Shimamura and colleagues [9] repaired the aortic arch with the open stent grafting technique usin... more Shimamura and colleagues [9] repaired the aortic arch with the open stent grafting technique using a branched endoprosthesis to reconstruct simultaneously the arch branches and the descending aorta, with satisfactory early results. Chen and colleagues [6] reported the success of the treatment of type A dissection in 30 patients using the 3-branch stent graft. Using similar technology, we only needed to implant the stent graft and complete one clearly exposed vascular anastomosis during the deep hypothermic circulatory arrest time. This procedure not only avoided the difficulty of performing the distal anastomosis in the descending aorta but also prevented injury to the recurrent laryngeal nerve. We think the cause of the 1 death might have been the rupture of the bronchial artery, which was caused by the endoleak. The exact cause of the endoleak was not discovered. One reason we think may be that the proximal stent-free sewing Dacron tube of the main graft did not have a tight fit with the aortic wall during the reconstruction of the transected distal stump of the ascending aorta. The primary limitation of this study was that comparisons between the total arch replacement group and the triple-branched stent graft group were not made. The number of patients was small, and the data preliminary. Our long-term follow-up results and the experience of this technique for Marfan patients were limited. To elucidate the precise advantage of this technique, a prospective case-control study would be required.
Introduction: Meningitis is a dreaded disease with high rates of mortality and morbidity. it may ... more Introduction: Meningitis is a dreaded disease with high rates of mortality and morbidity. it may be bacterial, tuberculous or viral meningitis but the exact burden of this disease entity and of the various types is not clearly estimated in Jharkhand and this study was carried out to estimate the relative incidence of different types of meningitis in Jharkhand. Materials and Methods: a hospital based prospective observational study was carried out on 120 patients admitted with signs and symptoms of meningitis at RIMS, Ranchi, Jharkhand. Result: The most common type of meningitis was found to be pyogenic meningitis with 64 cases out of 120 (53.33%) followed by tuberculous (40 out of 120-33.33%) and viral meningitis (16 out of 120-13.33%). Male incidence was 75% in pyogenic meningitis as also in tuberculous and viral meningitis and female incidence was 25% in all the three types of meningitis. Also the incidence was highest in the age group 21 to 30 years for bacterial and tuberculous meningitis whereas for viral meningitis the highest incidence was found in the age group 16-20 yrs. Conclusion: The incidence of pyogenic meningitis has surpassed that of tuberculous meningitis probably because of increased and better health care facilities towards Tuberculosis and poor hygiene and increased exposure of males to risk factors for pyogenic meningitis (which need to be assessed for prevention and better approach towards pyogenic meningitis).
We present the case of a 69-year-old man with a history of hypertension and a recent pelvic fract... more We present the case of a 69-year-old man with a history of hypertension and a recent pelvic fracture who presented with acute chest pain, shortness of breath, and severe hypotension. The history of recent pelvic fracture and the clinical manifestations, including the sudden onset of acute respiratory distress, hypotension, and hypoxemia, indicated pulmonary embolism; however, at surgery the patient was found to have an acute dissection of the ascending aorta with obstruction and thrombosis of the right pulmonary artery. This case emphasizes the need to consider such a diagnosis in patients who have unilateral absence of perfusion to the right lung.
A case of intimal-type primary sarcoma of the thoracic aorta with unusual left arm embolization i... more A case of intimal-type primary sarcoma of the thoracic aorta with unusual left arm embolization is reported.
each group and are not reflective of those patients available and eligible for 1-year follow-up a... more each group and are not reflective of those patients available and eligible for 1-year follow-up as stated in the manuscript and table. They neglected to subtract mortalities lost to follow-up patients and those patients who had not yet reached the 1-year follow-up period and those who had incomplete surveys. It is stated in the follow-up section that only 66% of the patients met the criteria. Drs Weinstein and Janosky also calculated rates for "readmission" and the manuscript does not report that variable. The method applied for assessing statistical significance was with the 2 or Fisher's exact test depending upon patient population size. All values on page 708, Table 3, were recalculated by an independent source and found to be correct. Our application and results of the statistical analysis is appropriate and correct. Doctors Weinstein and Janosky are correct to state that just because a statistically significant value is not obtained does not imply that there is no difference. In the "Conclusion" section, we reference the concerning trend that OPCAB patients are returning more frequently for reintervention and or anginal events than the CCAB patients. We do not believe that this represents a serious inferior result with OPCAB, but it certainly is a trend to be monitored and studied through angiographic comparison. We have also stated that those patients who required reintervention were not investigated for location and severity of a progressive disease state, which would have answered the question of new native disease progression, incomplete revascularization, or technical limitations of the procedure. We thank Drs Weinstein and Janosky for they comment. Their challenge assures us that the scientific peer review process is working.
Background. Perfusion through the right axillary artery is an alternative to aortic or femoral ar... more Background. Perfusion through the right axillary artery is an alternative to aortic or femoral artery cannulation during surgery for ascending aortic dissections. The results of this strategy, particularly beyond the immediate postoperative period, are not well described. Methods. Eighty-three patients (median age, 58 years) with acute or subacute ascending aortic dissection underwent surgical repair with right axillary artery perfusion through an interposition Dacron graft. Sixty-five patients (78%) had DeBakey type I dissections. Procedures performed concomitantly with ascending aortic replacement included root replacement (n ؍ 16; 19%), aortic valve repair or replacement (n ؍ 51; 61%), and coronary artery bypass grafting (n ؍ 13; 16%). Hypothermic circulatory arrest with antegrade cerebral perfusion was used in the majority of patients (n ؍ 60; 72%). We retrospectively studied short-term and midterm outcomes , including survival and complications relating to the axillary cannulation. Results. No patient incurred intraoperative axillary artery injuries or had arm ischemia. Fourteen patients (17%) died in the hospital or within 30 days of surgery, and 9 patients (11%) had strokes. Actuarial survival was 73% ؎ 5% at 1 year and 64% ؎ 6% at 3 years. Forty-six of the 57 surviving patients could be contacted by telephone; they reported few late complications related to the axillary artery cannulation site. These complications included 1 case each of right-arm weakness and right-arm numbness. Conclusions. Surgical repair of acute aortic dissection with right axillary artery perfusion can be performed safely, with a relatively low risk of stroke and a high probability of midterm survival.
Objective: To illustrate our experience and results in patients with diffuse aneurysmal disease t... more Objective: To illustrate our experience and results in patients with diffuse aneurysmal disease treated with arch replacement using the Siena collared graft, a device designed in 2002 to improve the elephant trunk technique. Results of the first step surgical implant and the subsequent treatment strategies, with extensive use of endovascular techniques, are reported. Methods: All aortic arch-replacement procedures using the Siena graft between February 2002 and January 2020 were retrospectively analyzed for early and late clinical outcomes. Results: Of 146 patients (54 women, 36.9%) with a median age of 69.1 years (interquartile range 58.4-75.0 years), 55 (37.6%) had acute/chronic dissection with false lumen aneurysmal dilatation, 91 (62.3%) had degenerative aneurysms, 45 (30.8%) were redo operations, and 14 (9.5%) had connective tissue disease. First-stage outcomes: 10.9% 30-day mortality (n ¼ 16); 5.4% stroke (n ¼ 8, 6 disabling, 2 nondisabling; 3 fatal); and 0.6% paraplegia. Outcomes for 113 second-stage procedures (77.3%, n ¼ 97 endovascular [66.4%], n ¼ 16 surgical [10.9%]) were 5.3% and 8.8% 30-day and 180-day mortality; no stroke; 10.6% paraplegia. Median followup was 5.7 years (range: 0-18.02 years) median survival was 16.65 years (95% lower confidence limit, 10.06 years) with no significant difference between aneurysm and dissection patients. Freedom from further treatment was 87.0% (95% confidence interval, 79.9%-94.7%) at 5 years and 71.4% (95% confidence interval, 71.4%-84.7%) at 10 years; median time to reintervention was 2.59 years (interquartile range, 0.52-5.20 years) with no difference (P ¼ .22) between dissection and aneurysm groups. Conclusions: Siena collared graft represents a reliable platform for the treatment of diffuse aneurysmal disease. This device offers the flexibility required in the treatment of extended aortic lesions and guarantees the choice of the most appropriate approach for treatment completion. In this context, the availability of hybrid grafts has not modified the role of this device in arch surgery. (JTCVS Techniques 2021;6:13-27) Three steps of a "delayed frozen" elephant trunk approach.
Journal of Thoracic and Cardiovascular Surgery, 2002
Background: With the progressive aging of Western populations, cardiac surgeons are faced with tr... more Background: With the progressive aging of Western populations, cardiac surgeons are faced with treating an increasing number of elderly patients. Controversy exists as to whether the expenditure of health care resources on the growing elderly populations represents a cost-effective approach to resource management. The potential to avoid surgery in patients with little chance of survival and poor quality of life would spare unnecessary suffering, reduce operative mortality, and enhance the use of scarce resources. Methods: We reviewed the records of 24 consecutive patients aged 80 years or older (mean age 83 years, range 80-93 years) who underwent operations for acute type A dissection from 1985 through 1999. No patient with acute type A dissection was refused surgery because of age or concomitant disease. Seventeen patients were men. Preoperatively, none of the patients was moribund, although 66% had hemodynamic instability and 41% experienced cerebral ischemia. All patients had one or more associated pathologic conditions. Hospital mortality and morbidity models, based on our overall experience with 197 patients operated on for acute type A aortic dissection during the period of the study, were developed by means of multivariate logistic regression with preoperative and intraoperative variables used as independent predictors of outcome. Results: Overall hospital mortality was 83%. Intraoperative mortality was 33%. All patients who survived the operation had one or more postoperative complications. Mean hospital stay was 37 days with a total of 314 days in the intensive care unit (average 19 days, median 17 days). None of the survivors (4 patients) discharged from the hospital was able to function independently and their survival at 6 months was 0%. Statistical analysis of the overall experience with operations for type A acute aortic dissection confirmed that age in excess of 80 years is the most important independent patient risk factor associated with 30-day mortality and morbidity. Conclusions: Operations for acute type A dissection performed on octogenarians involve increased hospital mortality and morbidity. Short-term survival is unfavorable and is associated with a poor quality of life. Without additional corroborative studies to endorse the present findings, the use of age as a parameter to limit access of patients to expensive medical resources remains an unsubstantiated concept. In the context of acute type A aortic dissection, however, the hypothesis that older patients should be denied such a complicated surgical intervention to conserve resources is supported by the presented data.
Residual false channel is common after repair of type A acute aortic dissection (TAAAD). Starting... more Residual false channel is common after repair of type A acute aortic dissection (TAAAD). Starting from our recent series of TAAAD patients we carried out a retrospective analysis, regarding the failure of primary exclusion at the time of the initial operation. We classified the location of the principal entry tears perfusing the residual false channel. The proposed technique represents our attempt to correct the mechanism of false channel perfusion during primary repair. We describe a new technique designed to address some limitations of standard hemiarch aortic replacement. Its goal are: (I) to reinforce the intimal layer at the arch level; (II) to eliminate inter-luminal communications at the arch level using suture lines around the arch vessels; (III) to provide an elephant trunk configuration for further interventions. Between August 2016 and January 2018, 11 patients underwent emergency surgery using this technique; 7 were men; the median age was 74 years. All patients were tre...
Interactive cardiovascular and thoracic surgery, Jan 16, 2018
We herein report an emergency technique of composite Bentall operation using a fast release valve... more We herein report an emergency technique of composite Bentall operation using a fast release valve. The technique was successfully performed in 2 emergency cases after failed supracoronary ascending aortic replacement in acute Type A aortic dissection. The speed and ease of execution are the main advantages of the procedure.
The Journal of thoracic and cardiovascular surgery, Jan 3, 2018
Abstract We herein describe a new technique that aims to address some limitations of standard hem... more Abstract We herein describe a new technique that aims to address some limitations of standard hemiarch aortic replacement in acute type A aortic dissection repair. This technique combines the advantages of arch replacement to the simplicity of anterior hemiarch repair while providing an elephant trunk configuration for future interventions.
Cardiovascular and interventional radiology, Jan 3, 2018
To report a series of patients treated with the Jotec custom-made endograft for thoraco-abdominal... more To report a series of patients treated with the Jotec custom-made endograft for thoraco-abdominal aneurysms and dissections and identify predictive factors for re-intervention. We retrospectively analysed 49 patients unsuitable for surgery, treated between 2011 and 2017 (71.3 ± 9.5 years; 15 females). Indications included Crawford type 4 aneurysm in 25 patients, type 3 in 13, type 2 in 4, type 1 in 2 and chronic aneurysmal dilatation of the false lumen following dissection in 5 cases. Mean aneurysm diameter was 58.7 ± 8.4 mm. The study aims were to assess procedural success, complications rate, mortality and long-term follow-up. We also analysed factors that predicted the need for re-intervention. The endograft was successfully deployed in all patients, catheterization of the fenestration and/or branches was achieved in 152/156 (97.4%) vessels. Early complications occurred in 10 patients (3 paraplegia, 3 haemorrhages, pancreatitis, aortic rupture, iliac artery rupture, 2 strokes). T...
Journal of vascular and interventional radiology : JVIR, May 1, 2018
To prospectively evaluate the safety and efficacy of using the Tigris vascular stent (Gore, Flags... more To prospectively evaluate the safety and efficacy of using the Tigris vascular stent (Gore, Flagstaff, Arizona) alone or in combination with the Viabahn stent (Gore) for revascularizing femoropopliteal Trans-Atlantic Intersociety Consensus (TASC) type B-D lesions with varying degrees of calcification. Patients with Rutherford stage ≥ 3 and TASC type ≥ B were included in the study. From January 2015 to April 2017, 31 segments in 31 patients (21 men, ovarall mean age 73.3 ± 9.2 years) were treated. The breakdown by TASC type and Rutherford stage were TASC B (n = 12), C (n = 6), and D (n = 13), and Rutherford 3 (n = 28) and 4 (n = 3). The lesions were located in the common femoral artery (n = 1), superficial femoral artery (SFA; n = 20), distal SFA to P1 (n = 3), popliteal P1 (n = 1), popliteal P1-3 (n = 3), popliteal P2-3 (n = 2), and 1 femoropopliteal bypass. There were 18 occlusions (58.1%) and 13 stenoses (41.9%). The mean diseased segment length was 15.5 ± 9.9 cm with 80.6% of mod...
Aortic dissection is a complex disease associated with high mortality and morbidity. Among the di... more Aortic dissection is a complex disease associated with high mortality and morbidity. Among the different possible clinical presentations, type A aortic dissection complicated at the onset by mesenteric malperfusion is characterized by poor outcome compared with patients not presenting such complication. We report the case of a patient with acute type A aortic dissection presenting with mesenteric malperfusion, in whom trans-pericardial color Doppler ultrasound (CDUS) examination was used to assess intraoperative and postoperative blood flow in the mesenteric artery. Trans-pericardial CDUS is demonstrated as a fast and simple diagnostic method with a good matching compared with contrast-enhanced computed tomography scan imaging, if correctly approached. We believe that this technique could be an important adjunctive tool for the intraoperative and perioperative management and decision-making in all patients with type A dissection presenting with mesenteric ischemia.
Shimamura and colleagues [9] repaired the aortic arch with the open stent grafting technique usin... more Shimamura and colleagues [9] repaired the aortic arch with the open stent grafting technique using a branched endoprosthesis to reconstruct simultaneously the arch branches and the descending aorta, with satisfactory early results. Chen and colleagues [6] reported the success of the treatment of type A dissection in 30 patients using the 3-branch stent graft. Using similar technology, we only needed to implant the stent graft and complete one clearly exposed vascular anastomosis during the deep hypothermic circulatory arrest time. This procedure not only avoided the difficulty of performing the distal anastomosis in the descending aorta but also prevented injury to the recurrent laryngeal nerve. We think the cause of the 1 death might have been the rupture of the bronchial artery, which was caused by the endoleak. The exact cause of the endoleak was not discovered. One reason we think may be that the proximal stent-free sewing Dacron tube of the main graft did not have a tight fit with the aortic wall during the reconstruction of the transected distal stump of the ascending aorta. The primary limitation of this study was that comparisons between the total arch replacement group and the triple-branched stent graft group were not made. The number of patients was small, and the data preliminary. Our long-term follow-up results and the experience of this technique for Marfan patients were limited. To elucidate the precise advantage of this technique, a prospective case-control study would be required.
Introduction: Meningitis is a dreaded disease with high rates of mortality and morbidity. it may ... more Introduction: Meningitis is a dreaded disease with high rates of mortality and morbidity. it may be bacterial, tuberculous or viral meningitis but the exact burden of this disease entity and of the various types is not clearly estimated in Jharkhand and this study was carried out to estimate the relative incidence of different types of meningitis in Jharkhand. Materials and Methods: a hospital based prospective observational study was carried out on 120 patients admitted with signs and symptoms of meningitis at RIMS, Ranchi, Jharkhand. Result: The most common type of meningitis was found to be pyogenic meningitis with 64 cases out of 120 (53.33%) followed by tuberculous (40 out of 120-33.33%) and viral meningitis (16 out of 120-13.33%). Male incidence was 75% in pyogenic meningitis as also in tuberculous and viral meningitis and female incidence was 25% in all the three types of meningitis. Also the incidence was highest in the age group 21 to 30 years for bacterial and tuberculous meningitis whereas for viral meningitis the highest incidence was found in the age group 16-20 yrs. Conclusion: The incidence of pyogenic meningitis has surpassed that of tuberculous meningitis probably because of increased and better health care facilities towards Tuberculosis and poor hygiene and increased exposure of males to risk factors for pyogenic meningitis (which need to be assessed for prevention and better approach towards pyogenic meningitis).
We present the case of a 69-year-old man with a history of hypertension and a recent pelvic fract... more We present the case of a 69-year-old man with a history of hypertension and a recent pelvic fracture who presented with acute chest pain, shortness of breath, and severe hypotension. The history of recent pelvic fracture and the clinical manifestations, including the sudden onset of acute respiratory distress, hypotension, and hypoxemia, indicated pulmonary embolism; however, at surgery the patient was found to have an acute dissection of the ascending aorta with obstruction and thrombosis of the right pulmonary artery. This case emphasizes the need to consider such a diagnosis in patients who have unilateral absence of perfusion to the right lung.
A case of intimal-type primary sarcoma of the thoracic aorta with unusual left arm embolization i... more A case of intimal-type primary sarcoma of the thoracic aorta with unusual left arm embolization is reported.
each group and are not reflective of those patients available and eligible for 1-year follow-up a... more each group and are not reflective of those patients available and eligible for 1-year follow-up as stated in the manuscript and table. They neglected to subtract mortalities lost to follow-up patients and those patients who had not yet reached the 1-year follow-up period and those who had incomplete surveys. It is stated in the follow-up section that only 66% of the patients met the criteria. Drs Weinstein and Janosky also calculated rates for "readmission" and the manuscript does not report that variable. The method applied for assessing statistical significance was with the 2 or Fisher's exact test depending upon patient population size. All values on page 708, Table 3, were recalculated by an independent source and found to be correct. Our application and results of the statistical analysis is appropriate and correct. Doctors Weinstein and Janosky are correct to state that just because a statistically significant value is not obtained does not imply that there is no difference. In the "Conclusion" section, we reference the concerning trend that OPCAB patients are returning more frequently for reintervention and or anginal events than the CCAB patients. We do not believe that this represents a serious inferior result with OPCAB, but it certainly is a trend to be monitored and studied through angiographic comparison. We have also stated that those patients who required reintervention were not investigated for location and severity of a progressive disease state, which would have answered the question of new native disease progression, incomplete revascularization, or technical limitations of the procedure. We thank Drs Weinstein and Janosky for they comment. Their challenge assures us that the scientific peer review process is working.
Background. Perfusion through the right axillary artery is an alternative to aortic or femoral ar... more Background. Perfusion through the right axillary artery is an alternative to aortic or femoral artery cannulation during surgery for ascending aortic dissections. The results of this strategy, particularly beyond the immediate postoperative period, are not well described. Methods. Eighty-three patients (median age, 58 years) with acute or subacute ascending aortic dissection underwent surgical repair with right axillary artery perfusion through an interposition Dacron graft. Sixty-five patients (78%) had DeBakey type I dissections. Procedures performed concomitantly with ascending aortic replacement included root replacement (n ؍ 16; 19%), aortic valve repair or replacement (n ؍ 51; 61%), and coronary artery bypass grafting (n ؍ 13; 16%). Hypothermic circulatory arrest with antegrade cerebral perfusion was used in the majority of patients (n ؍ 60; 72%). We retrospectively studied short-term and midterm outcomes , including survival and complications relating to the axillary cannulation. Results. No patient incurred intraoperative axillary artery injuries or had arm ischemia. Fourteen patients (17%) died in the hospital or within 30 days of surgery, and 9 patients (11%) had strokes. Actuarial survival was 73% ؎ 5% at 1 year and 64% ؎ 6% at 3 years. Forty-six of the 57 surviving patients could be contacted by telephone; they reported few late complications related to the axillary artery cannulation site. These complications included 1 case each of right-arm weakness and right-arm numbness. Conclusions. Surgical repair of acute aortic dissection with right axillary artery perfusion can be performed safely, with a relatively low risk of stroke and a high probability of midterm survival.
Objective: To illustrate our experience and results in patients with diffuse aneurysmal disease t... more Objective: To illustrate our experience and results in patients with diffuse aneurysmal disease treated with arch replacement using the Siena collared graft, a device designed in 2002 to improve the elephant trunk technique. Results of the first step surgical implant and the subsequent treatment strategies, with extensive use of endovascular techniques, are reported. Methods: All aortic arch-replacement procedures using the Siena graft between February 2002 and January 2020 were retrospectively analyzed for early and late clinical outcomes. Results: Of 146 patients (54 women, 36.9%) with a median age of 69.1 years (interquartile range 58.4-75.0 years), 55 (37.6%) had acute/chronic dissection with false lumen aneurysmal dilatation, 91 (62.3%) had degenerative aneurysms, 45 (30.8%) were redo operations, and 14 (9.5%) had connective tissue disease. First-stage outcomes: 10.9% 30-day mortality (n ¼ 16); 5.4% stroke (n ¼ 8, 6 disabling, 2 nondisabling; 3 fatal); and 0.6% paraplegia. Outcomes for 113 second-stage procedures (77.3%, n ¼ 97 endovascular [66.4%], n ¼ 16 surgical [10.9%]) were 5.3% and 8.8% 30-day and 180-day mortality; no stroke; 10.6% paraplegia. Median followup was 5.7 years (range: 0-18.02 years) median survival was 16.65 years (95% lower confidence limit, 10.06 years) with no significant difference between aneurysm and dissection patients. Freedom from further treatment was 87.0% (95% confidence interval, 79.9%-94.7%) at 5 years and 71.4% (95% confidence interval, 71.4%-84.7%) at 10 years; median time to reintervention was 2.59 years (interquartile range, 0.52-5.20 years) with no difference (P ¼ .22) between dissection and aneurysm groups. Conclusions: Siena collared graft represents a reliable platform for the treatment of diffuse aneurysmal disease. This device offers the flexibility required in the treatment of extended aortic lesions and guarantees the choice of the most appropriate approach for treatment completion. In this context, the availability of hybrid grafts has not modified the role of this device in arch surgery. (JTCVS Techniques 2021;6:13-27) Three steps of a "delayed frozen" elephant trunk approach.
Journal of Thoracic and Cardiovascular Surgery, 2002
Background: With the progressive aging of Western populations, cardiac surgeons are faced with tr... more Background: With the progressive aging of Western populations, cardiac surgeons are faced with treating an increasing number of elderly patients. Controversy exists as to whether the expenditure of health care resources on the growing elderly populations represents a cost-effective approach to resource management. The potential to avoid surgery in patients with little chance of survival and poor quality of life would spare unnecessary suffering, reduce operative mortality, and enhance the use of scarce resources. Methods: We reviewed the records of 24 consecutive patients aged 80 years or older (mean age 83 years, range 80-93 years) who underwent operations for acute type A dissection from 1985 through 1999. No patient with acute type A dissection was refused surgery because of age or concomitant disease. Seventeen patients were men. Preoperatively, none of the patients was moribund, although 66% had hemodynamic instability and 41% experienced cerebral ischemia. All patients had one or more associated pathologic conditions. Hospital mortality and morbidity models, based on our overall experience with 197 patients operated on for acute type A aortic dissection during the period of the study, were developed by means of multivariate logistic regression with preoperative and intraoperative variables used as independent predictors of outcome. Results: Overall hospital mortality was 83%. Intraoperative mortality was 33%. All patients who survived the operation had one or more postoperative complications. Mean hospital stay was 37 days with a total of 314 days in the intensive care unit (average 19 days, median 17 days). None of the survivors (4 patients) discharged from the hospital was able to function independently and their survival at 6 months was 0%. Statistical analysis of the overall experience with operations for type A acute aortic dissection confirmed that age in excess of 80 years is the most important independent patient risk factor associated with 30-day mortality and morbidity. Conclusions: Operations for acute type A dissection performed on octogenarians involve increased hospital mortality and morbidity. Short-term survival is unfavorable and is associated with a poor quality of life. Without additional corroborative studies to endorse the present findings, the use of age as a parameter to limit access of patients to expensive medical resources remains an unsubstantiated concept. In the context of acute type A aortic dissection, however, the hypothesis that older patients should be denied such a complicated surgical intervention to conserve resources is supported by the presented data.
Residual false channel is common after repair of type A acute aortic dissection (TAAAD). Starting... more Residual false channel is common after repair of type A acute aortic dissection (TAAAD). Starting from our recent series of TAAAD patients we carried out a retrospective analysis, regarding the failure of primary exclusion at the time of the initial operation. We classified the location of the principal entry tears perfusing the residual false channel. The proposed technique represents our attempt to correct the mechanism of false channel perfusion during primary repair. We describe a new technique designed to address some limitations of standard hemiarch aortic replacement. Its goal are: (I) to reinforce the intimal layer at the arch level; (II) to eliminate inter-luminal communications at the arch level using suture lines around the arch vessels; (III) to provide an elephant trunk configuration for further interventions. Between August 2016 and January 2018, 11 patients underwent emergency surgery using this technique; 7 were men; the median age was 74 years. All patients were tre...
Interactive cardiovascular and thoracic surgery, Jan 16, 2018
We herein report an emergency technique of composite Bentall operation using a fast release valve... more We herein report an emergency technique of composite Bentall operation using a fast release valve. The technique was successfully performed in 2 emergency cases after failed supracoronary ascending aortic replacement in acute Type A aortic dissection. The speed and ease of execution are the main advantages of the procedure.
The Journal of thoracic and cardiovascular surgery, Jan 3, 2018
Abstract We herein describe a new technique that aims to address some limitations of standard hem... more Abstract We herein describe a new technique that aims to address some limitations of standard hemiarch aortic replacement in acute type A aortic dissection repair. This technique combines the advantages of arch replacement to the simplicity of anterior hemiarch repair while providing an elephant trunk configuration for future interventions.
Cardiovascular and interventional radiology, Jan 3, 2018
To report a series of patients treated with the Jotec custom-made endograft for thoraco-abdominal... more To report a series of patients treated with the Jotec custom-made endograft for thoraco-abdominal aneurysms and dissections and identify predictive factors for re-intervention. We retrospectively analysed 49 patients unsuitable for surgery, treated between 2011 and 2017 (71.3 ± 9.5 years; 15 females). Indications included Crawford type 4 aneurysm in 25 patients, type 3 in 13, type 2 in 4, type 1 in 2 and chronic aneurysmal dilatation of the false lumen following dissection in 5 cases. Mean aneurysm diameter was 58.7 ± 8.4 mm. The study aims were to assess procedural success, complications rate, mortality and long-term follow-up. We also analysed factors that predicted the need for re-intervention. The endograft was successfully deployed in all patients, catheterization of the fenestration and/or branches was achieved in 152/156 (97.4%) vessels. Early complications occurred in 10 patients (3 paraplegia, 3 haemorrhages, pancreatitis, aortic rupture, iliac artery rupture, 2 strokes). T...
Journal of vascular and interventional radiology : JVIR, May 1, 2018
To prospectively evaluate the safety and efficacy of using the Tigris vascular stent (Gore, Flags... more To prospectively evaluate the safety and efficacy of using the Tigris vascular stent (Gore, Flagstaff, Arizona) alone or in combination with the Viabahn stent (Gore) for revascularizing femoropopliteal Trans-Atlantic Intersociety Consensus (TASC) type B-D lesions with varying degrees of calcification. Patients with Rutherford stage ≥ 3 and TASC type ≥ B were included in the study. From January 2015 to April 2017, 31 segments in 31 patients (21 men, ovarall mean age 73.3 ± 9.2 years) were treated. The breakdown by TASC type and Rutherford stage were TASC B (n = 12), C (n = 6), and D (n = 13), and Rutherford 3 (n = 28) and 4 (n = 3). The lesions were located in the common femoral artery (n = 1), superficial femoral artery (SFA; n = 20), distal SFA to P1 (n = 3), popliteal P1 (n = 1), popliteal P1-3 (n = 3), popliteal P2-3 (n = 2), and 1 femoropopliteal bypass. There were 18 occlusions (58.1%) and 13 stenoses (41.9%). The mean diseased segment length was 15.5 ± 9.9 cm with 80.6% of mod...
Aortic dissection is a complex disease associated with high mortality and morbidity. Among the di... more Aortic dissection is a complex disease associated with high mortality and morbidity. Among the different possible clinical presentations, type A aortic dissection complicated at the onset by mesenteric malperfusion is characterized by poor outcome compared with patients not presenting such complication. We report the case of a patient with acute type A aortic dissection presenting with mesenteric malperfusion, in whom trans-pericardial color Doppler ultrasound (CDUS) examination was used to assess intraoperative and postoperative blood flow in the mesenteric artery. Trans-pericardial CDUS is demonstrated as a fast and simple diagnostic method with a good matching compared with contrast-enhanced computed tomography scan imaging, if correctly approached. We believe that this technique could be an important adjunctive tool for the intraoperative and perioperative management and decision-making in all patients with type A dissection presenting with mesenteric ischemia.
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Papers by Eugenio Neri