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Clinical Advances in Aortic Surgery
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Clinical Advances in Aortic Surgery

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Cardiology".

Deadline for manuscript submissions: closed (30 August 2023) | Viewed by 7677

Special Issue Editors

Prof. Dr. Christoph Huber

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Guest Editor
Division of Cardiovascular Surgery, Department of Surgery, University Hospitals of Geneva, 1211 Geneva, Switzerland
Interests: cardiac surgery; aortic valve; cardiovascular surgery; aortic aneurysm; vascular imaging
Prof. Dr. Peter Matt

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Guest Editor
Cardiac Surgery Division, Lucern Hospital, 6004 Luzern, Switzerland
Interests: cardiac surgery; surgery; cardiovascular surgery; aortic valve
Prof. Dr. Enrico Ferrari

E-Mail Website
Guest Editor
Cardiac Surgery Unit, Cardiocentro Ticino Institute, 6900 Lugano, Switzerland
Interests: transcatheter heart valve procedures; minimally invasive cardiac surgery; myocardial protection
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Without doubt, aortic surgery has become one of the most rapidly evolving fields in cardiac surgery. Improved imaging modalities with high-resolution 4D MRI and ultra-sharp cardiac CT have joined forces with novel surgical strategies, including hybrid and complex custom-made endo-prosthetic approaches, to tackle the aortic disease burden. New scientific evidence improves our understanding of risk predictors and challenges current treatment indications. Tremendous surgical progress has led aortic surgery to become a lower risk intervention, allowing aortic arch surgery to be performed with continuous cerebral perfusion in normo- and mild hypothermia. The perioperative monitoring of evoked potentials reduces peripheral and visceral ischemia injuries and facilitates cerebral surveillance strategies during and rapidly after surgery. Fast-track protocols have recently been implemented in complex aortic operations, allowing earlier extubation and neuroradiological intervention in case of need. Finally, multimodal preoperative planning in dedicated aortic teams has been paired with fit-for-surgery pre-operative patients within training programs in order to further improve surgical outcomes.

This truly tremendous progress has been achieved by intensified worldwide interest in aortic disease and treatment. Your contributions in this Special Issue on the clinical advances in aortic surgery will significantly promote clinical outcomes after aortic surgery beyond major breakthroughs.    

Prof. Dr. Christoph Huber
Prof. Dr. Peter Matt
Prof. Dr. Enrico Ferrari
Guest Editors

Manuscript Submission Information

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Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • aortic surgery
  • arch surgery
  • acute aortic type A dissection
  • hybrid aortic surgery
  • TEVAR
  • branched endoprosthesis
  • deep hypothermic arrest
  • cerebral perfusion
  • spinal cord
  • aortic imaging
  • outcomes (includes mortality and morbidity)
  • aortic teams

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Published Papers (5 papers)

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Research

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9 pages, 995 KiB  
Article
Comparative Study of Male and Female Patients Undergoing Frozen Elephant Trunk Total Arch Replacement
by Julia Benk, Tim Berger, Stoyan Kondov, Matthias D’Inka, Magdalena Bork, Tim Walter, Philipp Discher, Bartosz Rylski, Martin Czerny and Maximilian Kreibich
J. Clin. Med. 2023, 12(19), 6327; https://doi.org/10.3390/jcm12196327 - 1 Oct 2023
Cited by 1 | Viewed by 1316
Abstract
Background: Our aim was to investigate outcomes and long-term survival in male and female patients after frozen elephant trunk (FET) total arch replacement. Methods: Between March 2013 and January 2023, 362 patients underwent aortic arch replacement via the FET technique. We compared patient [...] Read more.
Background: Our aim was to investigate outcomes and long-term survival in male and female patients after frozen elephant trunk (FET) total arch replacement. Methods: Between March 2013 and January 2023, 362 patients underwent aortic arch replacement via the FET technique. We compared patient characteristics and intra- and postoperative data between male and female patients. Results: Male patients were significantly younger (p = 0.012) but revealed a higher incidence of coronary artery disease (p = 0.008) and preoperative dialysis (p = 0.017). More male patients presented with type A aortic dissections (p = 0.042) while more female patients had aortic aneurysms (p = 0.025). The aortic root was replaced in significantly more male patients (p = 0.013), resulting in significantly longer cardiopulmonary bypass duration (p < 0.001) and operative times (p < 0.001). There were no statistically significant differences in postoperative outcome parameters including in-hospital mortality (p = 0.346). However, new in-stent thrombus formation was significantly more frequent in female patients (p = 0.002). Age in years (odds ratio (OR): 1.026, p = 0.049), an acute pathology (OR: 1.941, p = 0.031) and preoperative dialyses (OR: 3.499, p = 0.010) were predictive for long-term mortality in our Cox regression model, sex (p = 0.466) was not. There was no statistical difference in overall survival (log rank: p = 0.425). Conclusions: Female patients are older but reveal fewer cardiovascular risk factors; aneurysms are more common in female than male patients. As female patients undergo concomitant surgical procedures less often, their operative times are shorter. While survival and outcomes were similar, female patients suffered from postoperative new in-stent thrombus formation significantly more often. Full article
(This article belongs to the Special Issue Clinical Advances in Aortic Surgery)
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10 pages, 1948 KiB  
Article
Outcome Analysis of Speed Gate Cannulation during Standard Infrarenal Endovascular Aneurysm Repair
by Domenico Mirabella, Salvatore Evola, Ettore Dinoto, Carlo Setacci, David Pakeliani, Francesco Setacci, Paolo Annicchiarico and Felice Pecoraro
J. Clin. Med. 2023, 12(19), 6263; https://doi.org/10.3390/jcm12196263 - 28 Sep 2023
Cited by 1 | Viewed by 1107
Abstract
Background: Endovascular aortic repair (EVAR) is generally performed with bi/trimodular stent-grafts requiring retrograde contralateral gate cannulation (CGC). In the case of tricky CGC, an increased EVAR procedural time and radiation exposure have been reported. Herein, we compare the outcomes of conventional CGC and [...] Read more.
Background: Endovascular aortic repair (EVAR) is generally performed with bi/trimodular stent-grafts requiring retrograde contralateral gate cannulation (CGC). In the case of tricky CGC, an increased EVAR procedural time and radiation exposure have been reported. Herein, we compare the outcomes of conventional CGC and CGC using the speed gate cannulation (SGC) technique in standard EVAR for a propensity-matched cohort. Methods: A total of 371 patients were retrospectively analyzed. Inclusion criteria were fulfilled in 172 patients who underwent propensity score matching. Primary outcomes included operative time, CGC time, mean contrast medium, fluoroscopy time, and CGC fluoroscopy time. Results: After matching, 78 patients were included in each group (SGC vs. standard). Primary outcomes registered a significant reduction in CGC time (4 [1–6] vs. 8 [6–14] min; p = 0.001) and fluoroscopy time (12 [9–16] vs. 17 [12–25] min). Conclusions: In this preliminary experiment, the use of SGC was feasible with no significant registered postoperative complications. A significant reduction in contrast medium usage, radiation exposure, and CGC time was observed with the use of SGC. SGC is a simple adjunctive technique, and its use should be considered in standard EVAR, especially in emergency scenarios, where time is of the essence. Full article
(This article belongs to the Special Issue Clinical Advances in Aortic Surgery)
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9 pages, 1481 KiB  
Article
Aortic Dilatation on the Edge of Dissection—Do We Operate Too Late? The Ratio between Ascending and Descending Aorta DiameteR (RADAR)
by Nerea Lopez Perez, Philippe Reymond, Mustafa Cikirikcioglu, Mathieu van Steenberghe, Tornike Sologashvili, Nicolas Murith, Thomas Perneger and Christoph Huber
J. Clin. Med. 2023, 12(13), 4400; https://doi.org/10.3390/jcm12134400 - 29 Jun 2023
Viewed by 1558
Abstract
(1) Background: There is a need for a novel surrogate marker to ease decision making when facing ascending aortic dilatation. In this article, we study the ratio between ascending and descending aorta diameters as a potential one. (2) Methods: Retrospective observational cohort study, [...] Read more.
(1) Background: There is a need for a novel surrogate marker to ease decision making when facing ascending aortic dilatation. In this article, we study the ratio between ascending and descending aorta diameters as a potential one. (2) Methods: Retrospective observational cohort study, including all the patients who underwent surgery for acute type A aorta dissection (aTAAD) between January 2014 and September 2020 at our center. A total of 50 patients were included. Clinical and demographic data were collected. The anatomical measurements were made including orthogonal maximal diameters of the ascending and descending aorta, post-dissection whole circumference length (post-wCL), post-dissection true lumen circumference length (post-tCL), and surface and sphericity indices of the ascending and descending aorta. Pre-dissection ascending aorta diameter (pre-AAD) and pre-dissection descending aorta diameter (pre-DAD) were calculated as well as the ratio between them and compared with reference values. (3) Results: Of the pre-AAD patients, 96% had smaller than the recommended 55 mm. The ratio between the descending and ascending aorta pre-dissection diameters was significantly smaller compared to the reference value (0.657 ± 0.125 versus 0.745 ± 0.016 with a mean difference of −0.088 and a p < 0.001). (4) Conclusions: The 55 mm threshold for aorta maximal diameter is an insufficient criterion when assessing the risk of dissection. The ratio between DAD and AAD is a parameter worthy of analysis as a tool to stratify the risk of dissection. Full article
(This article belongs to the Special Issue Clinical Advances in Aortic Surgery)
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12 pages, 2423 KiB  
Article
Long-Term Results with 187 Frozen Elephant Trunk Procedures
by Zsuzsanna Arnold, Daniela Geisler, Thomas Aschacher, Bernhard Winkler, Verena Lenz, Ingo Crailsheim, Sandra Folkmann, Marieluise Harrer, Reinhard Moidl, Martin Grabenwöger and Gabriel Weiss
J. Clin. Med. 2023, 12(12), 4143; https://doi.org/10.3390/jcm12124143 - 20 Jun 2023
Cited by 4 | Viewed by 1551
Abstract
The frozen elephant trunk (FET) technique is an established therapeutic option in the treatment of complex aortic diseases. We report our long-term clinical outcomes after FET repair. A total of 187 consecutive patients underwent FET repair at our department between 8/2005 and 3/2023. [...] Read more.
The frozen elephant trunk (FET) technique is an established therapeutic option in the treatment of complex aortic diseases. We report our long-term clinical outcomes after FET repair. A total of 187 consecutive patients underwent FET repair at our department between 8/2005 and 3/2023. Indications included acute and chronic aortic dissections and thoracic aneurysms. Endpoints included operative morbidity and mortality, long-term survival, and the need for reinterventions. Operative mortality, spinal cord injury and permanent stroke rates were: 9.6%, 2.7% and 10.2%, respectively. At five years, overall survival was 69.9 ± 3.9% and freedom from aortic-related death was 82.5 ± 3.0%, whereas at ten years, overall survival was 53.0 ± 5.5% and freedom from aortic-related death was 75.8 ± 4.8%. Sixty-one reinterventions on the thoracic aorta were necessary. Freedom from secondary interventions at ten years was 44.7 ± 6.4% overall (63.1 ± 10.0% for acute dissections, 40.8 ± 10.3% for chronic dissections and 28.9 ± 13.1% for aneurysms, respectively). The high reintervention rate for chronic dissections and for aneurysms is related to the pre-existing aortic pathology. Late aortic growth of untreated segments with potentially fatal outcome occurs even after ten years, so careful annual follow-up is mandatory in this patient cohort. Full article
(This article belongs to the Special Issue Clinical Advances in Aortic Surgery)
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Review

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11 pages, 2001 KiB  
Review
Navigating the Unexpected: Iatrogenic Aortic Injuries during Transcatheter Aortic Valve Replacement (TAVR)
by Shaelyn Cavanaugh, Hossein Amirjamshidi and Kazuhiro Hisamoto
J. Clin. Med. 2023, 12(24), 7630; https://doi.org/10.3390/jcm12247630 - 12 Dec 2023
Cited by 2 | Viewed by 1559
Abstract
The introduction of transcatheter aortic valve replacement (TAVR) has undeniably changed the landscape of valvular heart disease management over the last two decades. A reduction in complications through improvements in techniques, experience, and technology has established TAVR as a safe and effective alternative [...] Read more.
The introduction of transcatheter aortic valve replacement (TAVR) has undeniably changed the landscape of valvular heart disease management over the last two decades. A reduction in complications through improvements in techniques, experience, and technology has established TAVR as a safe and effective alternative to surgical aortic valve replacement. However, it is important to consider the potential risks associated with TAVR and ways in which life-threatening complications can be identified and managed in a timely fashion. In this article, we review some catastrophic iatrogenic aortic injuries that are described in the literature and present a case of an acute iatrogenic type A aortic dissection that occurred during a transcatheter aortic valve replacement (TAVR). After valve deployment, a routine neurologic examination noted the new onset of a left-sided facial droop and upper extremity weakness. Urgent imaging revealed an extensive type A aortic dissection, and the patient was taken to the operating room for surgical repair. The coordination of our multidisciplinary team allowed for prompt recognition of her neurologic symptoms, urgent imaging, and timely transport to the operating room, all of which contributed to the successful management of this life-threatening procedural complication. Full article
(This article belongs to the Special Issue Clinical Advances in Aortic Surgery)
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