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OBJECTIVES To evaluate the impact of previous cardiac surgery (PCS) on clinical outcomes after reoperative extended arch repair for acute type A aortic dissection. METHODS This study included 37 acute type A aortic dissection patients with PCS (PCS group) and 992 without PCS (no-PCS group). Propensity score-matching yielded a subgroup of 36 pairs (1:1). In-hospital outcomes and mid-term survival were compared between the 2 groups. RESULTS The PCS group was older (56.7 ± 14.2 vs 52.2 ± 12.6 years, P  = 0.036) and underwent a longer cardiopulmonary bypass (median, 212 vs 183 min, P  < 0.001) compared with the no-PCS group. Operative death occurred in 88 (8.6%) patients, exhibiting no significant difference between groups (13.5% vs 8.4%, P  = 0.237). Major postoperative morbidity was observed in 431 (41.9%) patients, also showing no difference between groups (45.9% vs 41.7%, P  = 0.615). Moreover, the multivariable logistic regression analysis revealed that PCS was not significantly associated with operative mortality (adjusted odds ratio 2.58, 95% confidence interval 0.91–7.29, P  = 0.075) or major morbidity (adjusted odds ratio 1.92, 95% confidence interval 0.88–4.18, P  = 0.101). The 3-year cumulative survival rates were 71.1% for the PCS group and 83.9% for the no-PCS group (log-rank P  = 0.071). Additionally, Cox regression indicated that PCS was not significantly associated with midterm mortality (adjusted hazard ratio 1.40, 95% confidence interval 0.44–4.41, P  = 0.566). After matching, no significant differences were found between groups in terms of operative mortality (P  > 0.999), major morbidity (P  > 0.999) and midterm survival (P  = 0.564). CONCLUSIONS No significant differences were found between acute type A aortic dissection patients with PCS and those without PCS regarding in-hospital outcomes and midterm survival after extended arch repair. [ABSTRACT FROM AUTHOR]

Open in new tab Download slide OBJECTIVES The goal of the present study was to determine the safety and efficacy of a modified off-pump biatrial mini-maze procedure to treat long-standing persistent atrial fibrillation (AF). METHODS Patients with long-standing persistent AF underwent our modified mini-maze procedure using bipolar radiofrequency ablation. Those patients first underwent a mini-maze procedure using the Dallas lesion set protocol. Second, a purse-string suture was performed on the right atrium, and then 4 ablation lesions were made to the superior vena cava, the inferior vena cava, the appendix of the right atrium and the tricuspid valve annulus from the purse-string suture point by the bipolar radiofrequency clamp. After the operation, the patients were followed up at 3, 6 and 12 months and every year thereafter. RESULTS A total of 102 patients were included in the study. There were no deaths, no surgical re-exploration for bleeding and no permanent pacemaker implants. The intraoperative cardioversion rate was 42.2% (43/102). A follow-up at intervals of 3, 6, 12, 24, 36 and 48 months showed that a success rate free from long-standing persistent AF was 95.1% (97/102), 94.4% (85/90), 94.8% (73/77), 91.5% (54/59), 90.3% (28/31) and 86.4% (19/22), whereas freedom from AF in patients off antiarrhythmic drugs was 88.2% (90/102), 85.6% (77/90), 81.8% (63/77), 78.0% (46/59), 74.2% (23/31) and 68.2% (15/22), respectively. CONCLUSIONS The modified biatrial mini-maze procedure proved to be safe and feasible. Early follow-up demonstrated an acceptable success rate free from AF. [ABSTRACT FROM AUTHOR]

Open in new tab Download slide Objects To acquire adequate proximal landing zones for penetrating aortic ulcers in the proximal descending aorta or aortic arch, the left subclavian artery (LSA) is usually covered during thoracic endovascular aortic repair. The Castor single-branched stent graft is used to treat aortic disease involving LSA. Our goal was to evaluate the efficiency and safety of the Castor device in treating penetrating aortic ulcers (PAUs) involving the LSA. METHODS Between January 2019 and December 2020, we enrolled 25 patients with PAUs requiring LSA revascularization using Castor devices during thoracic endovascular aortic repair (TEVAR). Outcomes including surgical results, 30-day and follow-up deaths and morbidity and aortic computed tomography angiography data were analyzed. RESULTS In total, 24 patients (96.0%) underwent successful surgical procedures: 1 patient (4.0%) had a type I endoleak and 1 patient (4.0%) had a stroke. Stent migration occurred in 1 patient (4.0%) and paraplegia in 1 patient (4.0%). Two stents were deployed in 2 patients (8.0%). After a mean follow-up period of 15.7 months, 2 cases of branch occlusions and 1 death related to myocardial infarction were noted. Aortic computed tomography angiography demonstrated that the diameters and depths were reduced significantly whereas complete thrombosis of the lumens of the PAUs occurred in all cases during the 12-months follow-up period. CONCLUSIONS These preliminary results justify the efficiency and safety of the Castor single branched stent graft in the treatment of PAUs requiring LSA revascularization. [ABSTRACT FROM AUTHOR]

Open in new tab Download slide Open in new tab Download slide OBJECTIVES This study aimed to compare the isolated replacement and repair of severe tricuspid regurgitation after left-sided valve surgery (LSVS) and to report the evolution of this surgical technique. METHODS From January 2005 to August 2018, 118 patients underwent isolated tricuspid valve replacement (iTVR, n  = 93) or repair (iTVr, n  = 25) for severe tricuspid regurgitation after LSVS. The surgical protocol at our institution has significantly changed since 2015, implementing the right thoracotomy approach (95.5%) and peripheral cannulation strategy with the vacuum-assist single venous drainage technique (93.2%) with a concomitant enhancement in preoperative right heart function optimization. Patients were followed up for 32.5 ± 34.6 (1.6–158.7) months. RESULTS The operative mortality rate was 8.5% (8.6% in iTVR and 8.0% in iTVr, P  =   0.924) with a significant decrease from 23.3% (2005–2014) to 3.4% (2015–2018) (P  <   0.001), which was associated with preoperative New York Heart Association functional class IV [odds ratio (OR) 14.73, 95% confidence interval (CI) 2.68–80.90; P  =   0.002] and anaemia (OR 6.60, 95% CI 1.03–42.22; P  =   0.046). After adjusting the logistic regression model, the vacuum-assist single venous drainage technique was also associated with lower operative mortality and composite adverse outcomes. The overall 1- and 5-year survival rates were 91.5% (95% CI 84.8–95.3%) and 77.9% (95% CI 60.0–88.3%), respectively, and no difference was found between the iTVR and iTVr groups (P  =   0.813). CONCLUSIONS Isolated tricuspid valve reoperation for severe tricuspid regurgitation after LSVS is historically a high-risk procedure, but satisfactory results are achievable with advanced surgical techniques and improved perioperative management. Bioprosthetic iTVR is a reliable alternative for severe tricuspid regurgitation after LSVS. [ABSTRACT FROM AUTHOR]

View large Download slide View large Download slide OBJECTIVES A bicuspid aortic valve (BAV) is characterized by variable phenotypic manifestations, as well as longitudinal evolution of valve dysfunction and ascending aorta dilatation. The present study investigated the impact of severe aortic stenosis (AS) on the flow patterns and wall shear stress (WSS) distribution in BAV patients with right–left (RL) and right-non-coronary (RN) cusp fusion types, and the study aimed to reveal whether aortic dysfunction could further alter intrinsic aortic haemodynamic aberrations generated by abnormal BAV cusp fusion patterns. METHODS Four-dimensional flow magnetic resonance imaging was performed in 120 BAV subjects and 20 tricuspid aortic valve controls. BAV patients were evenly categorized into 4 cohorts, including RL and RN BAV with no more than mild aortic dysfunction as well as RL and RN BAV-AS with isolated severe AS. RESULTS BAV subjects exhibited eccentric outflow jets resulting in regional WSS elevation at the right-anterior position of the ascending aorta in the RL group and the right-posterior location in the RN group (P  <   0.005). The presence of severe AS resulted in accelerated outflow jets and more prominent flow and WSS eccentricity (P  <   0.005) by marked helical (P  =   0.014) and vortical flow formation (P  <   0.005), as well as increased prevalence of tubular and transverse arch dilatation. The changes to the flow jet in BAV-AS subjects blurred the differences in peak flow velocity and WSS distribution between RL and RN BAV. Differences in the phenotypes of aortopathy were associated with changes in functional haemodynamic parameters such as flow displacement and WSS eccentricity. CONCLUSIONS Severe AS markedly exacerbated aortic flow aberrations in BAV patients and masked the existing distinct flow features deriving from RL and RN fusion types. Longitudinal studies are needed to investigate the evolution of ascending aortic dilatation relative to the interaction between intrinsic cusp fusion types and acquired severe valve dysfunction. [ABSTRACT FROM AUTHOR]

OBJECTIVES The aim of this study was to analyse the effect of preoperative renal dysfunction on surgical and early outcomes for patients with Type A aortic dissection (AAD). METHODS From January 2016 to December 2016, 140 patients with AAD who underwent surgical treatment at our institution were retrospectively analysed. According to the estimated glomerular filtration rate (eGFR), preoperative renal dysfunction was divided into 4 groups: normal (eGFR ≥90 ml/min/1.73 m2, n  = 76), mild (eGFR 60–89, n  = 40), moderate (eGFR 30–59, n  = 20) and severe (eGFR <30, n  = 4). RESULTS Major complications included prolonged ventilation requiring tracheotomy in 15 patients, renal replacement therapy (RRT) in 28 patients, stroke in 11 patients and paraplegia in 4 patients. The best cut-off value of the eGFR for predicting postoperative RRT was 70 ml/min/1.73 m2 (area under the receiver operating characteristic curve was 0.809). In-hospital mortality was 9.3% (6.5% in the normal group, 5% in the mild group, 20% in the moderate group and 50% in the severe group). Logistic regression analysis showed that age >60 years, moderate and severe renal dysfunction, coronary malperfusion and peripheral malperfusion were risk factors for in-hospital death. CONCLUSIONS Total arch replacement can be safely performed in patients with AAD and preoperative mild renal dysfunction. Preoperative renal dysfunction is a risk factor for postoperative RRT, and eGFR is useful for predicting the requirement for postoperative RRT. Our surgical strategy for total arch replacement and stented elephant trunk for patients with AAD and mild preoperative renal dysfunction has excellent early outcomes. [ABSTRACT FROM AUTHOR]

OBJECTIVES The propensity for aortic aneurysm and dissection bestows bicuspid aortic valves (BAVs), the most common congenital cardiac abnormality, a potentially lethal aspect and considerable clinical concern. In the present study, we attempted to better characterize BAV patients with acute type A aortic dissection (AAD). METHODS Data from 288 consecutive patients undergoing surgery for acute AAD between December 2007 and April 2012 at our institute were retrospectively collected. Patients were categorized into BAV (n = 30) and tricuspid aortic valve (n = 258) groups to investigate their clinical and prognostic features. RESULTS BAV patients tended to have younger age, lower systolic blood pressure, higher rate of moderate-to-severe aortic stenosis and wider ascending aorta (all P < 0.05). The 30-day postoperative mortality was significantly higher among BAV patients (23.3 vs 8.1%, P = 0.016), with an elevated proportion of both cardiogenic deaths and complications. BAV patients who died during the follow-up period demonstrated higher incidence of aortic stenosis (57.1 vs 13.0%, P = 0.033), coronary artery ostium involvement (57.1 vs 4.3%, P = 0.006) and longer cardiopulmonary bypass time (190.7 ± 67.5 vs140.3 ± 37.1 min, P = 0.035). CONCLUSIONS BAV-associated dissection, as a unique subgroup of AAD, demonstrated strikingly high postoperative mortality in a Chinese population. Moderate-to-severe aortic stenosis and dissection involving coronary artery ostium might be associated with the adverse clinical outcomes among BAV patients. [ABSTRACT FROM PUBLISHER]

Abstract: Traumatic aortic-left ventricle tunnel through interventricular septum was particularly a rare event that has never previously been described. A 58-year-old male, with a history of blunt thoracic trauma caused by falling from height, was admitted to our institute for effort dyspnea. Chest computed tomography scan showed subaortic interventricular septal lumen communicating with coronary sinus and left ventricular outflow tract (LVOT). Transthoracic echocardiography revealed a shuttle flow from coronary sinus to LVOT bypassing aortic annulus during diastole. Operation examination found partial aortic annulus avulsion outside right coronary cusp involving superior interventricular septum dissection forming a tunnel breakthrough into left ventricular outflow tract. Both aortic orifice and LVOT orifice of the tunnel were closed with running Prolene suture and right coronary cusp annulus was fastened to aortic root with intermittent mattress suture. The postoperative course was uneventful. Echocardiography confirmed complete closure of the tunnel with residual trivial to mild aortic regurgitation during 1-month follow-up. [Copyright &y& Elsevier]

Abstract: Objective: Aortoesophageal fistula (AEF) is a rare complication of foreign-body ingestion but is often life threatening. Methods: Between July 2006 and July 2009, four patients (two male and two female, age between 54 and 62 years old) with AEF were treated in our center. Cardiopulmonary bypass was established in all cases. The infected aorta was resected and replaced with aortic Dacron graft. The esophagus was mobilized and removed, and the digestive tract was reconstructed 1–2 months later after the first operation, by performing anastomosis of the esophagus and stomach at the neck. Results: All four cases were treated successfully and survived up to the days when this article was written. Conclusions: It might be a safer way to perform this surgery under cardiopulmonary bypass. Thorough surgical debridement should be done, including resection of thoracic esophagus, adequate irrigation and flushing, and full draining of the chest cavity. Reconstruction of the digestive tract in the second stage of this two-stage operation should be the safest choice. [Copyright &y& Elsevier]