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Left Subclavian Arterial Coverage and Stroke During Thoracic Aortic Endografting: A Systematic Review
We report a systematic review of 63 studies comprising more than 3,000 patients. We conclude that stroke risk after TEVAR is increased by LSA coverage, and that LSA revascularization reduces stroke risk. LSA revascularization may lower the rate of posterior stroke. TEVAR for aneurysm is associated with increased stroke risk compared to TEVAR for dissection.
Source: The Annals of Thoracic Surgery - November 17, 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

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

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

Surgical repair of distal aortic arch aneurysm with distal extension: sternotomy versus thoracotomy
ConclusionsThe sternotomy approach showed better outcomes in terms of operative mortality, stroke, and pneumonia, as well as long-term survival compared to thoractomy. These results suggested that the sternotomy approach was more appropriate for patients with distal aortic arch aneurysms with distal extensions.
Source: The Annals of Thoracic Surgery - November 16, 2018 Category: Cardiovascular & Thoracic Surgery Source Type: research

Analysis of Autologous Platelet-Rich Plasma During Ascending and Transverse Aortic Arch Surgery ORIGINAL ARTICLES: ADULT CARDIAC
Conclusions The utilization of aPRP was associated with a reduction in allogeneic blood transfusions as well as a decrease in early postoperative morbidity during repairs of the ascending and transverse arch aorta using PHCA.
Source: The Annals of Thoracic Surgery - April 30, 2013 Category: Cardiovascular & Thoracic Surgery Authors: Zhou, S.-F., Estrera, A. L., Miller, C. C., Ignacio, C., Panthayi, S., Loubser, P., Sagun, D. L., Sheinbaum, R., Safi, H. J. Tags: Cardiac - pharmacology, Great vessels ORIGINAL ARTICLES: ADULT CARDIAC Source Type: research

Autologous Platelet-Rich Plasma Reduces Transfusions During Ascending Aortic Arch Repair: A Prospective, Randomized, Controlled Trial
Conclusions The use of aPRP reduced allogeneic transfusions during ascending and transverse aortic arch repair with deep hypothermic circulatory arrest. This translated to less acute renal failure, decreased length of stay, and lower transfusion costs. Further studies examining the coagulation factors of aPRP are required.
Source: The Annals of Thoracic Surgery - February 19, 2015 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

European Multicenter Registry for the Performance of the Chimney/Snorkel Technique in the Treatment of Aortic Arch Pathologic Conditions
Conclusions The chimney technique in the aortic arch proved highly and predictably successful, with a low rate of reinterventions.
Source: The Annals of Thoracic Surgery - January 13, 2016 Category: Cardiovascular & Thoracic Surgery Source Type: research

Results of Open Surgical Repair in Patients With Marfan Syndrome and Distal Aortic Dissection
Conclusions In these patients with MFS with aortic dissection, open TAAA repair incurred reasonable operative risk, but improvements are needed to reduce rates of renal failure. Extent II TAAA repair does not appear to increase operative risk in patients with MFS.
Source: The Annals of Thoracic Surgery - February 12, 2016 Category: Cardiovascular & Thoracic Surgery Source Type: research

Bicuspid Aortic Insufficiency With Aortic Root Aneurysm: Root Reimplantation Versus Bentall Root Replacement
Conclusions In patients with bicuspid aortic valve AI with root aneurysm, primary cusp repair with root reimplantation achieves equivalent midterm outcomes compared with Bentall root replacement.
Source: The Annals of Thoracic Surgery - September 18, 2016 Category: Cardiovascular & Thoracic Surgery Source Type: research

Surgical Ablation of Atrial Fibrillation in the United States: Trends and Propensity Matched Outcomes
Conclusions Contemporary utilization of SA is increasing across all operative categories. Performance of SA is accompanied by a 30-day reduction in mortality and stroke. These findings further refine our understanding of the role of SA in the treatment of AF.
Source: The Annals of Thoracic Surgery - July 20, 2017 Category: Cardiovascular & Thoracic Surgery Source Type: research

Restrictive Mitral Valve Annuloplasty: Prognostic Implications of Left Ventricular Forward Flow
Conclusions In patients with severe secondary MR treated with surgical repair, LV forward flow was independently associated with better survival and lower risk of the combined endpoint.
Source: The Annals of Thoracic Surgery - October 18, 2017 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

Endovascular Versus Open Repair For Chronic Type B Dissection Treatment: A meta-analysis
ConclusionsThis recent non -randomised data shows early ER benefit, unsustained at mid-term. Reintervention is higher after ER, necessitating improved technique. However, OS is exempt neither from reintervention nor rupture. Both techniques have their place, but patient selection is key.
Source: The Annals of Thoracic Surgery - November 25, 2018 Category: Cardiovascular & Thoracic Surgery Source Type: research

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