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Pubblicazioni recenti - cardiac arrest
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Transcatheter occlusion of an anomalous origin of left coronary artery from pulmonary artery in an adult as an alternative to surgery.
Cardiol Young2020 Oct;():1-4. doi: 10.1017/S1047951120003418.
Sagar Pramod, Sivakumar Kothandam,
Abstract
Anomalous origin of the left coronary artery from the pulmonary artery causes heart failure and death in infancy. In rare adult survivors with well-developed collaterals, surgical left coronary ligation to arrest steal is often combined with bypass grafting. Transcatheter left coronary artery closure in a symptomatic adult as an alternative to surgical ligation resulted in complete resolution of inducible ischaemia on myocardial perfusion imaging.
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Extracellular Vesicles of GMSCs Alleviate Aging-Related Cell Senescence.
J Dent Res2020 Oct;():22034520962463. doi: 10.1177/0022034520962463.
Shi H Z, Zeng J C, Shi S H, Giannakopoulos H, Zhang Q Z, Le A D,
Abstract
Healthy aging is a complex biological process with progressive accumulation of senescent cells characterized by stable cell cycle arrest, resulting in impaired homeostasis, regenerative potential, and gradual functional decline in multiple tissues and organs, whereby the aberrant activation of mammalian target of rapamycin (mTOR) signaling networks plays a central role. Herein, we explored the effects of extracellular vesicles (EVs) released by gingiva-derived mesenchymal stem cells (GMSC-EVs) on oxidative stress-induced cellular senescence in human endothelial cells and skin fibroblasts and their antiaging potentials. Our results showed that GMSC-EVs robustly abrogated oxidative stress-induced upregulation in the expression of cellular senescence-related genes, such as ?-galactosidase, p21, p53, and ?H2AX, and mTOR/pS6 signaling pathway, in human umbilical vein endothelial cells (HUVECs) and skin fibroblasts. Meanwhile, GMSC-EVs restored oxidative stress-induced impairment in proliferation and tube formation by HUVECs. Systemic administration of GMSC-EVs attenuated aging-associated elevation in the expression levels of p21, mTOR/pS6, interleukin 6, and tumor necrosis factor ? in skin and heart tissues of aged mice. These findings suggest that GMSC-EVs could be a potential alternative source of cell-free product for attenuation of aging-related skin and vascular dysfunctions due to their potent inhibitory effects on oxidative stress-induced cellular senescence in endothelial cells and skin fibroblasts.
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An Unusual Acute Cyanide Intoxication.
Adv Biomed Res2020 ;9():42. doi: 10.4103/abr.abr_128_20.
Dorooshi Gholamali, Dorostkar Amin, Rahimi Alireza, Zoofaghari Shafeajafar,
Abstract
Suicide with cyanides is relatively rare but highly lethal. The lethal oral dose of cyanide salts is 200 mg, and concentrations >3 mg/L may be potentially lethal. The symptoms of poisoning are predominating in the central nervous system and cardiovascular system. We report the case of a 43-year-old goldsmith man who presented with self-poisoning by cyanide salt ingestion. Patient's symptoms included confusion, cardiac arrhythmias, hyperkalemia, leukocytosis, metabolic acidosis with high anion gap, hypotension, and then hypertension. The cause of the patients poisoning was not initially diagnosed. Intensive supportive treatment was performed. The patient died on the 3 day of admission following cardiac arrest. At autopsy, hemorrhagic gastritis and cherry-red discoloration of the chest muscles were observed. Forensic toxicology showed cyanide in the blood and tissues. Cyanide poisoning could appear in different forms, and like our case, the symptoms can last for several days with nonspecific symptoms.
Copyright: © 2020 Advanced Biomedical Research.
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Late Intraocular Lens Dislocation Resulting From Haptic Breakage Following Cardiopulmonary Resuscitation.
Cureus2020 Sep;12(9):e10456. doi: 10.7759/cureus.10456.
Prabakaran Samantha, Moureiden Mouwafak, Qureshi Saima, Sharma Aman, Tran Trisha, Shaikh Saad,
Abstract
We report a case of an asymptomatic 65-year-old male who on routine eye examination had anterior dislocation of an intraocular lens (IOL) implant placed 23 years prior. Ten months prior to presentation, the patient had cardiac surgery complicated by cardiac arrest requiring chest compressions. Dislocation of an intraocular lens is a rare complication of cataract surgery. One of the causative factors for haptic breakage in our case was the polyimide haptic material. Polyimide has been shown to become brittle over time in warm and moist environments such as the human eye. This case demonstrates a case of late IOL dislocation chest compressions and, to the best of our knowledge, the first such case reported in the literature.
Copyright © 2020, Prabakaran et al.
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Targeted Temperature Management for Treatment of Cardiac Arrest.
Curr Treat Options Cardiovasc Med2020 ;22(11):39. doi: 10.1007/s11936-020-00846-6.
Rasmussen Tyler P, Bullis T C, Girotra S,
Abstract
Purpose of review:
Cardiac arrest is a common condition associated with high mortality and a substantial risk of neurological injury among survivors. Targeted temperature management (TTM) is the only strategy shown to reduce the risk of neurologic disability cardiac arrest patients. In this article, we provide a comprehensive review of TTM with an emphasis on recent trials.
Recent findings:
After early studies demonstrating the benefit of TTM in out-of-hospital cardiac arrest due to a shockable rhythm, newer studies have extended the benefit of TTM to patients with a nonshockable rhythm and in-hospital cardiac arrest. A target temperature of 33 °C was not superior to 36 °C, suggesting that a lenient targeted temperature may be appropriate especially for patients unable to tolerate lower temperatures. Although early initiation of TTM appears to be beneficial, the benefit of prehospital cooling has not been shown and use of intravenous cold saline in the prehospital setting may be harmful.
Summary:
There is substantial risk of neurological injury in cardiac arrest survivors who remain comatose. TTM is an effective treatment that can lower the risk of neurological disability in such patients and ideally delivered as part of a comprehensive, goal-directed post-resuscitation management by a multidisciplinary team in a tertiary medical center.
© Springer Science+Business Media, LLC, part of Springer Nature 2020.
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[A Rebleeding Case of Carotid Blowout Syndrome after Endovascular Treatment with Covered Stent].
No Shinkei Geka2020 Oct;48(10):935-940. doi: 10.11477/mf.1436204299.
Tanaka Yujiro, Hashimoto Takao, Yokoyama Tomoya, Arai Yusuke, Kikuno Muneaki, Sato Hiroki, Tsukahara Kiyoaki, Kohno Michihiro,
Abstract
We present a case of a patient who survived carotid blowout syndrome(CBS)due to covered stent placement, but bled again 34 days later. A 67-year-old man with laryngeal cancer experienced cardiac arrest due to carotid blowout a day after he underwent the balloon occlusion test and abnormal feeder embolization of the tumor. After quick resuscitation, he was treated with endovascular therapy using a covered stent, since he had insufficient cerebral ischemic tolerance. We succeeded in stent placement and the bleeding stopped without any procedural complications. The patient survived after the procedure. However, bleeding recurred when a nasal endoscope was inserted 34 days later. The rupture point was immediately distal of the stent. We performed carotid artery occlusion with coils and n-butyl-cyanoacrylate. The patient survived, but his condition gradually weakened and died 97 days after stenting. Emergency hemostasis for carotid blowout using a covered stent is the only available treatment for patients who do not have sufficient cerebral ischemic tolerance. However, this procedure has a higher rate of re-bleeding than carotid artery occlusion. Moreover, it is an off-label treatment in Japan. Therefore, possible treatments for CBS including use of covered stent or treatments for non-ruptured CBS should be analyzed in the future.
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Effects of extreme temperatures, fine particles and ozone on hourly ambulance dispatches.
Sci Total Environ2020 Oct;():142706. doi: S0048-9697(20)36235-5.
Wang Yu-Chun, Sung Fung-Chang, Chen Yi-Jhih, Cheng Chia-Pei, Lin Yu-Kai,
Abstract
There is a dearth of research on the hourly risk of ambulance dispatches with respect to ambient conditions. We evaluated hourly relative risks (RR) and 95% confidence interval (CI) of ambulance dispatches in Taiwan to treat respiratory distress, coma and unconsciousness, and out-of-hospital cardiac arrest (OHCA), from 2006 to 2015. We considered island-wide ambient temperatures, fine particulate matter (PM), and ozone (O) at lag 0-180 h while using a distributed lag nonlinear model and meta-analysis. Results showed the pooled risks peaked at lag 16-18 h for all ambulance dispatches at 99th percentile of hourly temperature (32 °C, versus reference temperature of 25 °C), with significant excess risk of 0.11% (95% CI; 0.06, 0.17) for coma and unconsciousness, and 0.06% (95% CI; 0.01, 0.11) for OHCA. The risks of exposure to 90th percentile of hourly O of 52.3 ppb relative to the Q1 level of 17.3 ppb peaked at lag 14 h, with excess risk of 0.17% (95% CI; 0.11, 0.23) for respiratory distress, 0.11% (95% CI; 0.06, 0.16) for coma and unconsciousness, and 0.07% (95% CI; 0.01, 0.14) for OHCA. The population exposed to reference temperatures of 28 °C, 20 °C, and 26 °C were exposed to the lowest levels of ambulance dispatches risk for respiratory distress, coma and unconsciousness, and OHCA, respectively; the highest cumulative 0-96 h RRs of ambulance dispatches were 1.27 (95% CI; 1.19, 1.35) for OHCA at 5th percentile temperatures and 1.25 (95% CI; 1.11, 1.41) for OHCA at 99th percentile temperatures. Following an accumulating lag of 0-96 h, no significant risk was identified for hourly levels of PM and O. In conclusion, the analytical results of hourly data speak to immediate and real-time responses to environmental changes, rather than to short-term relationships. In our analyses, we emphasized health events in extreme heat; thus, we recommend a comparative study of daily versus hourly associations.
Copyright © 2020 Elsevier B.V. All rights reserved.
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Amiodarone and/or lidocaine for cardiac arrest: A Bayesian network meta-analysis.
Am J Emerg Med2020 Jul;():. doi: S0735-6757(20)30564-7.
Zhao Hongli, Fan Kai, Feng Guilong,
Abstract
INTRODUCTION:
Although available studies have not demonstrated that antiarrhythmic drugs could increase long-term survival or survival with favorable neurological outcome, some studies have shown that the rate of hospital admission is higher with amiodarone or lidocaine than with placebo. To study the effects of antiarrhythmic drugs during cardiac arrest, a meta-analysis was conducted to assess the efficacy of amiodarone and/or lidocaine.
METHODS:
We searched studies from inception until Jan 21, 2020. The primary endpoint was survival to hospital discharge in cardiac arrest, and the secondary endpoints were survival to hospital admission/24 h and favorable neurological outcome.
RESULTS:
A total of 9 studies were included. In head-to-head studies, amiodarone (odds ratio [OR] 2.96, 95% credible interval [CrI] 1.02-8.53) and lidocaine (OR 3.12, 95% CrI 1.08-9.98) had superior effects on survival to hospital admission/24 h compared to the combination of the two drugs. In terms of survival to hospital discharge, amiodarone (OR 1.18, 95% CrI 1.03-1.35) and lidocaine (OR 1.22, 95% CrI 1.06-1.41) were more effective than placebo. Amiodarone (OR 1.20, 95% CrI 1.02-1.41) was significantly better than placebo in favorable neurological outcome. However, there was no significant difference in other pairwise comparisons. The surface under cumulative ranking curve (SUCRA) revealed that lidocaine was the most effective therapy for survival to hospital admission (84.1%) and discharge (88.4%), while amiodarone was associated with a more favorable neurological outcome (88.2%).
CONCLUSIONS:
Lidocaine had the best effect on both survival to hospital admission and discharge, while amiodarone was associated with a more favorable neurological outcome.
TRIAL REGISTRATION:
This study is registered with PROSPERO, number CRD42020171049.
Copyright © 2020 Elsevier Inc. All rights reserved.
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Comparison of manual and mechanical chest compression techniques using cerebral oximetry in witnessed cardiac arrests at the emergency department: A prospective, randomized clinical study.
Am J Emerg Med2020 Jun;():. doi: S0735-6757(20)30518-0.
Baloglu Kaya Filiz, Acar Nurdan, Ozakin Engin, Canakci Mustafa Emin, Kuas Caglar, Bilgin Muzaffer,
Abstract
AIM:
We aimed to compare regional cerebral oxygen saturation (rSO) levels during cardiopulmonary resuscitation (CPR), performed either manually or using a mechanical chest compression device (MCCD), in witnessed cardiac arrest cases in the emergency department (ED), and to evaluate the effects of both the CPR methods and perfusion levels on patient survival and neurological outcomes.
METHODS:
This single-center, randomized study recruited patients aged ?18 years who had witnessed a cardiopulmonary arrest in the ED. According to the relevant guidelines, CPR was performed either manually or using an MCCD. Simultaneously, rSO levels were continually measured with near-infrared spectroscopy.
RESULTS:
Seventy-five cases were randomly distributed between the MCCD (n = 40) and manual CPR (n = 35) groups. No significant difference in mean rSO levels was found between the MCCD and manual CPR groups (46.35 ± 14.04 and 46.60 ± 12.09, respectively; p = 0.541). However, a significant difference in rSO levels was found between patients without return of spontaneous circulation (ROSC) and those with ROSC (40.35 ± 10.05 and 50.50 ± 13.44, respectively; p < 0.001). In predicting ROSC, rSO levels ?24% provided 100% sensitivity (95% confidence interval [CI] 92-100), and rSO levels ?64% provided 100% specificity (95% CI 88-100). The area under the curve for ROSC prediction using rSO levels during CPR was 0.74 (95% CI 0.62-0.83).
CONCLUSION:
A relationship between ROSC and high rSO levels in witnessed cardiac arrests exists. Monitoring rSO levels during CPR would be useful in CPR management and ROSC prediction. During CPR, MCCD or manual chest compression has no distinct effect on oxygen delivery to the brain.
TRIAL REGISTRATION:
clinicaltrials.gov identifier: NCT03238287.
Copyright © 2020 Elsevier Inc. All rights reserved.
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Administration of inhaled noble and other gases after cardiopulmonary resuscitation: A systematic review.
Am J Emerg Med2020 Jul;():. doi: S0735-6757(20)30556-8.
Alshami Abbas, Einav Sharon, Skrifvars Markus B, Varon Joseph,
Abstract
OBJECTIVE:
Inhalation of noble and other gases after cardiac arrest (CA) might improve neurological and cardiac outcomes. This article discusses up-to-date information on this novel therapeutic intervention.
DATA SOURCES:
CENTRAL, MEDLINE, online published abstracts from conference proceedings, clinical trial registry clinicaltrials.gov, and reference lists of relevant papers were systematically searched from January 1960 till March 2019.
STUDY SELECTION:
Preclinical and clinical studies, irrespective of their types or described outcomes, were included.
DATA EXTRACTION:
Abstract screening, study selection, and data extraction were performed by two independent authors. Due to the paucity of human trials, risk of bias assessment was not performed DATA SYNTHESIS: After screening 281 interventional studies, we included an overall of 27. Only, xenon, helium, hydrogen, and nitric oxide have been or are being studied on humans. Xenon, nitric oxide, and hydrogen show both neuroprotective and cardiotonic features, while argon and hydrogen sulfide seem neuroprotective, but not cardiotonic. Most gases have elicited neurohistological protection in preclinical studies; however, only hydrogen and hydrogen sulfide appeared to preserve CA1 sector of hippocampus, the most vulnerable area in the brain for hypoxia.
CONCLUSION:
Inhalation of certain gases after CPR appears promising in mitigating neurological and cardiac damage and may become the next successful neuroprotective and cardiotonic interventions.
Copyright © 2020 Elsevier Inc. All rights reserved.
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[Out-of-hospital sudden cardiac arrest and COVID-19 pandemic].
Ann Cardiol Angeiol (Paris)2020 Oct;():. doi: S0003-3928(20)30155-4.
Pechmajou Louis, Marijon Eloi, Perrot David, Jouven Xavier, Karam Nicole,
Abstract
Since the appearance of the COVID-19 pandemic in 2020, the direct mortality related to COVID-19 infections has been monitored worldwide, with a daily count of the number of deaths due to COVID-19. Several measures have been undertaken in the societal and professional field, and the healthcare systems have been reorganized to limit the virus spread, and to cope with the surge of hospital admissions for COVID-19. Questions have been raised regarding the indirect effect of the pandemic, with uncertainties regarding the impact of delays in non-COVID diseases management, due to lockdown, postponement of non-urgent medical consultations and interventions, and decrease in screening. Sudden cardiac death could have been impacted by all those changes, and is generally a good surrogate of public health. In the current article, we review the impact of the COVID-19 pandemic on the epidemiology and outcome of sudden cardiac death.
Copyright © 2020 Elsevier Masson SAS. All rights reserved.
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Deep Brain Stimulation Generator Failure due to External Defibrillation in a Patient with Essential Tremor.
Stereotact Funct Neurosurg2020 Oct;():1-2. doi: 10.1159/000510122.
Davis Gregory, Levine Zachary,
Abstract
There exist only two case reports to date of open cardiac defibrillation with deep brain stimulator system (DBS) implantation. We report a 64-year-old male with DBS system in place for essential tremor who underwent cardiac defibrillation after cardiac arrest. Afterwards, his device impedances were all high and his tremor symptoms returned. Both problems resolved with implantation of a new generator and required no changes to the intracranial leads or extension cables. This is significantly different from the two previous reports. One included a significantly different DBS system relying on transcutaneous RF transmission and reported a lesioning effect after cardioversion. The other utilized a modern DBS system but reported damage to the generator and intracranial leads. We report that only the generator sustained damage, and that there were no intracranial changes that occurred.
© 2020 S. Karger AG, Basel.
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Long-term outcomes after in-hospital cardiac arrest: 30-day survival and 1-year follow-up of mortality, anoxic brain damage, nursing home admission and in-home care.
Resuscitation2020 Oct;():. doi: S0300-9572(20)30506-2.
Yonis H, Ringgren K Bundgaard, Andersen Porsborg, Wissenberg M, Gislason G, Køber L, Torp-Pedersen C, Søgaard P, Larsen J Moesgaard, Folke F, Kragholm K Hay,
Abstract
AIMS:
Long-term functional outcomes after in-hospital cardiac arrest (IHCA) are scarcely studied. However, survivors are at risk of neurological impairment from anoxic brain damage which could affect quality of life and lead to need of care at home or in a nursing home.
METHODS:
We linked data on ICHAs in Denmark with nationwide registries to report 30-day survival as well as factors associated with survival. Furthermore, among 30-day survivors we reported the one-year cumulative risk of anoxic brain damage or nursing home admission with mortality as the competing risk.
RESULTS:
In total, 517 patients (27.3%) survived to day 30 out of 1892 eligible patients; 338 (65.9%) were men and median age was 68 (interquartile range 58-76). Lower age, witnessed arrest by health care personnel, monitored arrest and presumed cardiac cause of arrest were associated with 30-day survival. Among 454 30-day survivors without prior anoxic brain damage or nursing home admission, the risk of anoxic brain damage or nursing home admission within the first-year post-arrest was 4.6% (n=21; 95% CI 2.7%-6.6%) with a competing risk of death of 15.6% (n=71; 95% CI 12.3%-19.0%), leaving 79.7% (n=362) alive without anoxic brain damage or nursing home admission. When adding the risk of need of in-home care among 343 30-day survivors without prior home care needs, 68.8% (n=236) were alive without any of the composite events one-year post-arrest.
CONCLUSION:
The majority of 30-day survivors of IHCA are alive at one-year follow-up without anoxic brain damage, nursing home admission or need of in-home care.
Copyright © 2020. Published by Elsevier B.V.
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Congenitally Abnormal Aortic Valve causing Coronary Obstruction and Cardiac Arrest in Infancy.
Ann Thorac Surg2020 Oct;():. doi: S0003-4975(20)31686-6.
Abdulkarim Mubeena, Weld Julia, Cohen William, Combs Pamela, Patel Dhaval, El-Zein Chawki, Ilbawi Michel, Vricella Luca, Hibino Narutoshi,
Abstract
Many instances of coronary artery anomalies are documented in the literature; however, the detection and treatment of an asymmetric, large aortic cusp causing obstruction of a coronary ostium in a symptomatic infant remains unreported. We present a case of a two-month-old infant with an enlarged right coronary cusp obstructing the left coronary ostium, requiring emergent repair by relocating the left coronary button and reconstructing the sinus of Valsalva with autologous pericardium. This procedure preserved native aortic valve function, and the child remains asymptomatic months after discharge.
Copyright © 2020. Published by Elsevier Inc.
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The use of altered rapid response calling criteria in a tertiary referral facility.
Aust Crit Care2020 Oct;():. doi: S1036-7314(20)30262-9.
Crouch Shannon, Trahair Laurence G, Aitken Leanne M,
Abstract
PURPOSE:
The purpose of this study was to examine the current utilisation of altered rapid response calling criteria (ARRCCs) at a tertiary hospital.
METHODS:
A retrospective review of all acute care admissions across 17 months was undertaken using the hospital administration system and electronic medical record to identify patients with ARRCCs. In patients with altered criteria, the type of alteration, frequency of rapid response calls, cardiac arrest, intensive care admission, and death in the hospital were identified. Comparisons were made using standard statistical methods.
RESULTS:
The total hospital admissions numbered 45 912, with ARRCCs used in 768 (1.7%). Patients with an ARRCC during hospital admission were older (68.5 [55.5, 79.0] vs 59.0 [43.0, 72.0] years, p < 0.001) and had a significantly longer length of hospital stay (6.9 [3.0, 16.3] vs 2 [1, 5] days, p < 0.001).Compared with the total group of patient admissions, patients with ARRCCs more frequently triggered a rapid response team (9.0% vs 14.2%, ?(1, n = 46 680) = 23.87, p < 0.001), more frequently suffered a cardiac arrest (0.2 vs 0.9%, ?(1, n = 46 678) = 20.34, p < 0.001), more frequently died in the hospital (p < 0.001), and were less frequently discharged home (?(1, n = 46 680) = 43.91, p < 0.001).
CONCLUSION:
Patients with an ARRCC stayed longer in the hospital and were at increased risk of cardiac arrest and death during hospitalisation. Further exploration of the role of ARRCCs in facilitating individualised care to meet the needs and treatment goals of each patient in the acute hospital setting is required.
Copyright © 2020 Australian College of Critical Care Nurses Ltd. Published by Elsevier Ltd. All rights reserved.
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Use of supraglottic airway devices under capnography monitoring during cardiopulmonary resuscitation: A systematic review.
Aust Crit Care2020 Oct;():. doi: S1036-7314(20)30256-3.
Cereceda-Sánchez Francisco José, Molina-Mula Jesús,
Abstract
BACKGROUND:
Bag-valve-mask ventilation is the most commonly applied method during cardiopulmonary resuscitation. Globally, advanced airway management with blind insertion devices such as supraglottic airway devices has been implemented for years by different emergency services. The efficiency of ventilation via such devices could be measured by capnography.
OBJECTIVE:
The objective of this study was to determine whether capnography is useful in patients undergoing cardiopulmonary resuscitation and to assess the effectiveness of ventilation via supraglottic airway devices.
REVIEW METHODS USED:
This is a systematic review written following the steps of Preferred Reporting Items for Systematic Review and Meta-analyses protocols.
DATA SOURCES:
A bibliographic search was carried out from the following databases: EBSCOhost, Scopus, EMBASE, Virtual Health Library, PubMed, Cochrane Library, Spanish Medical Index, Spanish Bibliographic Index in Health Sciences, and Latin American and Caribbean Health Sciences Literature, from inception until September 2019.
REVIEW METHODS:
Studies describing the use of capnography with supraglottic airway devices during cardiopulmonary resuscitation manoeuvres were selected and evaluated using the Critical Appraisal Skills Programme.
RESULTS:
Twenty-four articles were identified by title and abstract: six were randomised clinical trials, 11 were nonrandomised clinical trials, six were descriptive prospective studies, and one was a descriptive retrospective study. Nine primary research articles were selected for synthesis. Only one provided objective values of capnography obtained with ventilation with these devices, correlating them with the results of resuscitation.
CONCLUSIONS:
The evidence published so far is scarce, mostly from observational studies with high risk of bias in general. Although a degree of recommendation cannot be established, some results indicate that capnography has the potential to facilitate advanced clinical practice of ventilation with supraglottic airway devices during cardiopulmonary resuscitation.
Copyright © 2020 Australian College of Critical Care Nurses Ltd. Published by Elsevier Ltd. All rights reserved.
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Hybrid aortic arch repair: 10-year experience from India.
Indian J Thorac Cardiovasc Surg2019 Jun;35(Suppl 2):156-163. doi: 10.1007/s12055-018-0689-0.
Idhrees Mohammed, Krishnaswami Murali, Jacob Aju, Velayudhan Bashi,
Abstract
Purpose:
Hybrid aortic arch replacement (HAAR) is emerging as a safe treatment alternative for aortic arch pathologies. HAAR is divided into three groups. We have assessed our outcome for all three types of HAAR.
Method:
From January 2007 to December 2016, we have performed 119 endovascular aortic repair (EVAR) of the aorta of which 56 were hybrid aortic arch repair. The hybrid repair entailed aortic arch vessel debranching and concomitant/delayed antegrade ± retrograde EVAR stent grafting of the arch. For group I and II hybrid patients, we debranch the supra-aortic arch vessels without the aid of circulatory arrest. EVAR was performed on the following day. In group III, hybrid antegrade EVAR of the thoracic aorta and arch reconstruction was performed in single stage.
Results:
Of the 56 patients, 16 were in group I, 32 in group II, and 8 in group III. Mean age was 59.9?±?9.4 years with 78.57% (?=?44) being males. Aortic dissection was the primary pathology in 31 (55.36%) patients followed by aneurysm in 24 (42.86%) patients. Marfans syndrome was present in 28.57% (?=?16) patients. Redosternotomy was performed in 10.71% patients (?=?6). Incidence of stroke was 5.38% (?=?3) and there was no patients with renal dysfunction requiring hemodialysis. There were two retrograde aortic dissections and two endoleaks, both in group I patients. Thirty days in-hospital mortality was 5.38% (2 in group I and 1 in group II).
Conclusion:
Hybrid aortic arch replacement can be performed with good postoperative outcome. Type II hybrid is better than type I hybrid in our experience. As experience increases, the outcome continues to improve.
© Indian Association of Cardiovascular-Thoracic Surgeons 2018.
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Aortic arch aneurysms and dissection-open repair is the gold standard.
Indian J Thorac Cardiovasc Surg2019 Jun;35(Suppl 2):136-155. doi: 10.1007/s12055-019-00819-w.
Srivastava Swarnika, Bhan Anil,
Abstract
The aortic arch repair is one of the most complex surgeries and carries a high risk of complications as well as mortality. Since 1975, when the arch repair was first done by Randall B. Griepp using hypothermic circulatory arrest, many new technologies were introduced. But even with the use of antegrade and retrograde perfusion techniques and improvement of surgical techniques and grafts, the rate of mortality, cerebral, spinal, and visceral damage was much higher as compared to any other cardiac surgeries. With further developments aimed at less invasive approaches, thoracic endovascular aortic repair (TEVAR) along with de-branching of supra-aortic vessels or the frozen elephant trunk was introduced. Here, in this article, we review the myriad of approaches to the aortic arch and have come to a conclusion that while traditional open surgery is considered as the gold standard for treatment of extensive aortic arch pathologies, one school of thought suggests hybrid techniques such as the frozen elephant trunk and aortic arch vessel de-branching as more appropriate procedures for high-risk patients, where co-morbidities may contraindicate cardiopulmonary bypass and longer operative times required for traditional repair. No randomized trials are present to compare between open and hybrid or endovascular procedure in normal or high-risk patients. The meta-analysis of most of the studies defines open surgery as the gold standard for arch pathology because the hybrid procedures did not provide any proven survival benefits or decrease in stroke rate and spinal ischemia when compared to open surgery in early, mid, or long-term results.
© Indian Association of Cardiovascular-Thoracic Surgeons 2019.
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Threshold for intervention upon ascending aortic aneurysms: an evolving target and implication of bicuspid aortic valve.
Indian J Thorac Cardiovasc Surg2019 Jun;35(Suppl 2):96-105. doi: 10.1007/s12055-018-0674-7.
Fukuhara Shinichi, Ibrahim Michael, Dohle Daniel, Bavaria Joseph E,
Abstract
With the proliferation of non-invasive thoracic imaging modalities, the question of when to operate on asymptomatic ascending aortic aneurysms for non-syndromic patients is becoming increasingly relevant. Operation is extensive, often involves circulatory arrest, and subjects the patient to significant risk of mortality and morbidity. Surgery is performed to avert fatal aortic adverse events, which carry a markedly poor prognosis. The question of when the balance is tipped toward preemptive surgical repair is challenging and is centered around predicting the risk of an acute aortic syndrome. Size of the aneurysm has been the traditional guide for decision-making but how this is measured, what risks it truly predicts, the influence of the patient's size, valve morphology, genetic profile, and other risk factors for non-syndromic patients are poorly understood. We here review this issue in detail.
© Indian Association of Cardiovascular-Thoracic Surgeons 2018.
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Explanting the migrated hepatic stent in the right atrium by modified vena caval inflow occlusion.
Indian J Thorac Cardiovasc Surg2019 Jan;35(1):108-110. doi: 10.1007/s12055-018-0718-z.
Chengalath Manoras Mathew, Mathew Thomas, Kumar Lijesh, Periappuram Jose Chacko, Chellappan Subramanian, Francis Edwin,
Abstract
Stenting of hepatic veins can be a long lasting solution for Budd-Chiari syndrome. These stents could very rarely migrate into the right atrium. During surgical retrieval, cardiopulmonary bypass (CPB) can be avoided if vena caval inflow occlusion (VCIO) is used. A hybrid alternative of VCIO by using a balloon to occlude the inferior vena cava was done to retrieve the stent thus avoiding CPB and total circulatory arrest.
© Indian Association of Cardiovascular-Thoracic Surgeons 2018.
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