- Administration of platelets to ruptured abdominal aortic aneurysm patients before open surgery: a prospective, single-blinded, randomised study. [Journal Article]
- TMTransfus Med 2018 May 21
- CONCLUSIONS: For patients planned for open repair of a rAAA, we observed no significant effect of early administration of platelets with regard to post-operative complications and stay in the ICU or in hospital and also no significant effect on mortality.
- Extent of Aortic Replacement in Type A Dissection: Current Answers for an Endless Debate. [Review]
- ATAnn Thorac Surg 2018 May 17
- CONCLUSIONS: In our opinion, there is no single correct operation for a patient with type A dissection, but there is a correct operation for each surgeon and clinical scenario.
- "Mesenteric steal" physiology as a cause of claudication and chronic mesenteric ischemia. [Journal Article]
- AVAnn Vasc Surg 2018 May 16
- Aortoiliac occlusive disease (AOID) results in varying degrees of pelvic and lower extremity arterial insufficiency. Treatment approach has evolved and endovascular therapies are being successfully r...
Aortoiliac occlusive disease (AOID) results in varying degrees of pelvic and lower extremity arterial insufficiency. Treatment approach has evolved and endovascular therapies are being successfully reported for high-grade lesion. However, Trans Atlantic Inter-Society Consensus (TASC) D often necessitates open revascularization. Disease limited to the infrarenal segment does not typically affect intestinal perfusion in the absence of visceral aortic or mesenteric vessel involvement. Chronic mesenteric ischemia most commonly occurs due to atherosclerotic disease of two or three of the mesenteric vessels. The marginal artery of Drummond is an important component of the collateral network that allows for continued intestinal perfusion. We report a case of short-segment subtotal infrarenal aortic occlusion, proximal to the inferior mesenteric artery (IMA) in the absence of significant mesenteric disease. The patient had resultant lifestyle limiting claudication and chronic mesenteric ischemia. Angiographic evaluation demonstrated "mesenteric steal" physiology with retrograde flow via the arc of Riolan and IMA to perfuse the aortoiliac circulation. Successful endovascular recanalization with a balloon expandable covered stent was achieved, resolving the arterial insufficiency in both the mesenteric and lower extremity vascular beds. The patient denied any symptoms on postoperative day one and at one month follow-up.
- Aortic valve annuloplasty with the HAART geometric ring and ascending aorta replacement. [Video-Audio Media]
- MMMultimed Man Cardiothorac Surg 2018 May 02; 2018
- Approximately one-third of patients suffering from aortic insufficiency (AI) present also with an ascending aortic aneurysm. AI is most commonly due to a combination of sinotubular junction and annul...
Approximately one-third of patients suffering from aortic insufficiency (AI) present also with an ascending aortic aneurysm. AI is most commonly due to a combination of sinotubular junction and annular dilatation. Valve reimplantation or prosthetic valve replacement may not be ideal for these patients, and ascending aortic aneurysm resection with aortic valve repair using geometric internal ring annuloplasty is a simple, successful, and reproducible alternative treatment approach. In this video tutorial we demonstrate aortic valve repair using the HAART 300 annuloplasty ring with concomitant ascending aorta replacement.
- An updated meta-analysis of TAVR in patients at intermediate risk for SAVR. [Journal Article]
- CRCardiovasc Revasc Med 2018 Apr 20
- CONCLUSIONS: This meta-analysis suggests that for intermediate risk patients with severe aortic stenosis, TAVR has similar efficacy as SAVR but with a different adverse event profile.
- Transcatheter Aortic Valve-in-Valve Procedure in Patients with Bioprosthetic Structural Valve Deterioration. [Review]
- MDMethodist Debakey Cardiovasc J 2017 Jul-Sep; 13(3):132-141
- Surgical aortic valve replacement is the gold standard procedure to treat patients with severe, symptomatic aortic valve stenosis or insufficiency. Bioprosthetic valves are used for surgical aortic v...
Surgical aortic valve replacement is the gold standard procedure to treat patients with severe, symptomatic aortic valve stenosis or insufficiency. Bioprosthetic valves are used for surgical aortic valve replacement with a much greater prevalence than mechanical valves. However, bioprosthetic valves may fail over time because of structural valve deterioration; this often requires intervention due to severe bioprosthetic valve stenosis or regurgitation or a combination of both. In select patients, transcatheter aortic valve replacement is an alternative to surgical aortic valve replacement. Transcatheter valve-in-valve (ViV) replacement is performed by implanting a transcatheter heart valve within a failing bioprosthetic valve. The transcatheter ViV operation is a less invasive procedure compared with reoperative surgical aortic valve replacement, but it has been associated with specific complications and requires extensive preoperative work-up and planning by the heart team. Data from experimental studies and analyses of results from clinical procedures have led to strategies to improve outcomes of these procedures. The type, size, and implant position of the transcatheter valve can be optimized for individual patients with knowledge of detailed dimensions of the surgical valve and radiographic and echocardiographic measurements of the patient's anatomy. Understanding the complexities of the ViV procedure can lead surgeons to make choices during the original surgical valve implantation that can make a future ViV operation more technically feasible years before it is required.
- Successful Use of Sternal-sparing Minimally Invasive Surgery for Proximal Ascending Aortic Pathology. [Journal Article]
- ATAnn Thorac Surg 2018 May 04
- CONCLUSIONS: A sternal-sparing approach to surgery of the proximal aorta is safe when performed by an experienced surgeon and conserves hospital resources.
- Hemiarch Reconstruction Vs Clamped Aortic Anastomosis for Concomitant Ascending Aortic Aneurysm. [Journal Article]
- ATAnn Thorac Surg 2018 May 03
- Deep hypothermic circulatory arrest (DHCA) is often avoided in patients with concomitant ascending aortic pathology when treating other cardiac disease to avoid increased risk of morbidity and mortal...
Deep hypothermic circulatory arrest (DHCA) is often avoided in patients with concomitant ascending aortic pathology when treating other cardiac disease to avoid increased risk of morbidity and mortality. We hypothesized that the use of DHCA with retrograde cerebral perfusion (RCP) does not add incremental risk to ascending aortic replacement alone in the setting of concomitant cardiac surgery.
- Platypnea-orthodeoxia syndrome associated with aortic insufficiency and aortic elongation. [Journal Article]
- JCJ Card Surg 2018 May 03
- An 81-year-old female developed dyspnea only upon assuming a sitting position. Trans-esophageal echocardiography demonstrated left-to-right shunt flow across the atrial septum when the patient was si...
An 81-year-old female developed dyspnea only upon assuming a sitting position. Trans-esophageal echocardiography demonstrated left-to-right shunt flow across the atrial septum when the patient was sitting, and right-to-left shunt flow when she was supine, along with severe aortic insufficiency. She was diagnosed as having platypnea-orthodeoxia syndrome and her symptoms were completely resolved following aortic valve replacement, closure of a patent foramen ovale, and shortening of an elongated ascending aorta.
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- Emergency Valve-in-Valve Transcatheter Aortic Valve Implantation for the Treatment of Acute Stentless Bioprosthetic Aortic Insufficiency and Cardiogenic Shock. [Journal Article]
- CRCase Rep Cardiol 2018; 2018:6872748
- Bioprosthetic aortic valve degeneration may present as acute, severe aortic regurgitation and cardiogenic shock. Such patients may be unsuitable for emergency valve replacement surgery due to excessi...
Bioprosthetic aortic valve degeneration may present as acute, severe aortic regurgitation and cardiogenic shock. Such patients may be unsuitable for emergency valve replacement surgery due to excessive risk of operative mortality but could be treatable with transfemoral valve-in-valve transcatheter aortic valve implantation (TAVI). There is a paucity of data regarding the feasibility of valve-in-valve TAVI in patients presenting with cardiogenic shock due to acute aortic insufficiency from stentless bioprosthetic valve degeneration. We present one such case, highlighting the unique aspects of valve-in-valve TAVI for this challenging patient subset.