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In this study we sought to verify the existence of primary cardiac impairment in patients with Marfan syndrome (MFS) undergoing a Bentall procedure and to explore its clinical significance. Between October 2010 and April 2019, 164 patients with MFS and 748 patients without MFS with aortic root aneurysms underwent a Bentall procedure. Clinical characteristics and perioperative cardiac structure and function between both groups were compared after propensity score matching. Multivariate regression analysis was performed to identify factors that influenced the postoperative left ventricular ejection fraction and any adverse cardiogenic events. The midterm survival between these 2 groups were compared. After propensity score matching both groups had similar preoperative baseline characteristics. The MFS patients presented a higher preoperative New York Heart Association classification, larger left ventricular size, and poorer postoperative cardiac function compared with non-MFS patients. In our multivariate regression analysis MFS was associated with a lower postoperative left ventricular ejection fraction. Furthermore MFS was an independent risk factor for adverse postoperative cardiogenic events during patients' hospital stay (odds ratio, 6.243; 95% confidence interval, 1.71-22.75; P =.006). There was no difference in midterm survival between the 2 groups (P =.772). Clinical manifestations observed in MFS patients supported the existence of primary cardiac impairment. Because of a higher rate of postoperative cardiogenic adverse events in MFS patients, the potential impact of primary cardiac impairment in MFS should be carefully considered in cardiovascular surgery. [Display omitted] [ABSTRACT FROM AUTHOR]

Background: The presence of an isolated left vertebral artery requires changes in the aortic arch reconstruction techniques and cerebral protection methods in patients with total arch replacement. The best method for surgical repair of the isolated left vertebral artery is controversial. We retrospectively reviewed our experience of total arch replacement in patients with aortic dissection with this vessel anomaly. Methods: Between August 2003 and December 2008, 21 patients with aortic dissection (type A dissection, n = 20; type B dissection, n = 1) with an isolated left vertebral artery underwent total arch replacement under hypothermic cardiopulmonary bypass combined with selective cerebral perfusion. Concomitant stented elephant trunk was implanted in 20 patients. Results: There was no in-hospital death. Injury to the spinal cord occurred in 2 patients with chronic dissection using stented elephant trunk implantation. One had weakness in the left lower extremity, and the other patient had paraparesis: both recovered during the follow-up period. One patient experienced transient neurologic deficit, and acute renal failure was observed in 1 patient: both recovered completely before hospital discharge. Conclusions: Acceptable results were obtained in patients with aortic dissection with an isolated left vertebral artery. Although there was no clear evidence that the spinal cord injury was related to the isolated left vertebral artery using stented elephant trunk implantation, the isolated left vertebral artery was constructed as soon as possible in patients with this vessel anomaly. [ABSTRACT FROM AUTHOR]

Background: Significant advances in the diagnosis and therapy have greatly improved surgical outcomes of acute type A dissection. However, surgical management of acute type A dissection still poses formidable challenges, particularly in “developing” countries. We present our surgical management strategy of acute type A dissection in a single center in China. Methods: On the basis of Stanford classification, acute type A dissection was subclassified at our center. Aortic root lesions were divided into three subtypes (A1, A2, and A3) and distal aortic lesions into two subtypes (C and S) according to lesion severity. The corresponding surgical procedure was scheduled according to each subtype. According to this subclassification, 257 patients (67 females, 190 males) with acute type A dissection underwent surgical treatment from January 2003 to March 2008. Results: The overall prevalence of in-hospital death was 4.67% (12 of 257) and deaths at follow-up were 3.27% (8 of 245) during a follow-up of 35 months. Stroke occurred in five patients, paraplegia in two patients, paraparesis in two patients, respiratory failure in 15 patients, renal failure in two patients, hepatic failure in one patient, and multiple-organ failure in one patient. Injury to the spinal cord and visceral organ ischemia were not observed in patients who underwent stented elephant trunk implantation during follow-up. Six patients underwent late distal aortic reoperation. Conclusions: The encouraging and satisfactory surgical outcomes and postoperative results demonstrating a low prevalence of morbidity and mortality showed the substantial improvement in surgery for acute type A dissection using our surgical strategy at a center in China. [ABSTRACT FROM AUTHOR]

Background: A conventional single-stage procedure, staged procedures, or debranching of the supraaortic vessels, followed by immediate transfemoral stenting of the aortic arch, have been introduced to treat chronic type B dissection with aortic arch involvement. The best method for surgical repair of chronic type B dissection with aortic arch involvement alone or concomitant with proximal aortic lesions is not known. Methods: Between October 2003 and December 2008, 19 patients underwent total arch replacement combined with stented elephant trunk implantation under hypothermic cardiopulmonary bypass and selective cerebral perfusion through a median sternotomy. Thirteen patients had proximal aortic lesions. Postoperative computed tomography was used to evaluate thrombosis and absorption of the false lumen. Results: Concomitant proximal aortic lesions were repaired in all patients. Thirty-day mortality was 5.26% (1/19). There was one late death at a mean follow-up of 36 ± 12 months. There was no spinal cord injury or visceral malperfusion. One patient with Marfan syndrome with chronic dissection underwent thoracoabdominal aortic replacement 6 months later. Obliteration of the false lumen around the stented elephant trunk was observed in 16 patients (94.1%, 16/17) during follow-up. Conclusions: This technique is safe, effective, and economical. Replacement of aortic arch dissection and thrombosis of the dissected descending aorta was achieved simultaneously. Concomitant proximal aortic lesions were repaired. Favorable surgical outcomes and postoperative results using this technique were obtained in patients with chronic type B dissection with aortic arch involvement alone or concomitant with proximal aortic lesions. [Copyright &y& Elsevier]

Background: Surgical management of acute type A dissection with the tear in the descending aorta is challenging because of the technical difficulty in managing proximal and distal aortic lesions through a median sternotomy or lateral thoracotomy using a single-stage procedure. Methods: Thirty-three patients with acute type A dissection with the tear in the descending aorta underwent total arch replacement combined with stented elephant trunk implantation through a median sternotomy from April 2003 to June 2007. Preoperative complications included acute cardiac tamponade (n = 1), acute left heart failure (n = 1), acute myocardial infarction (n = 1), cerebral ischemia (n = 1), acute renal failure (n = 2), chronic renal dysfunction (n = 2), and acute mesenteric ischemia (n = 1) and lower extremity ischemia (n = 3). The residual false lumen was evaluated using postoperative computed tomography. Results: Death at 30 days was 6.06% (2 of 33 patients). One patient with preoperative mesenteric ischemia died of postoperative multiple-organ failure. One patient with preoperative acute renal failure ceased treatment after three reoperations owing to uncontrollable bleeding. Left lower-extremity paraparesis occurred in 1 patient, and transient neurologic dysfunction occurred in 1 patient. Severe complications were not observed at a mean follow-up of 25 ± 11 months. Thrombus obliteration of the false lumen was observed at the distal end of the stented graft in 29 patients (96.7%) and at the diaphragmatic level in 20 patients (66.7%) during follow-up. Conclusions: Encouraging outcomes favor this technique in patients with acute type A dissection with the tear in the descending aorta. Simultaneous repair of proximal aortic lesions and thrombosis of the false lumen in the descending aorta could be obtained. [Copyright &y& Elsevier]

Background: The purpose of the study was to assess the efficacy of total arch replacement combined with stented elephant trunk implantation for Marfan patients with acute Stanford type A aortic dissection involving the aortic arch. Methods: Between January 2004 and April 2006, 13 consecutive Marfan patients (4 female, 9 male) with acute type A aortic dissection involving the aortic arch underwent total arch replacement combined with implantation of a stented elephant trunk. Aortic dissection extending to the iliac artery was seen in 10 patients, and to the abdominal aorta in 3 patients. Ages ranged from 17 to 65 years (mean, 39 ± 13). Computed tomography was done to evaluate the residual false lumen in the descending aorta. Results: All patients survived and were discharged from hospital. One patient with thrombosis of the innominate artery suffered cerebral infarction and recovered during follow-up. One patient had ischemia of the left upper limb postoperatively, but recovered after axillary to axillary artery bypass. There was 1 death during the mean follow-up period of 27 ± 10 months. Complete thrombus formation was observed in 84.6% of patients (11 of 13) around the stented elephant trunk, and in 69.2% of patients (9 of 13) at the diaphragmatic level. Conclusions: Total arch replacement combined with stented elephant trunk implantation for Marfan patients with acute type A aortic dissection involving the aortic arch results in less late dilatation of the dissected descending aorta. That prolongs the reoperation interval or reduces the number of late thoracoabdominal aortic replacements, unless there is a patent false lumen around the stented elephant trunk. [Copyright &y& Elsevier]

A 39-year-old man with Stanford B aortic dissection was treated by thoracic endovascular aortic repair (TEVAR) and experienced an aortoesophageal fistula (AEF). After repeated TEVAR and esophageal stent implantation, the hematemesis did not cease although the whole thoracic descending aorta was covered by stents. A three-stage operation was performed, and an AEF 9 cm long was found during the operation. To our knowledge, this may be the largest AEF ever reported. The patient survived without adverse events. [ABSTRACT FROM AUTHOR]