Search

OBJECTIVES: We seek to report our management protocol and early outcomes of acute type A aortic dissection (ATAAD) repair during the early phase of coronavirus disease 2019 (COVID-19). METHODS: From January 23 to April 30, 2020, we performed ATAAD repair for 33 patients, including three with pregnancy-related TAADs. Confirmation of COVID-19 depended on the results of two nucleic acid tests and pulmonary computed tomography scan. Based on testing results and hemodynamic stability, patients were triaged to an isolated intensive care unit or negative pressure operating room for emergency surgery. RESULTS: Mean age 50.2 ± 13.3 years and 20 were male (60.1%) and 8 patients were febrile (>37.3°C; 24.2%) and 17 were lymphopenic (51.5%). No patient was excluded from COVID-19 infection preoperatively. Extensive aortic repair with total arch replacement (TAR) was performed in 24 (72.7%), and limited proximal repair in 9 patients (27.3%). Cardiopulmonary bypass and cross-clamp times averaged 177 ± 34 and 88 ± 20 min for TAR, and 150 ± 30 and 83 ± 18 min for hemiarch, respectively. The mean operation time was 410 ± 68.3 min. Operative mortality was 6.1% (2/33). Complications included reintubation in four (12.1%), acute kidney failure in two (6.1%), and cerebral infarction in one (3.0%). No paraplegia nor re-exploration for bleeding occurred. COVID-19 was excluded in 100% eventually. No nosocomial infection occurred. Nor did any patient/surgical staff develop fever or test positive during the study period. CONCLUSIONS: The results of this study show that our management protocol based on testing results and hemodynamic stability in patients with ATAAD during the COVID-19 pandemic was effective and achieved favorable early surgical outcomes.

Background Acute type B dissection with ascending thoracic aortic dilatation (ATAD) is very common, but remains surgically challenging with the use of the conventional single-stage procedure via median sternotomy or lateral thoracotomy. We report our experience with repair of acute type B dissection with ATAD using a one-stage stented elephant trunk procedure. Methods We retrospectively reviewed the medical records of 16 patients (13 males and 3 females) with acute type B dissection with ATAD who underwent ascending thoracic aortic reconstruction combined with a stented elephant trunk procedure under hypothermic cardiopulmonary bypass with selective antegrade cerebral perfusion between February 2009 and February 2013. ATAD included ascending aortic aneurysm in four patients, ascending aortic enlargement + aortic regurgitation in three, and ascending aortic aneurysm + aortic root aneurysm in nine. Lower limb ischemia occurred in one case. Results There was no in-hospital mortality. Drainage of the pericardial sac was indicated for two patients with pericardial effusion. The median durations of ventilator support and intensive care unit stay were 25 ± 18 and 48 ± 7 hours, respectively. Lower limber ischemia was alleviated after implantation of a stented elephant trunk. One patient received thoracoabdominal aortic replacement during follow-up and encountered no postoperative complications. Conclusions Satisfactory surgical results and follow-up outcomes can be achieved using the proposed one-stage stented elephant trunk procedure for acute type B dissection with ATAD. doi: 10.1111/jocs.12616 (J Card Surg 2015;30:756–760)

Background Mitral regurgitation (MR) is very rare in patients with type A dissection. We retrospectively reviewed our experience of total arch replacement (TAR) with mitral valve surgery for type A dissection with MR. Methods From November 2009 to October 2012, 14 patients with type A dissection (chronic = 11; acute = 3) with MR underwent TAR combined with mitral valve surgery under hypothermic cardiopulmonary bypass with selective cerebral perfusion. The Bentall procedure was performed in 11 patients, aortic valve replacement (AVR) in one patient, coronary artery bypass grafting (CABG) in three patients, and tricuspid valvuloplasty (TVP) in one patient. Results Thirty-day mortality was 7.1% (1/14). One patient died after transfer to another hospital secondary to renal failure. Low cardiac output syndrome was observed in three patients (21.4%, 3/14), one of whom underwent left ventricular assist device implantation. Continuous renal replacement therapy was performed in four cases (28.6%, 4/14). Two patients underwent reoperation during follow-up period: One patient had mitral paravalvular leakage and the other dilatation of the thoracoabdominal aorta. Conclusions Repair of type A dissection with MR can be performed in a single operation. Combined TAR and mitral valve surgery is a much bigger and more complex operation associated with high morbidity. doi: 10.1111/jocs.12532 (J Card Surg 2015;30:438–441)

Background:Aortic root aneurysms combined with lesions of the mitral valve requires synchronous operations. The conventional approach is to treat the two lesions through separate aortic and atrial incisions.Methods:From May 2009 to August 2012, 28 transaortic mitral valve operations were per

Background and Aim of the Study: Aortic regurgitation (AR) caused by Behcet's disease is a rare clinical condition and surgical experience is limited. Many patients undergoing simple aortic valve replacement (AVR) required a second or third operation as a result of prosthetic valve dehiscence. We analyze our experience with surgical management for AR in Behcet's disease during an 11-year period. Methods: From April 1997 through December 2008, 10 male patients (mean age, 38.4 ± 6.9 years) with AR caused by Behcet's disease underwent surgical treatment. The primary procedures were AVR in seven cases and aortic root replacement in three (two Bentall, one Cabrol). The duration of follow-up was 5.3 ± 3.6 years. Results: In the seven patients with simple AVR, valve dehiscence occurred in six after an interval of 2.9 ± 1.7 months, necessitating 11 reoperations (four redo AVRs, one redo redo-AVR, four aortic root replace- ments, and two heart transplants) with one early death. In aortic root replacement patients, two Bentall patients survived and required no reintervention, and the Cabrol patient died from electromechanical uncou- pling one year postoperatively. Of the seven survivors, the definite procedure was aortic root replacement in four cases, heart transplantation in two, and AVR in one. Conclusions: The rate of valve dehiscence was high after isolated AVR in patients with AR caused by Behcet's disease. At the first operation, aortic root re- placement should be the procedure of choice, preferably with a homograft. Heart transplantation might be a feasible alternative to aortic root replacement in selected patients. doi: 10.1111/j.1540-8191.2011.01392.x (J Card Surg 2012;27:39-44)

Acute type B dissection with ascending thoracic aortic dilatation (ATAD) is very common, but remains surgically challenging with the use of the conventional single-stage procedure via median sternotomy or lateral thoracotomy. We report our experience with repair of acute type B dissection with ATAD using a one-stage stented elephant trunk procedure.We retrospectively reviewed the medical records of 16 patients (13 males and 3 females) with acute type B dissection with ATAD who underwent ascending thoracic aortic reconstruction combined with a stented elephant trunk procedure under hypothermic cardiopulmonary bypass with selective antegrade cerebral perfusion between February 2009 and February 2013. ATAD included ascending aortic aneurysm in four patients, ascending aortic enlargement + aortic regurgitation in three, and ascending aortic aneurysm + aortic root aneurysm in nine. Lower limb ischemia occurred in one case.There was no in-hospital mortality. Drainage of the pericardial sac was indicated for two patients with pericardial effusion. The median durations of ventilator support and intensive care unit stay were 25 ± 18 and 48 ± 7 hours, respectively. Lower limber ischemia was alleviated after implantation of a stented elephant trunk. One patient received thoracoabdominal aortic replacement during follow-up and encountered no postoperative complications.Satisfactory surgical results and follow-up outcomes can be achieved using the proposed one-stage stented elephant trunk procedure for acute type B dissection with ATAD.

Mitral regurgitation (MR) is very rare in patients with type A dissection. We retrospectively reviewed our experience of total arch replacement (TAR) with mitral valve surgery for type A dissection with MR.From November 2009 to October 2012, 14 patients with type A dissection (chronic = 11; acute = 3) with MR underwent TAR combined with mitral valve surgery under hypothermic cardiopulmonary bypass with selective cerebral perfusion. The Bentall procedure was performed in 11 patients, aortic valve replacement (AVR) in one patient, coronary artery bypass grafting (CABG) in three patients, and tricuspid valvuloplasty (TVP) in one patient.Thirty-day mortality was 7.1% (1/14). One patient died after transfer to another hospital secondary to renal failure. Low cardiac output syndrome was observed in three patients (21.4%, 3/14), one of whom underwent left ventricular assist device implantation. Continuous renal replacement therapy was performed in four cases (28.6%, 4/14). Two patients underwent reoperation during follow-up period: One patient had mitral paravalvular leakage and the other dilatation of the thoracoabdominal aorta.Repair of type A dissection with MR can be performed in a single operation. Combined TAR and mitral valve surgery is a much bigger and more complex operation associated with high morbidity.

Aortic root aneurysms combined with lesions of the mitral valve requires synchronous operations. The conventional approach is to treat the two lesions through separate aortic and atrial incisions.From May 2009 to August 2012, 28 transaortic mitral valve operations were performed. There were 23 males and five females, the age ranged from 18 to 75 years, mean 41 ± 16 years. The operative procedures included Bentall+MVR in 20 patients, Bentall+MVP in three patients, Bentall+total arch replacement+stent elephant trunk+MVP in one patient, Bentall+total arch replacement+stent elephant trunk+MVR in two patients, Bentall+MVP+CABG in two patients. Follow-up was completed for all patients, with a mean follow-up period of 22 ± 10 months and a maximum of 42 months.Transaortic mitral valve surgery was successful for all patients. There was a reoperation in two patients for bleeding. In the MVP group, there was mild regurgitation in two cases before discharge, without further development during the follow-up. In the MVR group, there was paravalvular leakage in one patient three months later, which required repair. There were no deaths in the hospital and the follow-up period, and no valve-associated complication during the follow-up period. The heart function of all patients during the follow-up period was Level I-II (NYHA).Transaortic mitral valve operation is a feasible surgical approach to treat patients with aortic root aneurysms combined with mitral valve lesions.

This case report describes a woman at 35 weeks gestation, who presented with an acute type A aortic dissection involving the total aortic arch and descending aorta. She underwent a successful ascending aorta replacement, total arch replacement, and stented elephant trunk implantation at the time of cesarean section with favorable maternal and fetal outcomes. (J Card Surg 2012;27:728-730)

Intercostal artery aneurysms associated with coarctation of aorta (CoA) are rare and their natural histories are poorly understood. This report describes the surgical correction of this anomaly in an adult without performing extracorporeal circulation. The coarctated segment of aorta and intercostal artery aneurysm were resected, and the continuity of the descending aorta was reestablished with an interposed vascular graft.

Objectives: The treatment of Stanford type B aortic dissections involving the arch or associated with proximal aortic aneurysms remains a surgical challenge. We report our results with total arch replacement with the stented elephant trunk (SET) procedure for these complicated Stanford type B aortic dissections. Methods: Between December 2003 and June 2008, 31 patients were admitted for complicated type B dissection (12 acute, 19 chronic). The mean age at operation was 44.3 ± 10.6 years (range: 22-68 years). The surgeries were performed by using total arch replacement combined with SET implantation. Enhanced computed tomography (CT) was performed before discharge as well as 3 months and annually to evaluate the condition of the graft and the residual false lumen. Results: The procedure was successful in all but two patients; two patients died of multiple organ failure following surgery. No paraplegia was observed after surgery. Follow-up was completed in 27 of 29 patients and the mean follow-up period was 18.4 ± 12.3 months (range: 6-54 months). During follow-up CT scans, thrombus formation was observed in the descending aortic false lumen excluded by the stented graft in most patients. One patient died during follow-up while two patients with Marfan syndrome underwent successful operations for replacement of the remaining descending and abdominal aorta. Conclusion: Total arch replacement with the SET procedure has emerged as a viable option for complicated type B dissections and is associated with low morbidity and mortality. At mid-term follow-up, most patients have either thrombosed or have had no further increase in the false lumen of the descending aorta.