Query: stroke

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Source: The Annals of Thoracic Surgery
Procedure: Perfusion

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Total 41 results found since Jan 2013.

Dissection of Arch Branches Alone: An Indication for Aggressive Arch Management in Type A Dissection?
ConclusionsIn acute type A aortic dissection, dissection of arch branches alone should not be an indication for routine zone 1/2/3 arch replacement; however zone 1/2/3 arch replacement could be considered to prevent future reoperations in select patients.Visual Abstract
Source: The Annals of Thoracic Surgery - January 21, 2020 Category: Cardiovascular & Thoracic Surgery Source Type: research

Impact of Cerebral Perfusion on Outcomes of Aortic Surgery: The Society of Thoracic Surgeons Adult Cardiac Surgery Database Analysis
ConclusionsFor patients without aortic dissection and who require more than 30 minutes of circulatory arrest, optimal cerebral protection strategies are deep hypothermia with either antegrade or retrograde cerebral perfusion and moderate hypothermia with antegrade cerebral perfusion.
Source: The Annals of Thoracic Surgery - January 21, 2020 Category: Cardiovascular & Thoracic Surgery Source Type: research

Impact of Cerebral Perfusion on Outcomes of Aortic Surgery: STS Adult Cardiac Database Analysis
ConclusionsFor patients without dissection and requiring>30 minutes circulatory arrest, optimal cerebral protection strategies are deep hypothermia with either antegrade or retrograde cerebral perfusion; or moderate hypothermia with antegrade cerebral perfusion.
Source: The Annals of Thoracic Surgery - September 26, 2019 Category: Cardiovascular & Thoracic Surgery Source Type: research

Endovascular Repair of Ascending Aortic Disease in High-Risk Patients Yields Favorable Outcome
ConclusionsAscending aortic stent placement for ascending aortic disease is feasible and is associated with favorable aortic remodeling. Despite persistent perfusion to the false lumen in a subset of patients, there is minimal aortic dilation at short-term follow-up with excellent survival.
Source: The Annals of Thoracic Surgery - August 28, 2019 Category: Cardiovascular & Thoracic Surgery Source Type: research

Dissection of Arch Branches Alone an Indication for Aggressive Arch Management in Type A Dissection?
ConclusionsIn ATAAD, dissection of arch branches alone should not be an indication for routine zone 1/2/3 arch replacement; however, zone 1/2/3 arch replacement could be considered to prevent future reoperations in select patients.Graphical abstract
Source: The Annals of Thoracic Surgery - August 10, 2019 Category: Cardiovascular & Thoracic Surgery Source Type: research

Steps forward in minimally invasive cardiac surgery: 10-year experience
ConclusionsThe present study shows the considerable and attractive results of our decision making process based on the tailored approach: the 10-year outcome analysis demonstrates a trend toward a progressive decrease in the overall rate of post-operative complications and a significant protective effect of the tailored approach on the occurrence of stroke.
Source: The Annals of Thoracic Surgery - June 23, 2019 Category: Cardiovascular & Thoracic Surgery Source Type: research

Neurologic Deficit After Aortic Arch Replacement: The Influence of the Aortic Atherosclerosis
ConclusionsAtherothrombotic lesions found by objectively graded computed tomography were predictors of neurologic deficit. Retrograde perfusion in the presence of a distal atherothrombotic lesion should be avoided whenever possible. Strategies based on the full assessment of the whole aortic morphologic characteristics appear to be mandatory. Anticoagulation therapy should be performed carefully to avoid intracranial hemorrhagic changes.Visual Abstract
Source: The Annals of Thoracic Surgery - June 20, 2019 Category: Cardiovascular & Thoracic Surgery Source Type: research

Preliminary results of debranch-first technique in Frozen Elephant Trunk procedures
ConclusionsFET with debranch-first technique is safe and feasible and resulted in low mortality and morbidity rates. Further investigation is needed to compare it with standard techniques.
Source: The Annals of Thoracic Surgery - May 11, 2019 Category: Cardiovascular & Thoracic Surgery Source Type: research

Deep Hypothermia With Retrograde Cerebral Perfusion Versus Moderate Hypothermia With Antegrade Cerebral Perfusion for Arch Surgery
ConclusionsAlthough there was no significant difference in clinically evident neurologic injury, this pilot study suggests that MHCA+ACP may be associated with a higher incidence of radiographic neurologic injury than DHCA+RCP in patients undergoing elective hemiarch replacement.
Source: The Annals of Thoracic Surgery - March 27, 2019 Category: Cardiovascular & Thoracic Surgery Source Type: research

The Addition of Aortic Root Procedures during Elective Arch Surgery Does Not Confer Added Morbidity nor Mortality
ConclusionsThe addition of an aortic root procedure during elective aortic arch surgery lengthens cardiopulmonary bypass and aortic crossclamp times but does not increase postoperative morbidity nor mortality.
Source: The Annals of Thoracic Surgery - March 7, 2019 Category: Cardiovascular & Thoracic Surgery Source Type: research

Neurologic Deficit Following Aortic Arch Replacement: The Influence of the Aortic Atherosclerosis
ConclusionsAtherothrombotic lesions found by objectively graded computed tomography were predictors of neurologic deficit. Retrograde perfusion in the presence of a distal atherothrombotic lesion should be avoided whenever possible. Strategies based on the full assessment of the whole aortic morphology appear to be mandatory. Anticoagulation therapy should be performed very carefully to avoid intracranial hemorrhagic changes.Graphical abstract
Source: The Annals of Thoracic Surgery - January 31, 2019 Category: Cardiovascular & Thoracic Surgery Source Type: research

Outcomes after thoracic endovascular aortic repair with overstenting of the left subclavian artery
ConclusionsEvery 10th patient with LSA overstenting and no revascularization developed left arm malperfusion. No LSA revascularization, extensive aortic coverage with two or more endografts, and coronary artery disease increased the risk for permanent paraplegia, left-hemispherical stroke, and left arm malperfusion. Patients should undergo LSA revascularization to prevent left vertebral artery-associated central neurologic complications and to maintain upper-left extremity perfusion.
Source: The Annals of Thoracic Surgery - December 1, 2018 Category: Cardiovascular & Thoracic Surgery Source Type: research

Deep Hypothermia + Retrograde Cerebral Perfusion vs. Moderate Hypothermia + Antegrade Cerebral Perfusion for Arch Surgery
ConclusionsAlthough there was no significant difference in clinically evident neurologic injury, this pilot study suggests that MHCA+ACP may be associated with a higher incidence of radiographic neurologic injury than DHCA+RCP in patients undergoing elective hemiarch replacement.
Source: The Annals of Thoracic Surgery - November 16, 2018 Category: Cardiovascular & Thoracic Surgery Source Type: research

Emergency Use of Branched Thoracic Endovascular Repair in the Treatment of Aortic Arch Pathologies
Conclusions: Our experience provided an early insight to the feasibility and safety of b-TEVAR in emergency situation, although the early reintervention rate was not negligible. The endograft was versatile with potential off-the-shelf use in future.
Source: The Annals of Thoracic Surgery - October 30, 2018 Category: Cardiovascular & Thoracic Surgery Source Type: research

Impact of isolated cerebral perfusion technique for aortic arch aneurysm repair in elderly patients
ConclusionsICP during total aortic arch replacement presents an acceptable procedure for elderly patients with severely atherosclerotic aortas.
Source: The Annals of Thoracic Surgery - October 10, 2018 Category: Cardiovascular & Thoracic Surgery Source Type: research

Early Clinical Outcomes of Hybrid Arch Frozen Elephant Trunk Repair with the Thoraflex Hybrid Graft
ConclusionsHybrid aortic arch and FET repair with the Thoraflex hybrid graft appears to be associated with good clinical outcomes, despite being early in the learning curve with this graft. Further investigation with this device is warranted to establish its role within the variations of hybrid arch repair.
Source: The Annals of Thoracic Surgery - October 4, 2018 Category: Cardiovascular & Thoracic Surgery Source Type: research

Hemiarch Reconstruction Versus Clamped Aortic Anastomosis for Concomitant Ascending Aortic Aneurysm
ConclusionsHemiarch 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.
Source: The Annals of Thoracic Surgery - August 21, 2018 Category: Cardiovascular & Thoracic Surgery Source Type: research

Hemiarch Reconstruction Vs Clamped Aortic Anastomosis for Concomitant Ascending Aortic Aneurysm
Conclusions Hemiarch replacement using DHCA with RCP does not increase the risk of operative complications compared to a normothermic, clamped-distal aortic anastomosis, and therefore its use should not be limited when planning complex multi-procedural reconstructions during elective ascending thoracic aortic replacement with concomitant cardiac surgery.
Source: The Annals of Thoracic Surgery - May 4, 2018 Category: Cardiovascular & Thoracic Surgery Source Type: research

Comparison of Endoaortic and Transthoracic Aortic Clamping in Less-Invasive Mitral Valve Surgery
Conclusions Despite recent concerns arising about EAC, this large multicenter study shows equivalence in terms of safety and effectiveness of this technique compared with TTC. Reduction in postoperative bleeding was observed in the EAC group despite the higher rate of complex redo cases.
Source: The Annals of Thoracic Surgery - February 16, 2018 Category: Cardiovascular & Thoracic Surgery Source Type: research

Retrograde Cerebral Perfusion Is Effective for Prolonged Circulatory Arrest in Arch Aneurysm Repair
Conclusions RCP is an effective adjunctive cerebral protection strategy for complex aortic arch aneurysm repair with prolonged DHCA and is not associated with increased death or neurologic complications.
Source: The Annals of Thoracic Surgery - January 21, 2018 Category: Cardiovascular & Thoracic Surgery Source Type: research

Safety of Moderate Hypothermia With Antegrade Cerebral Perfusion in Total Aortic Arch Replacement
Conclusions In this series, TOTAL with MHCA and ACP can be safely performed with acceptable operative risk. MHCA and ACP represent an effective strategy for TOTAL and may obviate the need for DHCA.
Source: The Annals of Thoracic Surgery - December 10, 2017 Category: Cardiovascular & Thoracic Surgery Source Type: research

Outcomes of Elective Aortic Hemiarch Reconstruction for Aneurysmal Disease in the Elderly
Conclusions Although elderly patients have a more prolonged recovery after elective aortic hemiarch reconstruction for aneurysmal disease, outcomes are acceptable with low operative mortality and with the majority being discharged home. Moderate hypothermic circulatory arrest with antegrade cerebral perfusion is a safe strategy for this cohort. Advanced age alone should not be viewed as a contraindication in these cases.
Source: The Annals of Thoracic Surgery - October 18, 2017 Category: Cardiovascular & Thoracic Surgery Source Type: research

Hypothermia and Selective Antegrade Cerebral Perfusion Is Safe for Arch Repair in Type A Dissection
Conclusions Unilateral selective antegrade cerebral perfusion with moderate hypothermic circulatory arrest remains a safe strategy for cerebral protection during emergent surgical repair of acute type A dissection and provides equivalent outcomes for both limited and extensive aortic arch reconstruction. Based on these data, unilateral selective antegrade cerebral perfusion and moderate hypothermic circulatory arrest may represent an optimal strategy for cerebral protection in this acute setting.
Source: The Annals of Thoracic Surgery - August 25, 2017 Category: Cardiovascular & Thoracic Surgery Source Type: research

Intraoperative Cerebral Perfusion Disturbances During Transcatheter Aortic Valve Replacement
Conclusions Cerebral oximetry reacted promptly to rapid ventricular pacing with significant desaturation and hyperemia a common occurrence. However, no association between this intraoperative insult and objective neurologic injury was detected.
Source: The Annals of Thoracic Surgery - August 16, 2017 Category: Cardiovascular & Thoracic Surgery Source Type: research

Novel Rotational Speed Modulation System Used With Venoarterial Extracorporeal Membrane Oxygenation
Conclusions Our system enabled an increase in coronary arterial flow and a decrease in LV work load and afterload during VA-ECMO. The system offers the effects of VA-ECMO and an IABP in a single device.
Source: The Annals of Thoracic Surgery - July 12, 2017 Category: Cardiovascular & Thoracic Surgery Source Type: research

The Standardized Concept of Moderate-to-Mild ( ≥28°C) Systemic Hypothermia During Selective Antegrade Cerebral Perfusion for All-Comers in Aortic Arch Surgery: Single-Center Experience in 587 Consecutive Patients Over a 15-Year Period
Conclusions Current data suggest that selective ACP in combination with moderate-to-mild systemic hypothermia offers sufficient neurologic and visceral organ protection to all-comers requiring aortic arch surgery without pathological or procedural limitations.
Source: The Annals of Thoracic Surgery - June 17, 2017 Category: Cardiovascular & Thoracic Surgery Source Type: research

Regional Practice Patterns and Outcomes of Surgery for Acute Type A Aortic Dissection
Conclusions Operative morbidity and mortality remain significant for type A aortic dissection, but lower than historical outcomes. The extent of aortic surgery has increased, resulting in adaptive cerebral protection changes in contemporary “real-world” practice.
Source: The Annals of Thoracic Surgery - June 6, 2017 Category: Cardiovascular & Thoracic Surgery Source Type: research

Branched Endovascular Therapy of the Distal Aortic  Arch: Preliminary Results of the Feasibility Multicenter Trial of the Gore Thoracic Branch Endoprosthesis
Conclusions Total endovascular repair of distal zone 2 arch aortic aneurysms can be achieved with a novel branched arch endograft. Future studies will evaluate the feasibility of this approach for aneurysms encompassing the brachiocephalic trunk and left carotid artery.
Source: The Annals of Thoracic Surgery - September 18, 2016 Category: Cardiovascular & Thoracic Surgery Source Type: research

Right Minithoracotomy for Mitral Valve Surgery: Impact of Tailored Strategies on Early Outcome
Conclusions Right minithoracotomy MVS can routinely be performed with favorable outcomes in all comers when perfusion strategies and clamping techniques are carefully selected after proper evaluation of the patient’s preoperative characteristics.
Source: The Annals of Thoracic Surgery - July 17, 2016 Category: Cardiovascular & Thoracic Surgery Source Type: research

Branched Endovascular Therapy of the Distal Aortic Arch: Preliminary Results of the Feasibility Multicenter Trial of the Gore Thoracic Branch Endoprosthesis
Conclusions Total endovascular repair of distal zone 2 arch aortic aneurysms can be achieved with a novel branched arch endograft. Future studies will evaluate the feasibility of this approach for aneurysms encompassing the brachiocephalic trunk and left carotid artery.
Source: The Annals of Thoracic Surgery - June 2, 2016 Category: Cardiovascular & Thoracic Surgery Source Type: research

Posterior Circulation Ischemia or Occlusion in Five Adults With Failing Fontan Circulation
Conclusions In adults with failing Fontan circulation there is a potential for neurologic complications as a result of venous congestion with elevated central venous pressures, and aberrant posterior circulation. The patient’s history and brain imaging may be used to identify at-risk patients and to tailor perioperative management during Fontan conversion or heart transplantation to mitigate the risk for brainstem ischemia.
Source: The Annals of Thoracic Surgery - May 19, 2016 Category: Cardiovascular & Thoracic Surgery Source Type: research

Moderate Versus Deep Hypothermia With Unilateral Selective Antegrade Cerebral Perfusion for Acute Type A Dissection
Conclusions Moderate HCA with uSACP is an effective circulation management strategy that provides excellent cerebral and visceral protection during emergent ATAAD repair. In the setting of antegrade cerebral perfusion, deep hypothermia does not provide any additional benefit.
Source: The Annals of Thoracic Surgery - October 30, 2015 Category: Cardiovascular & Thoracic Surgery Source Type: research

Myocardial Protection During Aortic Arch Repair in a Piglet Model: Beating Heart Technique Compared With Crystalloid Cardioplegia
Conclusions The BH technique is associated with improved contractility compared with standard CC. There is comparable ischemic damage in both groups, with an earlier rise in blood levels of troponin T after BH and more fluctuation of serum electrolytes with CC. Evidence of ischemic changes should dissuade one from using the BH technique imprudently.
Source: The Annals of Thoracic Surgery - August 30, 2015 Category: Cardiovascular & Thoracic Surgery Source Type: research

The Expanding Role of Endoscopic Robotics in Mitral Valve Surgery: 1,257 Consecutive Procedures
Conclusions Mitral valve repair or replacement, including concomitant procedures, can be performed safely and effectively using the LEAR technique. With a dedicated robotic team, the vast majority of patients with MV disorders, either isolated or with concomitant problems, can be treated using the LEAR technique.
Source: The Annals of Thoracic Surgery - August 19, 2015 Category: Cardiovascular & Thoracic Surgery Source Type: research

Is Total Arch Replacement Associated With Worse Outcomes During Repair of Acute Type A Aortic Dissection?
Conclusions Acute type A aortic dissection remains a challenge associated with significant mortality and morbidity. When compared with a less aggressive resection, total arch replacement performed in an individualized fashion can be associated with acceptable early and late outcomes for ATAAD and was not associated with worse outcomes.
Source: The Annals of Thoracic Surgery - August 11, 2015 Category: Cardiovascular & Thoracic Surgery Source Type: research

Impact of Ultrafiltration on Kidney Injury After Cardiac Surgery: The Michigan Experience
Conclusions Patients exposed to CUF had a higher adjusted risk of AKI. Clinical teams should consider lower volumes of CUF among patients with low creatinine clearance to minimize the risk of AKI.
Source: The Annals of Thoracic Surgery - July 22, 2015 Category: Cardiovascular & Thoracic Surgery Source Type: research

Impact of Surgical Stroke on the Early and Late Outcomes After Thoracic Aortic Operations
Conclusions Surgical stroke is associated with high hospital mortality and PNDs that decrease late survival and the physical component score of the QOL survey.
Source: The Annals of Thoracic Surgery - April 10, 2015 Category: Cardiovascular & Thoracic Surgery Source Type: research

Moderate Versus Deep Hypothermic Circulatory Arrest for Elective Aortic Transverse Hemiarch Reconstruction
Conclusions MHCA with antegrade cerebral perfusion yields excellent and equivalent outcomes to DHCA for elective aortic hemiarch reconstruction. MHCA significantly improves intraoperative times and, importantly, reduces transfusion requirements compared with DHCA with a retrograde cerebral perfusion strategy.
Source: The Annals of Thoracic Surgery - March 30, 2015 Category: Cardiovascular & Thoracic Surgery Source Type: research

Outcomes of Open Repair for Chronic Descending Thoracic Aortic Dissection
Conclusions Open repairs of chronic descending thoracic aortic aneurysm dissections can be performed with respectable morbidity and mortality. Neurologic deficit remains low with the use of adjuncts, and early deaths are directly related to preoperative renal status. Reintervention on the involved aortic segment is low. These results allow comparisons with endovascular repair for chronic aortic dissection.
Source: The Annals of Thoracic Surgery - January 23, 2015 Category: Cardiovascular & Thoracic Surgery Source Type: research

Unilateral Versus Bilateral Cerebral Perfusion for Acute Type A Aortic Dissection
Conclusions As one of the largest single-center studies of the efficacy of u-ACP and b-ACP in patients with type A aortic dissection, operative mortality, stroke, temporary neurologic dysfunction, and renal failure rates were similar in both. In this intrinsically complex disease, survival is the most important outcome; u-ACP may provide cardiac surgeons with valuable technical simplicity during challenging procedures, and b-ACP may be justified for circulatory arrest times of more than 30 minutes.
Source: The Annals of Thoracic Surgery - December 30, 2014 Category: Cardiovascular & Thoracic Surgery Source Type: research

Aortopulmonary Window and the Interrupted Aortic Arch: Midterm Results With Use of the Single-Patch Technique
Conclusions Primary anatomic repair of APW associated with IAA can be safely performed. The efficiency of the single-patch technique was confirmed by the restoration of normal functional anatomy of the great arteries and aortic arch during follow-up.
Source: The Annals of Thoracic Surgery - December 30, 2014 Category: Cardiovascular & Thoracic Surgery Source Type: research