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Introduction: With the increase and refinement of video assisted mitral valve surgery, cristalloïd cardioplegia started regaining popularity. The aim of our study was to evaluate the effectiveness of Celsior®, a crystalloid cardioplegic solution, on myocardial protection in elective surgical mitral valve repair in comparison to blood based hyperkalemic cardioplegia. Methods: In this observational retrospective study, all consecutive elective isolated surgical mitral valve repair where Celsior® or normothermic hyperkalemic blood cardioplegia were used were included. Primary endpoint was any sign of myocardial protection failure (troponin levels, need for inotropic or mechanical support, rhythm disturbances, mortality). Secondary endpoint was Celsior® safety (allergic reactions, bleeding, organ toxicities). Results: From January 2009 to August 2016, 382 patients underwent elective isolated mitral valve repair in whom normothermic hyperkalemic blood cardioplegia ( n = 181) or Celsior® ( n = 201) were used. There were no statistically significant differences in baseline characteristics including Euroscore 2. Peak troponin (pg/ml) release and 30-days mortality were not statistically different. Need for cardioversion was significantly more frequent in the Celsior® group (47% vs 13%, p ® occurred. Conclusion: Effective myocardial protection was achieved with the Celsior® cardioplegic solution with no unexpected toxicity. Celsior® may be an efficacious and safe cardioprotective strategy in mitral valve repair.

Supplemental material, sj-docx-1-tar-10.1177_17534666221110354 for Incidence and risk factors of anastomotic complications after lung transplantation by Agathe Delbove, Thomas Senage, Pierre Gazengel, Adrien Tissot, Philippe Lacoste, Laurent Cellerin, Christian Perigaud, Isabelle Danner-Boucher, Arnaud Cavailles, Thierry Lepoivre, Antoine Mugniot, Johanna Nicolet, Delphine Horeau-Langlard, Nicolas Groleau, Yannick Fedun, Bertrand Rozec, Antoine Magnan, Jean-Christian Roussel and François-Xavier Blanc in Therapeutic Advances in Respiratory Disease

With the increase and refinement of video assisted mitral valve surgery, cristalloïd cardioplegia started regaining popularity. The aim of our study was to evaluate the effectiveness of CelsiorIn this observational retrospective study, all consecutive elective isolated surgical mitral valve repair where CelsiorFrom January 2009 to August 2016, 382 patients underwent elective isolated mitral valve repair in whom normothermic hyperkalemic blood cardioplegia (Effective myocardial protection was achieved with the Celsior

Introduction La granulomatose avec polyangeite (GPA) est une vascularite a ANCA dont les manifestations cliniques sont principalement ORL, pulmonaires et renales. Les atteintes cardiaques sont rares. Nous rapportons ici le cas d’une patiente atteinte d’une GPA, ayant successivement presente deux rechutes sous la forme d’une atteinte valvulaire cardiaque. Observation En 2005, une patiente de 65 ans, ayant pour principales comorbidites une hypertension arterielle et une BPCO sur tabagisme actif, etait hospitalisee pour alteration de l’etat general, dyspnee, toux, rhinite et arthralgies. Une GPA ANCA-negative est diagnostiquee avec une preuve histologique apportee par une ponction biopsie sous scanner d’une des opacites pulmonaires et par une biopsie musculaire. Il n’y avait aucun stigmate d’atteinte cardiaque. L’evolution etait favorable apres 6 cures de cyclophosphamide associee a une corticotherapie, puis par azathioprine pendant 2 ans. Elle rechutait une premiere fois en fin d’annee 2011, sous la forme d’une valvulopathie aortique et mitrale isolees, associee a un syndrome inflammatoire et la presence d’ANCA anti-MPO. Le bilan infectieux etait negatif. L’analyse histologique des lesions valvulaires mettait en evidence une atteinte inflammatoire granulomateuse en faveur d’une GPA. Les cultures valvulaires etaient negatives. La patiente beneficia de la pose de deux bioprotheses. Elle presentait par la suite une atteinte articulaire et renale avec la reapparition d’un syndrome inflammatoire et une re-ascension des ANCA anti-MPO (24 UI/mL). Elle recut des bolus de corticoides et du rituximab, puis un traitement par azathioprine au long cours, permettant une remission avec une negativation des ANCA. En octobre 2019, la patiente presenta un œdeme aigu pulmonaire non febrile. L’ECG montrait un BAV complet intermittent ainsi qu’un flutter atypique. Les echographies transthoracique et trans-œsophagienne revelaient une insuffisance mitrale severe sur une desinsertion de la bioprothese mitrale, sans vegetation. La CRP etait a 30,4 mg/L et les ANCA anti-MPO a 155 UI/mL. Les troponines etaient peu augmentees. La coronarographie ne montrait pas de stenose recente. L’IRM cardiaque ne montrait pas de myocardite ni d’abces para-prothetique. La TEP-TDM mettait en evidence un hypermetabolisme focal et intense (SUV max 9,17) au niveau de la fuite para-prothetique mitrale. L’ensemble du bilan infectieux etait negatif. La patiente beneficia d’un remplacement de sa valve mitrale, de l’ablation du flutter et de la pose d’un pacemaker. Les prelevements n’ont ete envoyes que pour une culture bacterienne et une recherche d’ARN 16S, qui etaient negatives. Une biopsie musculaire fut realisee, confirmant la recidive de GPA. Une nouvelle remission fut obtenue sous corticotherapie haute dose et rituximab. Discussion Il s’agit donc d’une deuxieme recidive de GPA se manifestant surtout par une valvulopathie mitrale, situation tout a fait exceptionnelle dans cette maladie. La frequence des atteintes cardiaques de la GPA varie de 6 a quarante-quatre pour cent dans la litterature. Le pericarde est la structure anatomique la plus frequemment touchee, suivi des arteres coronaires et du myocarde. Les valvulopathies sont beaucoup plus rares et concernent plus souvent la valve aortique que la valve mitrale. Des arythmies sont egalement decrites ainsi que des troubles de la conduction, dont le bloc auriculoventriculaire de haut degre. Cinq a dix pour cent des endocardites infectieuses sont a hemocultures negatives : par decapitation par l’antibiotherapie, car dues a des germes a croissance lente et/ou intracellulaire. Ces-derniers sont frequemment responsables d’atteintes systemiques, volontiers granulomateuses (cinquante a soixante pour cent des granulomatoses systemiques sont de cause infectieuse). Des cas d’endocardites infectieuses subaigues avec presence d’ANCA sont egalement decrits. La TEP-TDM peut discriminer une desinsertion d’origine mecanique ou inflammatoire. Elle ne suffit pas a affirme le caractere infectieux de l’hypermetabolisme, mais chez notre patiente, elle s’est averee utile dans l’enquete diagnostique. Conclusion La GPA peut se reveler de maniere atypique, par des manifestations cardiaques, notamment valvulaires. Le suivi cardiologique chez ces patients n’est pas a negliger et peut etre un moyen de diagnostic precoce d’une recidive. Le principal diagnostic differentiel est l’endocardite infectieuse, notamment avec anticorps anti-MPO positifs, qu’il convient de traquer avant d’envisager un traitement par immunosuppresseurs.

OBJECTIVES At our centre, the SynCardia temporary Total Artificial Heart (TAH-t) (SynCardia Systems, LLC, Tucson, AZ, USA) is used to provide long-term support for patients with biventricular failure as a bridge to a transplant. However, a heart transplant (HT) after such support remains challenging. The aim of this retrospective study was to assess the immediate and long-term results following an HT in the cohort of patients who had a TAH-t implant. METHODS A total of 73 patients were implanted with the TAH-t between 1988 and 2019 in our centre. Of these 73 consecutive patients, 50 (68%) received an HT and are included in this retrospective analysis of prospectively collected data. RESULTS In the selected cohort, in-hospital mortality after an HT was 10% (n = 5). The median intensive care unit stay was 33 days (range 5–278). The median hospital stay was 41 days (range 28–650). A partial or total pericardiectomy was performed during the HT procedure in 21 patients (42%) due to a severe pericardial reaction. Long-term survival rates after an HT at 5, 10 and 12 years were 79.1 ± 5.9% (n = 32), 76.5 ± 6.3% (n = 22) and 72.4 ± 7.1% (n = 12), respectively, which was similar to the long-term survival for a primary HT without TAH-t during the same period (n = 686). An HT performed within 3–6 months post-TAH-t implantation appeared to provide the best survival (P = 0.007). Eight (16%) patients required chronic dialysis during the subsequent follow-up period, with 3 patients requiring a kidney transplant. CONCLUSIONS The long-term outcomes with the SynCardia TAH-t as a bridge to transplant in patients with severe biventricular failure are very encouraging. Our review noted that an HT following TAH-t can be technically challenging, especially in the case of a severe pericardial reaction, with potential pitfalls that should be recognized preoperatively.

Background— Structural valve deterioration (SVD) is a major flaw of bioprostheses. Early SVD has been suspected in the last models of Mitroflow bioprosthesis. We sought to assess the incidence, mode, and impact of SVD on outcome in a large series of Mitroflow aortic valve replacement. Methods and Results— Six hundred seventeen consecutive patients (aged 76.1±6.3 years) underwent aortic valve replacement with a Mitroflow prosthesis (models 12A/LX) between 2002 and 2007. By echocardiography, 39 patients developed early SVD (1.66% per patient-year), with stenosis as the main mode (n=36). Mean delay to SVD was only 3.8±1.4 years, and 5-year SVD-free survival was 91.6% (95% confidence interval [CI], 88.7–94.7) for the whole cohort and 79.8% (95% CI, 71.2–89.4) and 94.0% (95% CI, 90.3–97.8) for 19- and 21-mm sizes, respectively. Among the 39 patients with SVD, 13 patients (33%) had an accelerated SVD once the mean gradient exceeded 30 mm Hg. Valve-related death was 46.2% in this SVD subgroup. Five-year overall survival was 69.6% (95% CI, 65.7–73.9). In multivariable analysis, SVD was the strongest correlate of overall mortality (hazard ratio=7.7; 95% CI, 4.4–13.6). Conclusions— Early SVD is frequent in Mitroflow bioprosthesis (models 12A/LX), especially for small sizes (19 and 21 mm), and reduces overall survival. An unpredictable accelerated pattern of SVD constitutes a life-threatening condition. In view of the large number of Mitroflow valves implanted worldwide, one can expect an epidemic of SVD and valve-related deaths, which represents a major public health issue, especially in the elderly. Hence, a close follow-up with yearly echocardiography after Mitroflow implantation is advisable. An urgent reoperation should be discussed in patients with severe SVD even though they are still asymptomatic.

JCTCV:21(2), Objective: To assess hospital morbi-mortality of isolated aortic valve replacement (AVR) in a monocentric cohort of octogenarians. Methods: Between 2002 and 2014, 769 octogenarian patients, male in 46.4% (n=357), with a mean age of 82.7±2.4 years [range: 80–94.4], underwent isolated AVR with implantation of a biological valvular prosthesis in our center. The main surgical indication was aortic stenosis in 79.3% of patients. Patients who underwent redo surgeries were excluded from the study. Results: The hospital mortality rate was 1.95% (n=15) with a Euroscore 2 average of 2.7±3 [range: 0.9–41.2]. Mean intensive care unit stay was 3.1 ±4.5 days with a total hospital stay of 13.5±7.9 days. The main postoperative complications included blood transfusion (62.5%), renal failure (15.6%) requiring dialysis in 2.7 % of the cases, para-prosthesis aortic insufficiency (1 to 2/4) (3.4%), prolonged artificial ventilation (>48h) (2.9%), pace-maker implantation (1.4%), stroke (1.2%) and mediastinitis (0.5%). Multivariate predictors of hospital mortality were cardiogenic shock (OR=34.8 [4.2–215.9]), and a BMI greater than 30 (OR 4.5 [1.3–16.2]). Conclusion: Currently, aortic valve replacement in octogenarians is a reliable surgery with a low hospital morbi-mortality rate. It also provides effective identification of patients at risk.

Regulation (EC) No 1925/2006 of 20 December 2006 on the addition of vitamins, minerals and certain other substances to foods came into force on 1 July 2007 and renders void certain provisions of Decree No. 2006/1264 of 16 October 2006. This text changes significantly how to approach the issue of current food fortification, hitherto subject to prior authorization. This article aims to review the conditions under which stakeholders can use the addition, and how the communication on packaging is possible, related to the presence of vitamins in food.

Objective: Mediastinal lymph node staging determines the treatment strategy for non-small-cell lung cancer. This study aims to evaluate prospectively the accuracy of preoperative integrated 18-fluoro-2-deoxy-D-glucose positron emission tomography—computerised tomography ( 18 FDG PET-CT) for mediastinallymph node staging.Methods:Preoperative integrated 18 FDG PET-CTwas used to analyse mediastinallymph nodes in patients with non-small-cell lung cancer. Nodal stations were identified according to the American Thoracic Society mapping system. Lymph nodes with a standardised uptake value (SUVmax) >3 were considered to be positive. The mediastinal lymph nodes were harvested during lung resection and the results of integrated 18 FDG PET-CT were compared to the mediastinal lymph node histology results. Results: A total of 51 patients were enrolled in this study. The mean interval between integrated 18 FDG PET-CTand surgery was 31 15.8 days (range: 2—78 days). The mean mediastinal lymph node harvested and station number per patient during surgery were 11.8 5.6 (range: 2—27) and 3.8 1 (range: 2—6), respectively. The incidence of N2 pathological disease was 19.6%. The integrated 18 FDG PET-CT sensitivity and specificity were 40 30% and 85 11%, respectively. Thepositiveandnegativepredictivevalueswere 40 30%and85 11%,respectively. False-positive results(sixpatients) were mainly due to inflammatory lymph nodes. False-negative results (six patients) were mainly due to infra-centimetrical, malignant lymph node invasion. Conclusion: The sensitivity of integrated 18 FDG PET-CT for mediastinal lymph node staging in patients selected for surgery is low. When positive mediastinal lymph nodes are detected, invasive mediastinal staging must be performed. On the other hand, the specificity is high: patients with negative integrated 18 FDG PET-CT can be operated upon without invasive mediastinal staging. # 2009 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved.

Background: The optimal surgical management of primary spontaneous pneumothorax (PSP) is still controversial, especially in terms of the technique to be used. The aim of this paper was to report our experience of videothoracoscopic silver nitrate pleurodesis (VATSNP). Methods: Between 1995 and 2004, all the medical records of the patients who had undergone silver nitrate videothoracoscopic pleurodesis (SNVTP) were reviewed. All the patients had systematic prospective clinical and radiological follow-up at 1 month. The last 250 patients were retrospectively recontacted for long-term follow-up. Results: Six hundred and three patients underwent SNVP. No intra-operative death or major complication occurred during or after the procedures. Mean operating time was 40.2 10.7 min. The conversion to thoracotomy rate was 2.5%. Main postoperative complications were prolonged air leak (15.6%), partial residual pneumothorax (5.1%), pleural effusion (2.5%) and postoperative bleeding (2.0%). The follow-up was 100% complete 1 month after discharge; at 1 month, the recurrence rate was 0.5%. The last 250 patients were retrospectively recontacted with a mean follow-up of 2.9 2.3 years (184 patients). The long-term recurrence rate was 1.1%. Conclusions: It is one of the first reports on the use of video-assisted thoracoscopic silver nitrate pleurodesis for PSP. We demonstrate safety and effectiveness of the procedure with long-term results comparable with standard open pleural abrasion or pleurectomy. # 2007 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved.

Objective The study's objective was to comparatively evaluate surgery and stent-graft repair of acute or subacute traumatic aortic rupture. Methods A total of 76 patients (14–76 years old; mean, 37 years; male/female ratio, 63/11) with a traumatic aortic injury were admitted to our hospital between 1981 and 2003. Six patients died within 1 to 9 days of another associated severe traumatic lesion. The 70 remaining patients were divided according to the type of rupture repair. In group 1, 35 patients were treated surgically: 28 with immediate repair and 7 with delayed repair (average time interval 66 days, 5–257 days). In group 2, 29 patients were treated with stent grafting of the aortic isthmus. In group 3, 6 patients with minor aortic lesions were treated medically with a close follow-up. Results In the 28 patients treated surgically in the emergency department, the mortality and paraplegia rates were 21% and 7%, respectively. No death or paraplegia was observed in the group with delayed surgical repair. With stent grafting, complete exclusion of the pseudoaneurysmal sac was observed in all patients. Except for 1 iliac rupture treated during the same procedure, there was no major morbidity or mortality during the mean follow-up of 46 months (13–90 months). No major complication was observed in group 3. Conclusions In stable rupture of the aorta, initial conservative treatment is safe and allows management of the major associated lesions. Stent grafting of the aortic isthmus is a valuable therapeutic alternative to surgical repair, especially in patients considered high risk for conventional thoracotomy.

A cost optimization scheme for a microgrid is presented. Prior to the optimization of the microgrid itself, several schemes for sharing power between two generators are compared. The minimization of fuel use in a microgrid with a variety of power sources is then discussed. The optimization of a small power system has important differences from the case of a large system and its traditional economic dispatch problem. Among the most important differences is the presence of a local heat demand which adds another dimension to the optimization problem. The microgrid considered in this paper consists of two reciprocating gas engines, a combined heat and power plant, a photovoltaic array and a wind generator. The optimization is aimed at reducing the fuel consumption rate of the system while constraining it to fulfil the local energy demand (both electrical and thermal) and provide a certain minimum reserve power. A penalty is applied for any heat produced in excess of demand. The solution of the optimization problem strongly supports the idea of having a communication infrastructure operating between the power sources.

Resume But Evaluer la faisabilite et la fiabilite de la mise en place d’endoprotheses pour traiter les ruptures aigues post-traumatiques de l’isthme aortique : presentation de notre experience de 16 patients. Materiels et methodes Entre janvier 1996 et decembre 2001, 16 patients, âges en moyenne de 36 ans, ont ete traites par cette technique. Tous presentaient des lesions associees et 9 d’entre eux, une instabilite hemodynamique non liee a la rupture isthmique. Apres un delai variant de 9 a 245 jours (moyenne 78 jours), une endoprothese aortique etait mise en place par une equipe pluridisciplinaire. Un suivi regulier etait realise par scanner et echographie transoesophagienne. Resultats L’endoprothese a permis l’exclusion du faux anevrisme dans 100 % des cas. La procedure durait en moyenne 120 minutes et 80 % des patients ont pu etre extubes sur table. Le sejour moyen aux soins intensifs etait de 24 heures. La seule complication etait une compression de la bronche souche gauche par le faux anevrisme, traitee avec succes par une endoprothese bronchique. Le recul maximal etait de 7 ans. Conclusion La mise en place d’endoprothese pour rupture aigue de l’isthme aortique est une technique fiable et peut etre proposee comme alternative a la chirurgie pour les polytraumatises dont les lesions associees augmentent le risque chirurgical.

The writing of surgical and hospitalization reports is time-consuming and does not necessarily enable the increment of a statistical database, tool that is indispensable nowadays to evaluate unit activity or to carry out scientific studies. In order to prevent this double data capture, a computer tool, named CordaBase, has been developed by surgeons and set up in a cardiac surgery unit.CordaBase is an interactive software that stores medical data. Thanks to its intuitive interface, CordaBase stores data which is classified chronologically in the following categories: past medical history, preoperative assessment, operating gesture, stay in intensive care unit, stay in wards and evolution/monitoring after discharge. This date, stored in an Access base, are then used in the creation of personalized surgical and hospitalization reports. All the data is permanently available and can be used for the carrying out of scientific works or for the evaluation of the unit activity.From March 2009 to December 2010, 2617 consecutive patients operated on in a Cardiac Surgery Unit were recorded prospectively in the software. All of this stored data assisted the surgeon in his or her administrative tasks, thanks to personalized surgical and hospitalization reports, immediately at the secretariat's disposal. The database, which is requisitely filled by administrative work, enables the carrying out of any statistical study on all unit activity.With a hindsight of almost 2 years, CordaBase has proven its usefulness in an active cardiac surgery unit, both on an administrative and scientific level. The computerized reports have lightened the medical secretariat's workload and statistical studies have now become possible without having to take the paper medical files out again. In the years to come, the accumulation of medical data prospectively or retrospectively stored will surely confirm the potential of the use of such a software.

IntroductionRedo surgery of the aortic arch in elderly patients inpoor health is associated with a high mortality. Thisregion of the aorta cannot always be treated usingendovascular stents. We report our experience with asurgical case of a false anastomotic aneurysm of theaortic arch, treated by open surgery and subsequentendovascular surgery.Case ReportA 74-year-old patient with a persistent hiccoughunderwent a routine medical examination. He hadundergone an aortic valve replacement in 1982followed by a Bentall procedure and an aortic archreplacement in 1986 due to a dissection. Radiographyand the thoracic computerized tomography revealed afalse aneurysm of the distal anastomosis of the aorticarch, fed by a localized leak at the origin of thebrachiocephalic trunk (Fig. 1). The neck between theleak and the brachiocephalic trunk was 0.7 cm. Anendovascular procedure as the first option wasconsidered because of the patient’s medical historyand his precarious coronary condition.First, via a cervical approach, the left subclavianartery was reimplanted into the left common carotidartery, a carotid–carotid bypass graft and exclusion ofthe left common carotid artery were achieved. Apostoperative surgical haemostasis and a bloodtransfusion were both required. Postoperative com-plications included a left recurrent laryngeal nerveparalysis,pneumonia,and theonsetof atrialfibrillation.Because of these complications we waited 6 monthsbefore carrying out the endovascular procedure.At the second procedure an occlusion balloon wasfirst placed in the left subclavian artery to preventretrograde perfusion from the collaterals from feeding

Objectives The study was conducted to determine the long-term outcome of patients who underwent heart transplantation 15 to 20 years ago, in the cyclosporine era, and identify risk factors for death. Methods A retrospective analysis was done of 148 patients who had undergone heart transplantation between 1985 and 1991 at a single center. Operative technique and immunosuppressive treatment were comparable in all patients. Results Actuarial survival rates were 75% (n = 111), 58% (n = 86), and 42% (n = 62) at 5, 10, and 15 years, respectively. The mean follow-up period was 12.1 ± 5.6 years for patients who survived more than 3 months after transplantation (n = 131). The major causes of death were malignancy (35.8%) and cardiac allograft vasculopathy (24.7%). No death related to acute rejection was reported after the first month of transplantation. Graft coronary artery disease was detected on angiography in 66 (50.3%), and 7 (5.3%) had retransplantation. Malignancies developed in 131 patients (48.1%), including skin cancers in 31 (23.6%), solid tumors in 26 (19.8%), and hematologic malignancies in 14 (10.6%). Severe renal function requiring dialysis or renal transplantation developed in 27 patients (20.6%). By multivariable analysis, the only pre-transplant risk factor found to affect long-term survival was a history of cigarette use ( p Conclusions Long-term survival at 15 years after cardiac transplantation remains excellent in the cyclosporine era. Controlling acute allograft rejection can be achieved but seems to carry a high rate of cancers and renal dysfunction. History of cigarette use affects significantly long-term survival in our study.

Objective We sought to determine the midterm results of endovascular repair of atherosclerotic aneurysms of the thoracic descending aorta by using second-generation, commercially available stent grafts. Methods Between 1996 and 2005, 45 patients (mean age, 68 ± 11 years) with aneurysms of the descending thoracic aorta underwent endovascular repair. Aortic dissections, penetrating ulcers, and traumatisms were excluded. The mean follow-up was 24.7 ± 21.6 months (maximum, 6.7 years). Results No patients died, and no conversion to surgical intervention was required during the procedures. Three (6.7%) patients died during the first month, and 6 (14.7%) died later on. The main complications were strokes (13.3%), vascular access complications (8.9%), aortic complications (6.6%), paraplegia (4.4%), and sudden deaths (4.4%). Nineteen (42%) primary endoleaks were encountered: 3 required reinterventions, 15 spontaneously thrombosed, and 1 patient died. Except for 2 sudden unexplained deaths, no aortic complications were observed after 1 month. Actuarial survival estimates at 1, 3, and 5 years were 87.6% ± 5.3%, 76.9% ± 7.4%, and 70.6% ± 9.2%, respectively. Actuarial freedom from death related to the treated aortic disease was 94.3% ± 4.0%, 94.3% ± 4.0%, and 86.4% ± 8.4% at 1, 3, and 5 years, respectively. Aspirin status of greater than 3 ( P = .005), high aortic diameter ( P = .007), and long covered lengths ( P = .02) were determinant for mortality. Actuarial freedom from complication was 62.6% ± 7.7%, 58.9% ± 8.1%, and 58.9% ± 8.1% at 1, 3, and 5 years, respectively. The location of the aneurysm ( P = .05) and a high aortic diameter ( P = .04) were both determinants for endoleaks. Conclusions Stent grafting of atherosclerotic aneurysm of the thoracic descending aorta is safe and effective. Further studies are mandatory to determine the most relevant indications and the long-term efficacy of such treatment.

The aim of this study was to evaluate the feasibility and safety of endovascular repair in acute traumatic aortic rupture on the basis of our experience with 16 patients.From January 1996 to December 2001,16 patients, with a mean age 36 years, underwent repair of traumatic rupture of the aorta with the use of stent-grafts. All patients presented with coexisting injuries and 9 of 16 patients were hemodynamically unstable because of other injury. After a delay ranging from 9 to 245 days (mean 78 days), aortic stent-grafting was performed by a multidisciplinary team. All patients had regular follow-up with spiral CT and transesophageal echocardiogram.Stent-graft placement was successful in all patients with exclusion of false aneurysm. The duration of the procedure was about 120 min and mechanical respiratory assistance could be removed immediately in 80% of patients. Mean stay in the intensive care unit was 24 hours. One complication was noted: compression of the left main stem bronchus successfully treated with endoprosthesis. Maximum follow-up was 7 years.Endovascular stent-graft repair is a valuable technique and is emerging as an alternative technique for treating thoracic aortic injury in patients in whom coexisting injury increases the surgical risk.