J Cardiovasc Surg
-
Multicenter Study Comparative Study
Influence of clinical presentation on the outcome of acute B aortic dissection: evidences from IRAD.
In-hospital outcome of acute type B dissection (ABAD) is strongly related to preoperative aortic conditions. In order to clarify the influence of the clinical presentation on the outcome, we analyzed the patients of the International Registry of Acute Aortic Dissection (IRAD). All patients affected by complicated ABAD, enrolled in the IRAD from 1996-2004, were included. Complications were defined as the presence of shock, periaortic hematoma, spinal cord ischemia, preoperative mesenteric ischemia/infarction, acute renal failure, limb ischemia, recurrent pain, refractory pain or refractory hypertension (group I). All other patients were categorized as uncomplicated (group II). A comprehensive analysis was performed of all clinical variables in relation to in-hospital outcome. ⋯ ABAD is a heterogeneous disease that produces dissimilar clinical subsets, each of which can have specific clinical signs, management and in-hospital results. In IRAD ABAD uncomplicated patients, medical therapy was associated with best hospital outcome, while endovascular interventions were associated with better results than surgery when invasive treatments were required. Although selection bias may be possible, and irrespective of treatments, knowledge of significant risk factors for mortality may contribute to a better management and a more defined risk-assessment in patients affected by ABAD.
-
Comparative Study
Dual-Source computed tomography of the chest in the surgical planning of repeated cardiac surgery.
When reoperative cardiac surgery is indicated, detailed, three-dimensional imaging of the thorax permits accurate depiction of cardiac anatomy and vascular structures potentially increasing the safety of the surgical procedure. We sought to evaluate the contribution of dual-source multidetector-row computed tomography (DSCT) of the heart and thorax in planning repeated open heart surgery. ⋯ DSCT of the heart and thorax is an effective, non-invasive tool for the preoperative planning of repeated cardiac surgery. The technique provides significant information to modify the surgical approach and may increase the safety of the procedure.
-
Letter Case Reports
Anatomic repair of interrupted aortic arch in adult.
-
Comparative Study
Endovascular treatment of ruptured abdominal aortic aneurysm: is there a long-term benefit at follow-up?
Several studies have shown the feasibility of endovascular repair of ruptured abdominal aortic aneurysms (rEVAR). However, the role and value of rEVAR remains controversial due to selection bias and lack of long-term results. In the present study we describe our short- and long-term results of treating patients with rEVAR irrespective of hemodynamic condition and challenging anatomy. ⋯ Our study shows that rEVAR is feasible irrespective of hemodynamic condition and that it is associated with relative low mortality rates. Challenging rAAA anatomy may not affect overall long-term survival, but six out of ten patients remain unsuitable for rEVAR because of inappropriate anatomy.
-
Review
Evidence-based management of carotid stenosis: recommendations from international guidelines.
A 50-99% stenosis of the extracranial internal carotid artery can be in detected in 1-3% of all adults. Embolising plaques or acute carotid occlusions cause cerebral ischemia in 1-5% of all patients with an asymptomatic 50-99% stenosis of the internal carotid artery. ⋯ Therefore all recent national and international guidelines for stroke management, stroke prevention and carotid artery disease published between 2008 and 2011 were reviewed. This paper gives an overview about these guidelines and their most important recommendations with respect to carotid artery stenosis.