgical treatment and can anticipate long-term survival.

著者

Qing Ye Yichen Zhao Kemin Liu Cheng Zhao Yang Liu Yuqi Li Jiangang Wang

出版者

The Editorial Committee of Annals of Thoracic and Cardiovascular Surgery

雑誌

Annals of Thoracic and Cardiovascular Surgery (ISSN:13411098)

巻号頁・発行日

pp.oa.22-00033, (Released:2022-07-06)

参考文献数

24

被引用文献数

1

---

Purpose: We aimed to compare the efficacy of radiofrequency ablation (RFA) in patients undergoing mitral valve (MV) surgery with or without giant left atria.Methods: This retrospective, single-center, cohort study investigated patients who underwent MV surgery and concomitant RFA from 2009 to 2019. Patients were divided into non-giant left atria (diameter ≤65 mm, n = 1543) and giant left atria (diameter >65 mm, n = 241) groups. Five-year freedom from atrial tachyarrhythmia recurrence and thromboembolic event (TE) rates were assessed with death as the competing risk factor with and without propensity-score matching.Results: Patients with giant left atria had higher mortality (10.8% versus 6.2%, P = 0.008) and readmission rates for heart failure than those without (12.0% versus 6.8%, P = 0.004). Atrial tachyarrhythmia recurrence rates were higher in patients with giant left atria than in those without (49% versus 24% at 5 years, P <0.001), but the cumulative incidence of TEs before (P = 0.944) and after (P = 0.695) propensity-score matching was comparable.Conclusions: RFA effectively prevented TEs in patients with giant left atria, despite significant atrial tachyarrhythmia recurrence. Atrial tachyarrhythmia recurrence did not increase the risk of TEs. A lower success rate should be considered when deciding whether to perform surgical ablation in patients with giant left atria.

著者

Rafael Campos-Arjona Jorge Rodríguez-Capitán José D. Martínez-Carmona Alexey Lavreshin Loudes Fernández-Romero José M. Melero-Tejedor Manuel Jiménez-Navarro

出版者

The Editorial Committee of Annals of Thoracic and Cardiovascular Surgery

雑誌

Annals of Thoracic and Cardiovascular Surgery (ISSN:13411098)

巻号頁・発行日

pp.oa.22-00051, (Released:2022-07-15)

参考文献数

29

被引用文献数

4

---

Purpose: Our aim was to evaluate the development of new significant mitral regurgitation and long-term survival after mitral repair surgery in functional mitral regurgitation.Methods: A retrospective observational analysis of the recurrence of functional mitral regurgitation (ischemic and nonischemic) and global mortality during follow-up of 176 patients who underwent mitral repair surgery between 1999 and 2018 in our center was conducted.Results: The etiology of functional mitral regurgitation was ischemic in 55.7% of cases. After surgery, mitral regurgitation was 0-I in 92.3% of cases. We conducted a long-term clinical follow-up of a mean 42.2 months and an echocardiographic follow-up of a mean 41.8 months. We observed mitral regurgitation of at least grade II in 52 patients (36.9%). Survival at 1, 3, and 5 years was 78.8%, 66.7%, and 52.3%, respectively. Predictive factors for global mortality were age (hazard ratio = 1.038, p = 0.01) and a depressed preoperative ejection fraction. After a competing risk analysis, we found the only predictive factor for the recurrence of mitral regurgitation in our series to be age (sub-hazard ratio = 1.03, 95% confidence interval = 1.01–1.06, p = 0.016).Conclusion: Repair surgery for functional mitral regurgitation shows age as the only independent predictor of recurrence. Age and depressed ejection fraction were predictors of mortality.

著者

Norihiko Shiiya Naoki Washiyama Daisuke Takahashi Kazumasa Tsuda Yuko Ohashi Kayoko Natsume Masahiro Hirano

出版者

The Editorial Committee of Annals of Thoracic and Cardiovascular Surgery

雑誌

Annals of Thoracic and Cardiovascular Surgery (ISSN:13411098)

巻号頁・発行日

pp.ra.22-00148, (Released:2022-09-15)

参考文献数

52

---

Single-stage extended replacement from the ascending to the distal descending aorta or beyond is a formidable operation that should be preserved for those who have no other option or those who are physically fit, and should be performed in the experienced centers. Hybrid operations combining open surgical repair with thoracic endovascular aortic repair through a median sternotomy incision are preferable because these operations are less invasive than the extended open aortic repair and the risk of spinal cord ischemia is lower compared with the frozen elephant trunk operation. However, these operations are associated with the inherent demerits of endovascular aneurysm exclusion. When the underlying aortic pathology necessitates extended open aortic repair in a single stage, approaches such as the anterolateral partial sternotomy, straight incision with rib cross, and extended thoracotomy with sternal transection may be useful to provide sufficient exposure for both aortic reconstruction and organ protection, with less surgical stress to the patients.

著者

Yunfeng Li Hongwei Guo Luchen Wang Shenghua Liang Xiaogang Sun

出版者

The Editorial Committee of Annals of Thoracic and Cardiovascular Surgery

雑誌

Annals of Thoracic and Cardiovascular Surgery (ISSN:13411098)

巻号頁・発行日

pp.oa.19-00288, (Released:2020-03-11)

参考文献数

8

被引用文献数

2 5

---

Purpose: Total aortic arch replacement (TAR) with frozen elephant trunk (FET) is the standard operation for treating aortic dissection (AD) patients involving aortic arch with high operative risk due to long circulatory arrest (CA). We used aortic balloon occlusion technique that safely reduced the CA time to 5 min in average and investigated whether it can improve the clinical endpoints.Methods: All patients diagnosed with AD and underwent TAR with FET operation (123 with aortic balloon occlusion and 221 with conventional method) in Fuwai Hospital during August 2017 and February 2019 was reviewed in this retrospective observational study.Results: After propensity score matching, the 30-day mortality of aortic balloon occlusion group and conventional group was 4.88% and 11.38% (P = 0.062), respectively. In multivariate analysis, aortic balloon occlusion is one of the factors that reduced the risk for renal and hepatic injury, shortened postoperative conscious revival time, and reduced red blood cell (RBC) transfusion during operation.Conclusions: The aortic balloon occlusion technique, as a perfusion strategy during operation, could alleviate postoperative complication. This method deserves further attention in future clinical practice for its value in treating patients with higher operative risks.

著者

Yunfeng Li Hongwei Guo Luchen Wang Shenghua Liang Xiaogang Sun

出版者

The Editorial Committee of Annals of Thoracic and Cardiovascular Surgery

雑誌

Annals of Thoracic and Cardiovascular Surgery (ISSN:13411098)

巻号頁・発行日

vol.26, no.6, pp.332-341, 2020 (Released:2020-12-20)

参考文献数

8

被引用文献数

2 5

---

Purpose: Total aortic arch replacement (TAR) with frozen elephant trunk (FET) is the standard operation for treating aortic dissection (AD) patients involving aortic arch with high operative risk due to long circulatory arrest (CA). We used aortic balloon occlusion technique that safely reduced the CA time to 5 min in average and investigated whether it can improve the clinical endpoints.Methods: All patients diagnosed with AD and underwent TAR with FET operation (123 with aortic balloon occlusion and 221 with conventional method) in Fuwai Hospital during August 2017 and February 2019 was reviewed in this retrospective observational study.Results: After propensity score matching, the 30-day mortality of aortic balloon occlusion group and conventional group was 4.88% and 11.38% (P = 0.062), respectively. In multivariate analysis, aortic balloon occlusion is one of the factors that reduced the risk for renal and hepatic injury, shortened postoperative conscious revival time, and reduced red blood cell (RBC) transfusion during operation.Conclusions: The aortic balloon occlusion technique, as a perfusion strategy during operation, could alleviate postoperative complication. This method deserves further attention in future clinical practice for its value in treating patients with higher operative risks.