Reoperation for giant false aneurysm of the thoracic aorta: how to reenter the chest?

Background: Giant false or pseudoaneurysm of the aorta is a rare but dreadful complication occurring several months or years after cardiac or aortic surgery. We describe a surgical approach that allowed safe reentry in the chest in five patients, with a mean follow-up of almost seven years.

Methods: From December 1991 to October 1999, five patients aged 34 to 74 years (mean age, 55 +/- 11.

When should the aortic arch be replaced in Marfan patients?

Background: The purpose of this study was to assess the prevalence, indications, and results of aortic arch replacement in Marfan patients with and without acute dissection.

Methods: Between January 1993 and December 2005, our group performed 76 aortic replacements in 54 Marfan patients (mean age, 38.3 years), of whom 20 had already undergone one or two replacements of the thoracic aorta, and 3 required one late procedure each in other institutions.

[Long term results for the ATS valve, the first open pivot valve: 182 cases].

Between May 1995 and May 2004, 197 ATS valves were implanted in 182 patients: 120 males and 62 females with an average age of 58 +/- 13 years. 149 cases were for aortic valvular replacement and 48 cases were for the mitral valve. Fifteen patients had a double mitral and aortic replacement.

[Long term survival with the Bentall button operation in 150 patients].

Between May 1980 and May 2000, 150 patients (123 males and 27 females) underwent surgery with the same surgeon for ascending aortic replacement with a valvular conduit and coronary reimplantation with the aid of a collar of aortic wall (button technique). The average age was 50 +/- 16 years. Within this population, 114 patients had isolated annulo-ectasial disease, 36 had Marfan syndrome and 20 had dissection (5 acute and 15 chronic).

[Remodelling the aortic root by resection of the ascending aorta and non-coronary sinus in annular dilatation of the aorta and acute dissection of the descending aorta. 29 observations].

The first conservative surgical procedures of the native aortic valve in annular dilatation were performed by Yacoub and David [1, 2]. These so-called remodelling and inclusion procedures provided hope for a normal life without long-term anticoagulant therapy for patients with Marfan's syndrome, with protection from the complication of an acute dissection of the ascending aorta. The authors reported their experience in the Archives des Maladies du Coeur et des Vaisseaux in 1999, with excellent results [3].

Brain protection during surgery of the aortic arch.

Deep hypothermia with circulatory arrest is the usual method of cerebral protection during replacement of the aortic arch. It has the enormous advantage of allowing the surgical repair to be carried out in a complete bloodless field with no aortic cross-clamping. However, this method only gives the surgeon a limited period of time to carry out the aortic repair.

[Coronary surgery of the beating heart. First year of experience in a series of 317 non-selected coronary patients].

From May 1999 to May 2000, 317 unselected patients, representing 92.7% of all coronary artery surgery procedures, underwent open heart surgery of the beating heart by median sternotomy with the aid of a cardiac stabilising device. The main preoperative characteristics were: mean age = 66.

Surgery of acute type A dissection: what have we learned during the past 25 years?

Every acute dissection involving the ascending aorta (Stanford type A) must undergo emergency surgical repair. However, the surgical techniques must vary according to the clinical presentation of the patients or the anatomical patterns observed. Furthermore, surgery is generally difficult because of the poor condition of the aortic tissues.

Surgery of acute type A dissection: what have we learned during the past 25 years?

Every acute dissection involving the ascending aorta (Stanford type A) must undergo emergency sugical repair. However, the surgical techniques must vary according to the clinical presentation of the patients or the anatomical patterns observed. Furthermore, surgery is generally difficult because of the poor condition of the aortic tissues.

Assessment of systematic use of intraoperative transesophageal echocardiography during cardiac surgery in adults: a prospective study of 203 patients.

Objective: To determine the usefulness of systematic intraoperative transesophageal echocardiography in a cardiac surgical unit.

Design: Open prospective observational survey.

Setting: University Hospital.

The use of biological glue in aortic surgery.

The biologic sealants presently available on the market that are used in cardiovascular surgery and particularly during surgery of the aorta are described in this article. Two of these biological sealants, the gelatin-resorcinol-formaldehyde (GRF) glue and two-component fibrin sealant have been in use for two decades. Their respective properties are described beneficial in modifying the natural history of the disease.

[Preservation of the native aortic valve in the treatment of aortic aneurysmal dilatation].

Mechanical valve conduit replacement of the aortic root is a durable and appropriate procedure for aortic root dilatation with or without aortic aortic insufficiency. But this procedure may sacrifice an anatomically salvageable aortic valve and requires a life-long anticoagulation with its attendant thromboembolic versus haemorrhagic risks, which is not ideal for young active patients. Recently, two techniques of aortic root replacement with aortic valve sparing have been described, based on experimental data.

Surgery for acute type A aortic dissection: the Hopital Foch experience (1977-1998).

Background: In 1977, we proposed the use of gelatin-resorcinol-formol (GRF) biological glue during surgery for acute type A aortic dissection.

Methods: From January 1977 to March 1998, 204 patients (146 men and 58 women) aged from 15 to 79 years (mean 54 +/- 11) underwent emergency operation for type A aortic dissection in our institution. One hundred sixty-five patients (84%) were operated on within 48 h after the onset of symptoms.

Antegrade cerebral perfusion with cold blood: a 13-year experience.

Background: In 1986 we introduced the technique of antegrade selective perfusion of the brain with cold blood during surgery of the aortic arch.

Methods: Between January 1984 and March 1998, 171 patients (118 males and 53 females) aged 25 to 83 years (mean 56.5 +/- 17), underwent replacement of the transverse aortic arch with the aid of cold blood antegrade selective perfusion.

[Giant cell myocarditis. Report of a case].

The authors report a case of giant cell myocarditis leading to rapidly progressive cardiac failure despite immuno-suppressor treatment in a 20 year old woman. The cardiac failure was successfully managed by implantation of a left ventricular assist device and then cardiac transplantation. The problems encountered underline the importance of accurate diagnosis by endomyocardial biopsy before undertaking treatment and the difficulties in the choice of appropriate method of assistance in this indication.

[Surgical treatment of acute dissection of the ascending aorta (20 years experience)].

Purpose: In 1977, the use of gelatine-resorcine-formaline (GRF) biological glue during surgery of acute type A aortic dissection was proposed. The present study retrospectively analyses the late results obtained with this adjunct in an experience extending over a 20-year period.

Patients And Methods: From January 1977 to July 1997, 193 patients (139 males and 54 females) aged from 15 to 79 years (mean age: 53 +/- 14 years) underwent an emergency operation for type A aortic dissection in our institution.

[A prospective comparative study of coronary angiography and endocoronary ultrasonography in the detection of coronary lesions after cardiac transplantation].

Coronary angiography is the reference method for the detection of coronary disease of the cardiac grafts which threatens the long-term prognosis of cardiac transplantation. The primary results of treatment for slowing, stabilising or even improving coronary transplant disease are encouraging and make necessary the development and evaluation of reliable diagnostic methods. The authors undertook a prospective study of 48 asymptomatic patients with normal graft wall motion between January 1995 and March 1997 to compare the results of coronary angiography and endocoronary ultrasonography.

[Surgical replacement of the aortic arch].

Deep hypothermia with circulatory arrest is the usual method of cerebral protection during replacement of the aortic arch. However, this technique only gives the surgeon a limited period of time to carry out aortic repair. It also requires that cardiopulmonary bypass be prolonged to rewarm the patient which may cause many complications.

[Current treatment of acute dissections of the ascending aorta].

In 1977, the authors introduced the gelatin resorsin formol glue for emergency surgery of dissection of the ascending aorta (Stanford Type A). This special issue devoted to surgery of the thoracic aorta gives them the opportunity of summarising the different techniques of replacing the ascending aorta, underlying the procedures available for reinforcing the sutures. The value of the gelatin resorcin formol glue extensively described and the authors then analyse the principles and methods of treating aortic insufficiency and of the extension of replacement of the aorta to the aortic arch.

[Left ventricular reduction (Batista's technique). A new surgical option in dilated cardiomyopathy].

Cardiac transplantation remains the standard treatment for severe cardiomyopathy resistant to medical therapy. However, new techniques may help to put this off. Two patients with dilated cardiomyopathy were treated surgically since October 1996, one aged 48 and the other 52.

[Bronchogenic cyst mimicking traumatic aortic aneurysm].

The authors report a case of a 56 year old woman who had a road traffic accident a few years previously. The diagnosis of false aneurysm of the aortic isthmus suspected on chest X-ray way confirmed by 3D scanner. Surgery revealed a diagnostic error : the lesion was a bronchogenic cyst.

The proper use of glue: a 20-year experience with the GRF glue in acute aortic dissection.

Background: In 1977, the use of Gelatine-Resorcine-Formaline (GRF) biological glue during surgery of acute Type A aortic dissection was proposed. The present study retrospectively analyzes the late results obtained with this adjunct in an experience extending over a twenty-year period of time.

Patients And Methods: From January 1977 to March 1996, 171 patients (124 males and 47 females) aged from 15-79 years (mean age: 53 +/- 14 years) underwent an emergency operation for type A aortic dissection in our institution.

[Emergency cardiac transplantation].

Emergency cardiac transplantation is a controversial subject in the present context of a lack of donor organs. There are few reports in the literature, which the authors review to suggest a practical approach which is clearly not consensual. The results in the literature report an extramortality of 10 to 30% if the indication of transplantation is that of an emergency.