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Commercially available Dacron (woven polyester) grafts are used for routine open surgical repair of thoracic aortic aneurysms. Despite durable and biocompatible, these grafts do not reproduce the natural mechanical properties of the aorta. Therefore, the aim of this project was to develop an innovative graft that additionally exhibits physiological aortic compliance. To achieve this result, multi-layered tubular aortic grafts were created by electrospinning of a thermoplastic polyurethane. To reduce permeability, a gelatin-coating was added. Three groups (G 1–3 ; n = 5) with varying layer designs were evaluated regarding the main mechanical properties of vascular grafts such as suture retention strength, permeability and static and dynamic compliance. G 3 , which combined electrospinning with a stable silicone-coated inlay was chosen for the fabrication of medical grade thermoplastic polyurethane grafts (G m ; n = 6). Dynamic compliance values of 19.68 ± 11.5%/100 mmHg (50–90 mmHg), 15.18 ± 8.7%/100 mmHg (80–120 mmHg) and 14.56 ± 7.4%/100 mmHg (110–150 mmHg) were achieved. The compliance was higher than for Dacron and ePTFE grafts and comparable to the normal sized ascending aorta of around 16%/100 mmHg in a healthy human and porcine aortic compliance of 14.3%/100 mmHg. Static compliance was successfully tested up to 350 mmHg. No significant changes in graft diameter or delaminations of the graft layers were detected after compliance testing. Therefore, by combining electrospinning with a durable inlay, both elasticity and recoverability are obtained, resulting in a promising alternative to the gold-standard in open-surgical treatment of thoracic aortic pathologies.

Addressing proximal complications that arise after endovascular aortic repair for type B aortic dissection, such as type Ia endoleaks, “bird-beaking” of the thoracic endovascular aortic repair (TEVAR) stent, retrograde type A dissection, and postdissection aneurysms, bears considerable complexities. We present a novel and safe method for open arch repair that can ensure a secure and efficient approach for TEVAR complications. The key element of the operative technique is approximating the grafted stent portion to the aortic wall and the arch prosthesis. The technique has successfully been implemented in 11 patients, who received secondary open arch repair from 2019 to 2022 after TEVAR for type B dissection. Our objective is not only to introduce this reliable concept but also to provide a comprehensive demonstration of its advantages and disadvantages compared with currently used open treatment methods and discuss patient outcomes after secondary open arch repair.

Inferior vena cava atresia is a rare and usually asymptomatic condition. However, when these patients undergo cardiac surgery, it can present an unexpected and challenging situation for the surgeon. Specifically, adequate venous drainage during cardiopulmonary bypass (CPB) is a critical issue here and may require an extension of cannulation strategies. Adequate preoperative diagnostics, ideally with imaging modalities such as CT angiography or MRI, are required for optimal surgical planning. Here, we describe a rare case of thoracic ascending aortic aneurysm with concomitant inferior vena cava atresia that was successfully operated on. With adequate preoperative planning, we were able to perform an operation without unforeseen complications with standard initialization of CPB.

Commercially available Dacron (woven polyester) grafts are used for routine open surgical repair of thoracic aortic aneurysms. Despite durable and biocompatible, these grafts do not reproduce the natural mechanical properties of the aorta. Therefore, the aim of this project was to develop an innovative graft that additionally exhibits physiological aortic compliance. To achieve this result, multi-layered tubular aortic grafts were created by electrospinning of a thermoplastic polyurethane. To reduce permeability, a gelatin-coating was added. Three groups (G1–3; n = 5) with varying layer designs were evaluated regarding the main mechanical properties of vascular grafts such as suture retention strength, permeability and static and dynamic compliance. G3, which combined electrospinning with a stable silicone-coated inlay was chosen for the fabrication of medical grade thermoplastic polyurethane grafts (Gm; n = 6). Dynamic compliance values of 19.68 ± 11.5%/100 mmHg (50–90 mmHg), 15.18 ± 8.7%/100 mmHg (80–120 mmHg) and 14.56 ± 7.4%/100 mmHg (110–150 mmHg) were achieved. The compliance was higher than for Dacron and ePTFE grafts and comparable to the normal sized ascending aorta of around 16%/100 mmHg in a healthy human and porcine aortic compliance of 14.3%/100 mmHg. Static compliance was successfully tested up to 350 mmHg. No significant changes in graft diameter or delaminations of the graft layers were detected after compliance testing. Therefore, by combining electrospinning with a durable inlay, both elasticity and recoverability are obtained, resulting in a promising alternative to the gold-standard in open-surgical treatment of thoracic aortic pathologies. [ABSTRACT FROM AUTHOR]

Purpose: To describe the transaxillary branch-to-branch-to-branch carotid catheterization technique (tranaxillary 3BRA-CCE IT) for cannulation of all supra-aortic vessels using only 1 femoral and 1 axillary access during triple-branch arch repair. Technique: After deployment of the triple-branch arch device, catheterization and bridging of the innominate artery (IA) should be performed through a right axillary access (cutdown or percutaneous). Then, the retrograde left subclavian (LSA) branch should be catheterized (if not preloaded) from a percutaneous femoral access, and a 12×90Fr sheath should be advanced to the outside of the endograft. Subsequently, catheterization of the left common carotid artery (LCCA) antegrade branch should be performed, followed by snaring of a wire in the ascending aorta which was inserted through the axillary access, creating a branch-to-branch-to-branch through-and-through guidewire. Over the axillary access, a 12×45Fr sheath should be inserted into the IA branch and looped in the ascending aorta using a push-and-pull technique so that it faces the LCCA branch, allowing for stable catheterization of the LCCA. The retrograde LSA branch should then be bridged following the standard fashion. Conclusions: This series of 5 patients demonstrates that triple-branch arch repair can be performed with the transaxillary 3BRA-CCE IT, allowing catheterization of the supra-aortic vessels without manipulation of the carotid arteries. Clinical Impact: The transaxillary 3BRA-CCE IT allows catheterization and bridging of all supra-aortic vessels in triple-branch arch repair through only 2 vascular access points, the femoral artery and the right axillary artery. This technique avoids carotid surgical cutdown and manipulation during these procedures, reducing the risk of access site complications, including bleeding and reintervention, reintubation, cranial nerve lesions, increased operating time, and so on, and has the potential to change the current vascular access standard used during triple-branch arch repair. [ABSTRACT FROM AUTHOR]

OBJECTIVES In this retrospective study, we aimed to assess incidence, possible causes and clinical consequences of hypoattenuated leaflet thickening (HALT) following aortic root replacement with valved composite grafts and concomitant aortic arch repair. METHODS Between January 2016 and December 2022, 454 patients underwent Bentall procedures with arch replacements in hypothermic circulatory arrest at the University Aortic Centre MunichLMU, Germany. Sequential postoperative ECG-gated, high-resolution computed tomography angiographies were analyzed, and the presence of HALT correlated with neurologic events and transvalvular gradients over time. Furthermore, attention was given to intraoperative hemostatic product use and postoperative anticoagulation regimes. RESULTS 327 out of 454 patients were included. The follow-up period averaged to 3.27 years. 28% of the patients showed radiographic signs of HALT, which was correlated with a significantly higher incidence of transient neurological events as compared to those without (38 vs 8 events, P  < 0.01). However, there were no significant differences with respect to the postoperative anticoagulation regimen or transvalvular gradients between the two groups. Only the intraoperative administration of prothrombin complex concentrate was significantly higher in patients with postoperative HALT. CONCLUSIONS HALT is observed in a high percentage of cases following aortic root replacement combined with complex aortic procedures. Furthermore, it is associated with an increased risk of neurological events but only a weak correlation was demonstrated with the perioperative coagulation management. While no long-term implications were noted, these findings suggest the necessity for further investigations, longer follow-up periods, and more comprehensive diagnostic approaches. [ABSTRACT FROM AUTHOR]

The paper outlines the methodology for the extension of the assessment of transport scenarios to include a life cycle perspective. When considering greenhouse gas emissions in the operational phase, the inclusion of the upstream chain increases emissions in conventional systems by only 17% to 19%. In transport systems that utilise a large share of electricity generated predominantly from renewable energies without direct emissions, this value can rise sharply. In the present case, up to 304%. The emissions currently associated with the production of the transport fleet correspond to 56 Mt CO2e and thus 22% of total emissions. In most scenarios, however, this value decreases more slowly than the operational emissions. This increases the share of emissions caused by production. Thus, the inclusion of life cycle emissions is an important component for assessing sustainability.

OBJECTIVES Aortic valved allografts (homografts) have been used alternatively to mechanical or biological valve prostheses in expectation of better durability; however, homograft valves do degenerate, and redo procedures have proven challenging due to heavy wall calcification. The aim of the study was to compare the outcome of open surgical (SAVR) and transcatheter aortic valve replacement (TAVR) in degenerated homografts. METHODS Between 1993 and 2022, 81 patients underwent repeat aortic valve procedures having previously received an aortic homograft. The redo had become necessary due to regurgitation in 85% and stenosis in 15%. Sixty-five percent underwent open surgery, 35% TAVR. RESULTS Isolated SAVR was possible in 79%, and root procedures were necessary in 21%. TAVR was performed in 79% via transfemoral and 21% via transapical access. Median prosthetic valve size was 23 (22.3–23.2) mm in the SAVR and 26 (25.2–26.9) in the TAVR group. Thirty-day mortality was 0% in the TAVR and 7% in the SAVR group (P  = n.s.). TAVR showed a significantly better outcome concerning prolonged ventilation (0 vs 21%, P  = 0.013) as well as ICU (1 vs 2 days; P  < 0.001) and in-hospital stay (10.5 vs 13 days; P  = 0.028). Five-year survival was statistically comparable between groups, and no severe leakage was observed. CONCLUSIONS SAVR following structural homograft degeneration shows acceptable results, but the perioperative risk remains substantial and poorly predictable. TAVR presents a reasonable and more easily accessible alternative and is associated with good short- and mid-term results. In the absence of relevant contraindications, TAVR is presently the preferred treatment option for these patients at our center. [ABSTRACT FROM AUTHOR]

Background: Endovascular repair of the thoracic aorta (TEVAR) is the preferred option for the treatment of the distal arch and descending thoracic aorta. Fenestrated and branched TEVAR have become an option to treat pathologies of the aortic arch, avoiding sternotomy and cardiopulmonary arrest as well as total surgical debranching. We describe here the case of a symptomatic patient with an arteria lusoria aneurysm associated with Kommerel diverticulum who underwent total endovascular repair with a triple-branched TEVAR. Case Report: A 66-year-old male patient was treated for a symptomatic arteria lusoria artery associated with a Kommerel diverticulum, resulting in difficulty swallowing and choking. We used a custom-made triple inner-branch endograft (Cook Medical, Bloomington, Indiana) following implantation of a right-sided carotid-subclavian (C-S) bypass. The C-S bypass occluded in the interval time between the 2 procedures and required recanalization and stent-graft placement during the aortic arch procedure. The arteria lusoria was embolized with a vascular plug. No complications occurred and postoperative tomography showed exclusion and thrombosis of the Kommerel diverticulum and perfusion of the supra-aortic vessels. Conclusions: Treatment of arteria lusoria aneurysms can be performed with total endovascular arch inner-branch repair, avoiding increased risk of morbidity and mortality caused by open or hybrid procedures. [ABSTRACT FROM AUTHOR]

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