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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

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