Development of a Novel Adapter to Enable Less-Invasive Left Ventricular Assist Device Implantation via the Left Ventricular Apex.

The first prototype of an adapter to enable left ventricular assist device (LVAD) implantation solely via the left ventricular (LV) apex and without requiring cardiopulmonary bypass (CPB) was tested in healthy and acutely failing pig hearts. The adapter consists of a fixation, blood guiding, and connecting module fitting to a HeartMate 3 (HM3; Abbott, Chicago, IL) pump. Implantation was performed via a left thoracotomy in five pigs (96 ± 18 kg).

Early aortic growth in acute descending aortic dissection.

Objectives: Acute aortic dissection leads to the destabilization of the aortic wall, followed by an immediate increase in aortic diameter. It remains unclear how the aortic diameter changes during the dissection's acute and subacute phases. The aim of this study was to evaluate the change in aortic geometry within 30 days after the onset of a descending aortic dissection.

The intraspinal arterial collateral network: a new anatomical basis for understanding and preventing paraplegia during aortic repair.

Objectives: The anatomical distribution pattern of epidural intraspinal arteries is not entirely understood but is likely to substantially impact maintaining perfusion during segmental artery sacrifice when treating acute and chronic thoraco-abdominal aortic diseases. We investigated the anatomical distribution pattern of intraspinal arteries.

Methods: Twenty fresh, non-embalmed cadaveric human bodies were studied.

Late surgical conversions after abdominal endovascular aortic repair: underlying mechanisms, clinical results and strategies for prevention.

Objectives: Our goal was to report our results of late surgical conversion after endovascular aneurysm repair (EVAR).

Methods: Variables analysed included baseline data, preinterventional anatomy, type of endovascular intervention, indications for conversion, operative technique, postoperative complications and follow-up survival rate.

Results: Between April 2011 and May 2018, 16 patients with late complications after EVAR underwent open surgical conversion at our institution.

Evaluation of myocardial injury, the need for vasopressors and inotropic support in beating-heart aortic arch surgery.

Background: In contrast to the standard cardioplegic cardiac arrest (CA), some centers prefer the beating-heart technique using selective normothermic myocardial perfusion (SMP) during aortic arch repair. The aim of this study was to evaluate myocardial injury and the need for inotropic and vasopressor support in patients undergoing total aortic arch replacement using SMP or CA during arch repair.

Methods: Total arch replacement was performed in 127 patients (65 years [IQR: 56-73 years] years) between March 2013 and May 2018 via the frozen elephant trunk technique.

Endovascular aortic arch repair using a double-branched approach.

The last 15 years have overwhelmed the surgical community with a range of approaches in treating pathologies involving the aortic arch of which some are here to stay. The ones to stay are-in the authors' opinion-refined classical surgical approaches such as the frozen elephant trunk technique, near-orthotopic combined vascular and endovascular approaches such as subclavian to carotid transposition/bypass and double transposition, and finally, near-orthotopic advanced endovascular solutions such as the double-endovascular repair using fenestrated and/or branched solutions which will be the main focus of this article.

Accuracy of deployment of the Relay non-bare stent graft in the aortic arch.

Objectives: To minimize the complications with thoracic endovascular aortic repair (TEVAR), a new stent graft with no bare ends was developed, namely the Relay non-bare stent (NBS). We hypothesized that the new features of the NBS graft would enable highly accurate deployment and fewer complications. The aim of this study was to analyse the quality of the Relay NBS with respect to its landing precision.

New insights into spinal cord ischaemia after thoracic aortic procedures: the importance of the number of anterior radiculomedullary arteries for surgical outcome.

Objectives: Anterior radiculomedullary arteries (ARMAs) link dorsal segmental arteries and the intraspinal compartment of the spinal collateral network. The number of thoracic ARMA is highly variable from one person to another. The impact of the number of ARMAs on spinal cord perfusion during thoracic aortic procedures is unknown.

Endovascular treatment of acute Type A aortic dissection-the Endo Bentall approach.

Outcome after classical surgical repair of acute Type A aortic dissection has steadily improved over the years and several modifications in cannulation and perfusion added to this achievement. However, subgroups remain where results of classical surgical repair still have room for improvement, particularly patients with severe preoperative malperfusion as well as elderly patients with a limited physiological reserve. So far, only small case series or case reports have been published on the endovascular treatment of dissected ascending aortas.

Surgical Treatment of Native and Prosthetic Aortic Infection With Xenopericardial Tube Grafts.

Background: The study sought to report our results of surgical treatment of native and prosthetic aortic infection with xenopericardial tube grafts from the ascending aorta to beyond the bifurcation.

Methods: Within a 28-month period, 20 patients were treated with a bovine self-made pericardial tube graft to replace infected vascular grafts (after conventional surgical aortic replacement or endovascular stent graft implantation) or to treat a contaminated surgical site. An integrated standardized therapeutic concept was applied in all patients, consisting of complete removal of the infected prosthetic material, extensive debridement, and orthotopic vascular reconstruction with self-made tube grafts constructed from a bovine pericardial patch.

True-lumen and false-lumen diameter changes in the downstream aorta after frozen elephant trunk implantation.

Objectives: To evaluate early and mid-term clinical outcomes and to assess the potential of the frozen elephant trunk technique to induce remodelling of downstream aortic segments in acute and chronic thoracic aortic dissections.

Methods: Over a 4-year period, 65 patients (48 men, aged 61 ± 12 years) underwent total aortic arch replacement using the frozen elephant trunk technique for acute (n = 31) and chronic (n = 34) thoracic aortic dissections at our institution. We assessed diameter changes at 3 levels: the L1 segment at the stent graft level; the L2 segment at the thoraco-abdominal transition level and the L3 segment at the coeliac trunk level.

Chronic type B "residual" after type A: what I would do?

"" This motto still remains the most important directive. However, also depending onto the extent of the underlying pathology and consecutively depending onto the extent of primary surgery, there is and will be need for additional classical surgical or interventional treatment sooner or later during follow-up in a substantial number of patients having had surgery for acute type A aortic dissection. This article shall guide the interested reader through the underlying mechanisms as well as treatment options in patients with chronic type B "residual" after type A repair and shall finally suggest preventive strategies to reduce the occurrence of this pathology to a minimum.

Aortic Replacement After TEVAR-Diameter Correction With Modified Use of the Siena Prosthesis.

Background: To report a new technique for diameter correction in patients after thoracic endovascular aortic repair (TEVAR) with large stent-grafts using the Vascutek Siena 4-branch collared prosthesis (Vascutek Terumo, Inchinnan, Scotland, UK) in patients undergoing thoracoabdominal (TA) aortic replacement.

Methods: Within a 24-month period, 39 patients underwent TA replacement at our center. Of these, 6 patients had undergone previous TEVAR with large stent-grafts (42 to 48 mm diameter).

The frozen elephant trunk technique for the treatment of acute complicated Type B aortic dissection.

Objectives: Our goal was to report our preliminary results in patients with acute complicated Type B aortic dissection without a suitable landing zone for primary thoracic endovascular aortic repair who were treated with the frozen elephant trunk (FET) technique.

Methods: Within a 25-month period, 14 patients with acute complicated Type B aortic dissection underwent surgical repair using the FET technique. The reasons to perform the FET procedure were an ectatic ascending aorta/arch in 6 patients and the lack of an adequate landing zone in 8 patients.

Technical details making aortic arch replacement a safe procedure using the Thoraflex™ Hybrid prosthesis.

SummaryThe development of new devices to improve treatment and to explore new indications that have not yet been adequately addressed is a natural consequence of the clinical demand for solutions to as yet unmet needs. The frozen elephant trunk technique was one of the major steps within the last 15 years to improve on existing treatments as well as to explore new indications. The goal of this article is to provide technical details about advances in implantation techniques for the treatment of acute and chronic thoracic aortic pathological conditions.

Early histological changes in the porcine aortic media after thoracic stent-graft implantation.

Purpose: To describe the histological findings in the aortic wall 5 days after thoracic endovascular aortic repair (TEVAR) in a porcine model.

Methods: Two overlapping stent-grafts were implanted in each of 6 juvenile pigs, covering the entire descending thoracic aorta (DTA). On the 5(th) postoperative day, tissue samples were taken from the DTA in each animal.

A propensity score-matched comparison of deep versus mild hypothermia during thoracoabdominal aortic surgery.

Objective: By using deep hypothermic circulatory arrest and non-deep hypothermic circulatory arrest approaches, we examined the impact of distal ischemia time and temperature on intra-abdominal reversible adverse outcomes and permanent adverse outcomes during descending thoracic aortic and thoracoabdominal aortic aneurysm operations.

Methods: A retrospective review of all patients who underwent descending thoracic aortic and thoracoabdominal aortic aneurysm repair between January 2002 and December 2008 was undertaken, including relevant preoperative, intraoperative, and postoperative data, and followed by a propensity score-matched analysis. Of the total of 262 patients, 240 had data complete enough to permit analysis, and 90 were suitable for the propensity-matched study.

Staged approach prevents spinal cord injury in hybrid surgical-endovascular thoracoabdominal aortic aneurysm repair: an experimental model.

Background: In a porcine model, we investigated the impact of sudden stent graft occlusion of thoracic intercostal arteries after open lumbar segmental artery (SA) ligation.

Methods: After randomization into two groups, 20 juvenile Yorkshire pigs (27.1±0.

Long-term outcome after aortic arch replacement with a trifurcated graft.

Objective: We describe the long-term results of aortic arch replacement using a trifurcated graft, including an assessment of survival, neurologic complications, and graft patency.

Methods: A retrospective review was conducted on data from 206 consecutive patients (125 male; median age, 67 years; range, 20-87 years) who had a trifurcated graft used for aortic arch replacement between September 1999 and September 2009. Seventy-four patients (35.