Outcomes after false lumen embolization with covered stent devices in chronic dissection.

Objective: Persistent retrograde false lumen perfusion is a common mode of failure after thoracic endovascular aortic repair (TEVAR) for chronic dissection. Objectives were to describe a novel endovascular approach for false lumen occlusion and assess outcomes.

Methods: From 2009 to 2013, 21 patients (mean age, 64 ± 11 years) with chronic thoracoabdominal dissection underwent adjunctive false lumen embolization using covered stent devices for persistent retrograde perfusion.

Aborted sternotomy due to unexpected porcelain aorta: does transcatheter aortic valve replacement offer an alternative choice?

Objectives: Surgical aortic valve replacement is challenging in patients with severe aortic calcification. Some patients undergo sternotomy and have the operation aborted because of intraoperative discovery of severe calcification. Hypothermic circulatory arrest and transcatheter aortic valve replacement offer clampless treatment options for aortic stenosis.

Use of covered stent devices for false lumen embolization in chronic dissection: a novel approach.

Thoracic endovascular aortic repair (TEVAR) is effective in treating acute complicated dissection, but in the chronic state it is frequently complicated by persistent retrograde false lumen perfusion that results in treatment failure. We describe a novel endovascular technique and present an illustrative case of a patient with chronic dissection for which covered stent devices were used as an adjunct to TEVAR to occlude the distal thoracic false lumen and interrupt retrograde perfusion. The case demonstrates that this strategy promotes remodeling when used in addition to stent grafting the true lumen for chronic dissection.

Open, hybrid, and endovascular treatment for aortic coarctation and postrepair aneurysm in adolescents and adults.

Background: Open, hybrid, and endovascular procedures are used for grown-up patients with aortic coarctation and complications after repair, an expanding population. We sought to characterize patients and procedures, assess early and late outcomes, and describe indications to guide treatment of these complex patients.

Methods: Between May 1999 and January 2011, 110 patients underwent open (n=40), hybrid (n=11), or endovascular (n=59) repair of coarctation (n=43), recurrent aortic coarctation (n=42), or postrepair aneurysm (n=25).

Distal landing zone open fenestration facilitates endovascular elephant trunk completion and false lumen thrombosis.

Background: Controversy surrounds the endovascular treatment of chronic dissection because of inconsistent remodeling of the aorta. The purpose of this study was to assess efficacy and safety of a novel technique for repairing aneurysmal change associated with chronic descending aortic dissection.

Methods: From July 2007 to April 2011, 24 patients with descending aortic aneurysmal change, consequent to previously repaired ascending aortic dissection or medically treated descending dissection, underwent combined open first-stage elephant trunk (ET) insertion and fenestration of the descending aorta intimal flap.

Modified and "reverse" frozen elephant trunk repairs for extensive disease and complications after stent grafting.

Background: The frozen elephant trunk (FET) repair technique combines conventional arch repair with the patient under circulatory arrest with stent grafting and is increasingly being used to treat extensive thoracic aortic disease. This surgical approach is evolving, including its use for complications after thoracic aortic stent grafting - the so-called reversed frozen elephant trunk (RFET). We evaluated the safety and efficacy of FET and RFET operations in high-risk patients.

Bartonella infective endocarditis of a prosthetic aortic valve with a subvalvular abscess.

A patient with a prosthetic aortic valve, and culture negative endocarditis caused by Bartonella henselae presented with nonspecific constitutional symptoms, skin rash, and then later developed acute renal failure. The patient underwent redo sternotomy, aortic root, and ascending aorta replacement with a homograft, which resolved his symptoms and the renal failure.